1

Que st
Na me :
Indic at
eme t
hodofdi agnost
ic“ cancerinsit
u”:
Histol
o gy
Cytology
Ult
ra s
onogr aphy
X-Ra y
Radiologyc
Que st
Na me :
Whi c hsortoft r
e atmentpati
e ntwi t
hc a
nceristhebe s
tforconvales
cence:
Surgicaltre a
tme nt
Chemo therapy
Radiationt herapy
Hormonot herapy
Immun othe r
apy
Que st
Na me :
Wha tplacedoma li
gnanttumor soc c
upyi nstr
uc t
ureofmortal
ityadult
s:
Fir
st
Second
Third
Fourth
Fif
th
Que st
Na me :
Wha tkindofdi a gnost
icme thodsofma l
ignanttumorsisthebest:
Cli
ni c
a l
Cytology
X-Ra ydi agnos t
ic
Endos copy
Gystology
Que st
Na me :
Whi c hcanc erisnumbe roneins tr
uctureofma l
ei nci
denceinUkr a
ine:
Canc erofs toma ch
Lungc ance r
Canc erofs kin
Rectalc anc e
r 
Breastc anc e
r
Que st
Na me :
Whi c hcanc erisnumbe roneins tr
uctureoffema l
eincide
nceinUkr ai
ne:
Canc erofs toma ch
Lungc ance r
 
Canc erofs kin
Rectalc anc e
r 
Breastc anc e
r
Que st
Na me :
Whi c hcanc ercanbec ompletalyerradi
catedbyr adi
ati
ontherapy:
Canc erofs toma sh
Lungc ance r
 
