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A 51-year-old man who works in a factory that produces plastic pipe has experienced weight loss, nausea, and vomiting over the past 4 months. On physical examination, he has tenderness to palpation in the right upper quadrant of the abdomen, and the liver span is increased. Laboratory findings include serum alkaline phosphatase of 405U/L AST, 45U/L, ALT 30U/L, and total bilirubin 0.9mg/dL. An abdominal CT scan shows a 12-cm mass in the right lobe of the liver. A liver biopsy is performed, and microscopic examination shows an angiosarcoma. The patient has most likely been exposed to which of the following agents.__

Arsenic
B. Asbestos
C. Benzene
D. Beryllium
E. Vinyl chloride

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A 39-year-old woman underwent a routine health maintenance examination for the first time in many years. A Pap smear was obtained, and the result reported was abnormal. On pelvic examination, a red, slightly raised, 1-cm lesion on the anterior ectocervix at the 2-o’ clock position was excised and biopsied. The microscopic appearance on medium-power magnification is shown above. Which of the following statements best characterizes the patient’s condition.__

A primary site should be sought
B. This is a high-grade lesion
C. The cell of origin is fibroblast
D. A chest radiograph will show nodules
E. Local excision will be curative

A 6l-year-old woman has felt a lump in her breast for the past 2 months. On physical examination, there is a firm 2-cm mass in the right breast. An excisional biopsy specimen of the mass shows carcinoma. Immunoperoxidase stains for protease cathepsin D and matrix metalloproteinase-9 are performed on the microscopic tissue section and show pronounced cytoplasmic staining in the tumor cells. Which of the following characteristics is most likely to be predicted by this marker.__

Angiogenesis
B. Invasiveness
C. Differentiation
D. Heterogeneity
E. Aneuploidy

A 22-year-old woman, who works as a secretary for an accounting firm, has noted a palpable nodule on the side of her neck for the past 3 months. On physical examination, there is a 2-cm firm, nontender nodule involving the right lobe of the thyroid gland. A fine-needle aspiration biopsy specimen of the nodule shows cells consistent with carcinoma of the thyroid. No other family members are affected by this disorder. Which of the following would be considered most relevant in the woman's past medical history.__

A. Chronic alcoholism
B. Ataxia telangiectasia
C. Radiation therapy in childhood
D. Blunt trauma from a fall
Exposure to arsenic compounds

An epidemiologic study is performed to assess risks for cervical carcinoma. The cells from cervical lesions in a population of women are analyzed. Binding of certain viral proteins to pRB is found in patients in whom dysplastic cells are present. Viral proteins from which of the following are most likely to bind pRB, increasing the risk for dysplasia.__

A. Cytomegalovirus
B. Epstein-Barr virus
C. Herpes simplex virus
D. Hepatitis B virus
E. HIV

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