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Download DemoVendor: USMLE
Certifications: USMLE Certifications
Exam Code: USMLE-STEP-3
Exam Name: United States Medical Licensing Step 3
Updated:
Q&As: 804
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Which of the following risk factors has the strongest association with the development of malignant melanoma?
A. dark skin and hair color with tendency to tan easily and not to burn easily
B. personal history of sunburn, especially early in life
C. pigmented lesion with asymmetric irregular borders, color variegation, and diameter 8 mm
D. family history of non-melanoma skin cancer
E. development of actinic keratosis
Correct Answer: C Section: (none)
Explanation: History of excess sun exposure and sunburn early in life is associated with increased incidence of skin cancers, including melanoma, but the highest risk would be the development of a suspicious pigmented lesion. Clinicians can be guided by the "ABCD" rules: asymmetry, irregular borders, color variegation within the same lesion, and diameter >6 mm. Other risk factors for melanoma would include fair skin and hair with tendency to burn easily and a family history of melanoma. Actinic keratoses are premalignant lesions, but can develop into cutaneous squamous cell malignancies, not melanoma.
A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly.
You are concerned about a possible malignancy. What is the most common malignancy of childhood?
A. medulloblastoma
B. Wilms' tumor
C. leukemia
D. neuroblastoma
E. rhabdomyosarcoma
Correct Answer: C Section: (none)
Explanation:
The most common malignancy in childhood is leukemia/lymphoma. The most common solid tumors of childhood are CNS tumors, followed by neuroblastoma and Wilms tumors. The mildly elevated WBC with lymphocyte predominance with the presence of "atypical" lymphocytes would indicate that his child most likely has acute EBV infection (infectious mononucleosis). This acute EBV infection is usually subclinical in younger children, but can be manifested by acute hemolytic anemia and splenomegaly. Testing for the diagnosis of EBV includes EBV DNA PCR and heterophile antibody response testing (monospot test). Diagnosis usually is made based upon serology testing for anti-EBV IgG and IgM levels. There is no specific therapy indicated for the acute EBV infections. Acute Lyme disease is very uncommon in children. The early stage of acute Lyme disease is characterized by a distinctive rash (erythema migrans). This is then followed by a multiple annular rash of disseminated Lyme disease. Often seen in this stage is cranial nerve palsies, specifically facial nerve (CN VII) palsy. Late Lyme disease is characterized by recurrent arthritis and arthralgia. Serologic testing is only recommended if there is a very high clinical index of suspicion, unlike this child. Acute systemic-onset JRA (Still disease) can present in a child of this age in a nonspecific manner (i.e., fever of unknown origin). Children with Still disease will typically have dramatic elevations in acute-phase reactants (i.e., ESR). This child's ESR being 5 would go against JRA.
A 61-year-old female is diagnosed with osteoporosis by a screening dual-energy x-ray absorptiometry (DEXA) scan.
Which of these is a risk factor for postmenopausal osteoporosis?
A. black race
B. lack of exercise
C. obesity
D. multiparity
E. late menopause
Correct Answer: B Section: (none)
Explanation:
Risk factors for postmenopausal osteoporosis include cigarette smoking, thinness, early menopause (natural or surgical), nulliparity, northern European heritage, some medications (e.g., glucocorticoids), high alcohol or caffeine intake, low dietary calcium consumption, and a family history of osteoporosis. Dietary calcium and vitamin D supplementation and exercise (preferably weight bearing) are the classic lifestyle changes recommended to prevent or treat osteoporosis. (
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