Canc erofs kin
Rectalc anc e
r 
Breastc anc e
r
Que st
Na me :
Wha tistheme aningof  
rel
aps eofma li
gnanttumor :
Return of simptoms  of dise
ase
Lessening  ofsympt omsof  
disease
Inc
re aseof  s
ympt oms of di
sea se
Disappe arof  
sympt oms  of 
disease
Sta
bi l
iza t
ionof  symptoms  
of dise
ase
Que st
Na me :
Wha tistheme aningof  
remissionofma li
gnanttumor :
Returnof  sympt oms  
of disease
Lessening  ofsympt omsof  
disease
 2
Increa seof  sympt oms  of dise
a s
e
Disappe a
r ofsympt omsof  di
sease
Stabiliz ati
onof  sympt oms  of
 di
sease
Que stNa me :
Whi chs i
gndoweus eforpoor l
yhis tol
ogicaldif
fe rent
iat
ionofc anc
er:
G1
G2
G3
G4
Gx
Que stNa me :
Whi chs i
gndoweus eforhighhi s
tologicaldiff
ere nti
at
ionofc ancer
:
G1
G2
G3
G4
Gx
Que stNa me :
Whi chs i
gndoweus eforundiffer
ent ia
tedca nc
er:
G1
G2
G3
G4
Gx
Que stNa me :
Al loft hef ollowingme dic
ationa r
ec yt
ostat
icage ntsEXCEPT:
5-Fluor ouracil
Cyc lop hos phami de
Me totr exat
Sandos tati
ne
Adr i
obl ast
ine
Que stNa me :
Whi chme t
hodi sdisti
ngui
she dforc onfi
rmationofga st
ri
cc ancer
:
Clinic alme t
hod
Ultras oundExa mi na ti
on
BariumEne maRa diography 
Ga st
r os copywi thbi opsy
Compu t
erisedTomogr aphy
Que stNa me :
Whi choft hef ol
lowingtes
tswi llprovide 
thebe ste val
uationofthepat
ientwi
thc
ol orecta
lca
ncer
:
CA19–9
CA125
CEA  (c arc
inoe mbr yoni ca nti
gen)
AFP( alpha -
foetopr otein)
HCG( huma nc hor ionic gonadotropi
n)
Que stNa me :
Whi choft hef ol
lowingtes
tswi llprovidethebe ste val
uationofthepat
ientwi
thl
ive rcancer
:
CA19–9
CA125
CEA( c arc
inoe mbr yoni ca nti
gen)
AFP  ( alpha -
foetopr otein)
HCG( huma nc hor ionic gonadotropi
n)
Que stNa me :
Whi choft hef ol
lowingtes
tswi llprovidethebe ste val
uationofthepat
ientwi
thc
a nc e
roftheovar
y:
CA19–9
CA125
CEA( c arc
inoe mbr yoni ca nti
gen)
AFP( alpha -
foetopr otein)
HCG( huma nc hor ionic gonadotropi
n)
 3
Que stNa me :Whi choft hef ollowingt est
swi l
lprovi
det hebe s
tevaluat
ionofthepat
ie
ntwit
hcanc
erofthet
est
es:
CA19–9
CA125
CEA( ca rcinoe mbr yoni ca ntige n)
AFP( a lpha -foetopr otein)
HCG( huma nc horioni cgona dot r
opi n)
Que stNa me :Whi choft hef ollowingt est
swi l
lprovi
de  
thebe s
tevaluat
ionofthepat
ie
ntwit
hpancr
eati
ccance
r:
CA19–9
CA125
CEA( ca rcinoe mbr yoni ca ntige n)
AFP( a lpha -foetopr otein)
HCG( huma nc horioni c  gona dot r
opi n)
Que stNa me :Whi chs ignoft hema lignanttumori smostc hara
cte
rist
ic:
Fistul a
Ulc er
Infiltration
Swe lling
Itc
hi ng
Que stNa me :Whoi si nc ha rgeoft heonc ologica
lorganizati
onalandme thodol
ogi
calwor
kinther
egions
:
De nt ist
De rma tol ogi s
t
Onc ologi s t
Sur ge on
Fami lydoc tors
Que stNa me :Ca nc er–i sama ligna nttumorf r
o mwhicht ypeofcells:
Fibr ous .
Epi the lial
Ce llsf romt heAPUDs ys tem
Mus c ula r
Allc orre ct
Que stNa me :Sa rcomai sama lignantt umorf r
om:
Sof tti ssue s
Blood
Ce llsoft heAPUDs ys tem
Lymph opr oliferati
ve
Me la no c ytes
Que stNa me :Ade noc arcinomai sama li
gnanttumorfrom:
Squa mousc ellepithe l
i um
Fibr oust issue
Gla ndul are pithelium
Sof tti ssue s
Serousme mbr ane
Que stNa me :Whi chme thodi smos treli
able:
Compu tert omogr aphy
Cyt ol ogi cale xa mina tion
Endos copy
Ra diog raphy
His tolo gy
Que stNa me :Che mot he rapyt ha tispr escri
bedbe f
oreope rat
ioncall
ed:
Be for eOPc he mothe ra py
Firsts t
e pc he mot he rapy
 4
Sta r
tingc he mot he ra py
Adj uva ntc he mot he rapy
Ne o-a djuva ntc he mot he rapy
Que s
tNa me :Ca nc e roft hevi sua lloca l
izat
ioni ncludea llexc ept:
Ski nc anc er
Re ctalc a nce r
Ce rvica lc anc e r
Stoma chc anc e r
Br eastc a nce r
Que s
tNa me :Howmuc ht imedoyouha veford e
live r
ingofma ter
ialf orc ytologica lexami nationt ot hec ytol ogica
l
labora t
or y:
1hour
Be fore2hour s
Be fore6hour s
12hour s
24hour s
Que s
tNa me :Wa ysofme t
a stasi
ngi ncludea lle xcept :
Impl ant ationme t
a sta ses
Lymph oge ni c
Gyma t
oge nic
Cove ri
ngme ta stase s
Donotc hoos et hisone
Que s
tNa me :Ac c or dingt oTNM c l
a s
s i
fica
tionT1f ors toma c hi sat umor :
Be fore2c m
Be fore4c m
Mor etha n4c m
Tumoroft hemus cul arl ayer
Tumorl imi te dt omuc osa
Que s
tNa me :Pa t
i ent,39ye arsol d,c ompl ai
ni nga boutt hepr e senceoft hepa tch-likef orma t
ionont hel ef
t
calf.Thef orma tione me rge di na boutoneye ara go.Twot ime sa fterlights cratche stherewa sas ma llbleedi ng.The
patientc ompl a i
nsoft hei t
chi nt hisl e
sion.Ob j
ec t
ively:ont hei nne rsur fa
c eoft hel owe rthirdoft hel eftc alfthere
isas pot( pa tch)2x3c mi ndi ame ter,t hec olori sblac k,c learma rgins ,withi nfilt
rati
on,i ss l
ightlya bovet he
surfac eoft hes kin.I ngui nall ymphnode sa res oft,mo bilea ndnoti nc r
e asedi ns i
ze .Phys i
ciande s
id edtha tthi s
lesioni sme lanoma .Wha ta ret hec li
ni ca
la ndmor phol ogica lformsoft hesedi sease :
Ac ralf orm
Supe rfic ialle ntigi ousf orm
Not -pigme nt edme lanoma
Nodul arf or m
Infilt
rat i
vef or m
Que s
tNa me :Pa t
i ent ,42ye arsol d,i njuredhi spi gme ntedf orma t
ionoft hes kinoft helumba rr egi
oni na na c ci
dent.
Thene xtda yhede cide dt os eedoc tor.Dime nsionsoft hef orma ti
ona ndi tsc ondi ti
onbe for ethei njuryc a nnotbe
spe ci
fie d.OBJ ECTI VEont hes kinoft hel eftla t
e r
all umba r5c mf rom t hepa ra vert
ebr allinethe reisapi gme nt
tumora bout1. 5c mi ndi ame ter,l i
ghtbr owni nc ol orint er
spe rsedwi t
hbl a
c k,wi t
has c
ratchont hes urface ,c over
e d
wi thdr iedbl ood.Pe ri
phe rallymphnode swe renote nla rged.Wha tisthet ac t
icofma nageme ntoft hispatie nt:
Ele ct
roc oa gul a t
ion
Oi ntme ntba nds
Ant isept ictre atme ntunt ilhe aling
Wi dee xc ision
Obs erva tion
Pa ti
ent,51,t u rne dt ot heout pa t
ientde partme ntoft heonc ologica lhos pit
a lwi thc ompl aintsofc r at
e rsore sont he
skinoft hel e ftte mpl e.Be d( bottom)oft hes oresi spa le-r
e di nc olor,bl eedse asily.Cyt ologicalc onc l
usion–ba sal
 5
cellca rci noma .Whi choft he seme thodsoft rea tme nti st heme thodofc hoi ceint hiss itua t
ion:
Clos e-ra diot he ra py
Surgic ale xc ision
Electrokni fee xc isi on
Electroc oa gul ation
Cryot h era py
Que stNa me :Pa tie nt ,35ye a rsol d,i st ake ntot hehos pita lwi t
hc ompl aint soft hepr esenc eoft hepi gme ntforma t
ion
ont hes ki noft hemi ddl ethi rdoft her i
ghtt high.Si nc ec hildhoodt hispi gme ntf orma tionwa sont hisa rea.
The
patientha sal ights ki n.Fr e que nts unba thing.Not ic edt ha tthet umori nc rea sedi ns ize.Dur ingpr e
gna ncy,1ye a r
ago,t het umorbe ga nt ogr owr api dl y.As kedf orme di calc areonl ywhe nt herewa sbl ee dingf romt hetumor .
Whe nvi ewe df romt hef r
on tsur fac eoft her ightt hight umori sda rki nc olor,cont actbl e eding,2x4c m.I nther i
ght
axill
a ryr egiont he rei si ncr ea sedde ns elymphnode .
Yourdi agnos is:
Ke ratoma
Squa mousc e llc a rc inoma
Me lano ma
He ma ngi oma
Ba salc el lc arci noma
Que stNa me :Pa tie nt,30ye a rsol d.Af teras tayi nt hes out hdur inga1ye arpe riodont hei ntac tskino ftheright
templ ea ppe a redpl a quel ikef orma tion,whi c hr api dl yi nc rea sedi ns i
z e.Se l
f-tr
e atme ntbyoi ntme ntswi t
hn oe ff
ec t
.
La t
erf or ma tionbe c a mei tc hywi ths c alings ur fa ce .De rma t
ologi s
tpr e scribedc ons erva t
ivet re at
me nt.Thet umor
bega nt ogr owi ns iz e,a ndt he ns het urne dt ot heonc ologi st.One xa mina t
ion-ont hes ki noft hetempl eatumor
withi rre gul arc ont our s2x1c m," Pe arlr oller"a r oundt hef orma t
ion.Yourdi agnos is:
Ke ratoma
Squa mousc e llc a rc inomaoft hes ki n
Me lano ma
He ma ngi oma
Ba salc el lc arci noma
Que stNa me :Pa tie nt,51ye a rsol d.Dur ingt hepa s t8ye ar swa sunde rthes upe rvisionoft hes ur geona boutc hr onic
venousi ns uffic ienc y,va r
icos eve insoft hel eg.Dur i
ngt he se2ye arsr ece i
ve dc ons erva ti
vet reatme nt,
phys i
ot he rapy.Twoye arsa got he rewa sa nul ce ront hes kin,whi chs lowl yinte nsified.Thi ssituationphys i
c ian
tooka sat rophi cul c er.Cons erva tivet reatme nt,whi chwa sc ar
r iedoutwi thnoe ffect.Amont hbe f
orea dmis siont o
thehos pi talp at ientf oundbyhi ms e lfat ightno dul ei nt hegr oin.Hewa ss entt ot hehos pitalwi t
hadi agnosisof
"chroni cul ce roft hel e g,c h ronicve nousi nsuff i
c ie ncy,i ngui na llympha de nitis".Yourdi agnos is
:
Ke ratoma
Squa mousc e llc a rc inomaoft hes ki n
Me lano ma
He ma ngi oma
Ba salc el lc arci noma
Que stNa me :Pa tie nt(54ye a rsol d)t urne dt ode rma tologi stcompl ainingoff eelingpa in,bur ni ngi npa pi
ll
oma t
ous
nevus .Obj ective lyont hes kinoft he ba ckt he r
ei sat ight,s wol lenf or ma ti
onwi t
has t
ro ngbl ui
s h- bl
ac k
pigme nta tion,r im oft hei nflamma tionont hepe riphe ry.Ac c
or dingt ot hepa ti
e nt’sa namne sisne vuswa s
repeate dl yi njur e d.Whi chdi seas es houl dbes us pe c t
ed:
Ne urof i
br oma
Bowe n’ sdi sea se
Me lano ma
Epithe lioma
Ba salc el lc arci noma
Que stNa me :Ont hes i
deoft hec he sti napa tien t(30ye a rsol d)da rkbr own" mol e"wa sr e move dint heout pa t
ient
depa rtme nt.Hi stol ogi cale xa mi na tion wa s notpe rf orme d.Af ter4 mont hsi nt heunde rarm a reawa sa
congl ome rateofl ymphno de s.Thes c ari nt her e gionofs ur gicali nte rventioni ss moot ha nds oft.Wha ti sthe
diagnos is:
 6
Bubo(tul
aremia)
Lymphogranul
oma t
osi
s
Me t
ast
ati
cme l
anomaa ft
ernon-
radic
alt
umorr
emova
l
Inf
lammatoryaxi
lla
rylymphadenit
is
Lymphostas
isoftheupperext
remit
y

Ma n42ye arsol d,noti

cedapi gme ntforma ti
onbe t
we ent hef i
nge rsofhi sri
ghtfeet
,whi c
hi ncreas
edinsiz
ewi th
time ,we ar
ings hoeswa sunc omf ortable,a ndrecentl
yf orma ti
onha ss t
art
edtobl e
e d.Tre a
tedintheoutpat
ient
regi me nbyma nganeseba t
hes,bands .Thes urgeons entapa ti
e nttoonc ol
ogi
stforconsultat
ion.OBJECTIVEon
thei nne rsurfaceofthe2ndf i
ngerofhi sr ightfoottumor -
likefor ma t
ionofda r
kc ol
or,s i
ze1x1,5c m,macera
ted,
slightlybl e
e di
ngwhe nr emovingdr e s
sings.Nos i
gnsofi nflamma tioni nthesurr
oundingtis
s uesthe
re.Int
hegroin,
bel owt hei nguinalli
game ntthede nsel ymphnode ,s i
ze2x2c mwa sf ound.Theothe rgroupsofr e
gion
allymph
node sisintact:
Me lanomaoft he2ndf i
nge rofhisrightf ootwithme tasta
sesi nthel ymphnode sofinguinala r
ea
He ma ngioma
He ma ngiomawi thi
nguinallympha denitis
Me lanomaoft he2ndf i
nge rofhisrightf ootwithinguinallympha deniti
s
Pigme ntedne vusofthe2ndf i
ngerofhi sr i
ghtfoot,inguinallympha deniti
s

Thepa t
ient(39yea r
sold)complai
nsoft hepre
senc
eoft umorinthear
eaofthesc
alp.Thepat
ientfoundthis
t
umors ixmonthsago.Theoccur
renc
eofthetumorpat
ientl
inkswit
htra
uma.Tumorwasincr
eas
inginsizeslowly
anddi dn’tworri
edthepat
ie
nt.Palpat
ionr
eveal
edthetumor,siz
e2x1,5cm,cir
cul
ar,withsmoot
hs ur
face,ti
ght
elas
ticconsis
tency:
Lipoma
Cys t
He matoma
Ateroma
Osteoma

Ona dmi ssi

ontotheoncol
ogi
stwoma n(36year
sold)wi thcompl
aint
sofpres
enceofat umorformat
ioninthe
areaoft herightbut
toc
k,whichshenoti
cedamont hago.Obje
cti
veintheext
ernaluppe
rquadr
a ntoftheri
ght
buttockt hereisa tumor ,si
ze4x4c m ,deepinthemus c
les
.Re gi
ona
llymphnode swereno
te nla
rged.She
receivedi nt
ramuscul
ari
nje
cti
onsmorethanoneyea
rago:
Fibrosarcoma
Fibroma
Mi osar
c oma
Lipoma
Abs cess

Pat
ient(67ye arsold),onthefa
cetherei
satumorintheformoful
cer
swithcrus
t,wi
thawhit
ishr
imar
ound,2x
3cmi nsize.Sel
f-t
reat
mentduri
ng2ye ar
s.Pr
eviousdi
agnosi
s:s
kinc
ancerT2N0M0,cl
ini
calgr
oupII
.Whic
h
methodi smostappropr
iat
etousetoconfi
rmthediag
nosis:
Inc
isionalbiopsy
Radioisotopest
udies
Radioimmuno a
ssay
Thermogr aphy
Ma cr
os copy

Sat
el
li
teofthemali
gnantme l
anomaisa:
Tumorari
si
nginthepostoper
ati
vescars
Tumortha
tdevel
opedint her
egiona
llymphnode
s
 7
Mela
no bl
astomame t
ast
asi
sint
heinter
nalorgans
Tumorsthatdeve
lopedint
heski
na tadis
tanceof5cmfromthepr
imar
ylesi
on
Tumorsthatdeve
lopedint
heski
na tadis
tanceofmor
ethan5cmfromthepri
mar
yle
sion

Tra
nsitr
elapsesofthema lignantme l
anomaa re:
Locat
edmor ethan5c mf romt hepr i
maryl e
sion
Tumorinvasionofthepos t
ope rat
ivescar
Metas
tase
soft heme lanomai ntotheint
ernalorgans
Dis
seminat
ionoft hetumori nthea re
aoft he5c mfromt
hepr
ima
ryl
esi
on
Metas
tase
si ntot
hec ontra
la t
erall
ymphnode s

Themostimpor
tantpr
ognosti
cf a
ctorf
ormela
nomais
:
Tumorsiz
e
Gende
rident
it
y
Tumorthi
cknes
sa ndl
evelofinvasi
onofunde
rlyi
ngt
is
sue
Ageofthepat
ie
nt
Tumorloca
li
sat
ion

Thema i
nme t
hodsofs
qua
mousc
ellc
arc
inomat
rea
tme
nta
re:
Sur
gical
Combined
Hormonal
Immunother
apy
Chemother
apy

Thema inme thodofbi

ops
yint
hec
aseofme
lanomai
s:
Scrapin
g
Brushstr
okepr i
nt
Trepanbiopsy
Biopsybyt ongs
Inci
sionbiopsy

Themainfeat
uresofthenevusma l
ignanc yincl
ude:
Shar
pma rgi
ns
Pre
senceofhai
rsont hesur
faceofthene vus
Par
ti
alorcompletecolorcha
ngeoft hene vus
Absenc
eoftheulcer
soft heepide
rmi sove rt
henevus
Theprese
nceoftheskinpatt
ernont hesur f
aceoft
henevus

Thefollowingarethesubtype
sofcla
ssi
calnon
-Hodgki
n’sl
ymphomaEXCEPT:
Nodularlymphoc yt
epredominant
Nodularscler
osis
Mixedc el
lula
ry
Lymph ocytedeplet
ed
Macrophagep r
e domina
nt

Attheti
meofdi
agnos
isofHodgki
n’sl
ymphoma
,wh
ichoft
hef
oll
owi
nga
rea
sisof
feni
nvol
ved:
Back
Chest
Groin
Neck
 8
Le
g

Whe npr ogressi

vee nlargementofamul ti
nodul
argoi
te
rca
use
ssympt
oma
ti
ctr
ache
alc
ompr
ess
ion,t
hepr
efe
rre
d
ma na gementinot herwisegood-r
iskpati
ent
sis:
Iodinetre a
tme nt
Thyr oidhormonet r
eat ment
Sur gica
lr es
ectionoft heabnormalthyr
oid
Ra dioacti
veiodi net
re atment
Immun otherapy

Themostprecis
edia gnos
ti
cs c
reeni
ngpr
oce
dur
efordi
ff
ere
nti
at
ingbe
nignt
hyr
oidnodul
esf
romma
li
gna
ntone
sis
:
Thyr
oidult
rasonography
Thyr
oidsci
nti
s ca
n
Fi
ne-ne
edle-
aspirat
ionbiopsy(FNAB)
Thyr
oidhormones uppress
ion
Donotchoosethisone

Thepr efe
rre
dope r
ati
onfori
nit
ialma
nage
mentofat
hyr
oidnodul
etha
tisc
ons
ide
reds
uspi
ci
ousf
orma
li
gna
ncyby
FNABi s:
Exci
sion
Par
ti
a llobect
omy
Tot
all obect
omya ndis
thmus
ectomy
Tot
alt hyroi
dect
omy
Par
athy r
oidect
omy

Advantagesoft
otalt
hyroidectomyf ormanagementofpapi
ll
arycarc
inomasofthethyr
oidl
arge
rtha
n1.
5cm
i
nclude:
Pos
s i
bili
tyofusi
ngradioacti
veiodinepostoper
ati
vel
ytoidenti
fyandtre
atmeta
s t
ases
Thea bil
it
ytonotusethyr
oglobulinlevel
sa samarkerf
orrecur
rence
Don'tlowerover
allr
ecurr
e ncerat
e
Lowe rri
skofhypopar
a t
hyroidis
m
Donotc hooset
hisone

Whi c
hoft hefoll
owings t
a t
eme nt
saboutfolli
cularcar
cinomais/
aref
als
e:
Itpresentsa
tal a
terageth anpapil
larycar
cinoma
Itdissemina
tesviahema togenousroute
s
Itisthemos tcommont yp eofwe l
l-di
ff
erentia
tedthyr
oidcarc
inoma
Extens i
veangioi
nvasionp ort
endsapoorpr ognosis
Folli
c ul
arcarc
inomasa refrequent
lymulticentr
ic

Af amilialformofme dul
lar
ythyr
oidcar
cinoma(
MTC)s houl
dbesuspe
ctedwhenever
:
Thet umori smul t
ifocal
Thet umori sbilat
eral(f
ocioft
umorareprese
nti
nbot
hthyroi
dlobe
s)
Pathologice xaminati
onoftheres
ect
edthyroi
dgl
andr
evealst
hepre
senceofC-c
ellhyper
pla
siai
nar
easoft
he
gl
anda dj
a c
e nttofociofMTC
Alloft heabove

Allofthefol
lowingar
ecomponentsoft
heMENtype2Bs
yndr
omee
xce
pt:
Multi
pleneuromasonthel
ips
,tongue,a
ndor
almucos
a
Hyperpara
thyroi
dis
m
MTC
 9
Phe
ochr
omoc yt
oma
Donotchoos
ethisone

Thepa ra
thyroidglands:
Developfromt hese c
onda ndthir
dpha r
yngealpouches,al
ongwit
hthepal
at
inetonsi
landthethymus
Migratecaudallyintheneckinnorma ldevel
opme ntbutcanbef
oundanywherefr
omt hephar
yngea
lmuc
osat
othe
deepme dias
tinum
Secre
tePTHa ndc alci
toni
ntoma nagecalci
umhome osta
sis
Usuall
ynumbe rfour,butfre
quentl
ynumbe ronlytwoort hr
ee
Containenzyme sthatcata
lyzetheconversi
onof25( OH)vita
minD3t o1,
25(OH)2vi t
aminD

Radioacti
veiodineise
ffe
cti
vet
rea
tme
ntf
orme
tas
tat
icl
ungdi
sea
sef
orwhi
choft
hef
oll
owi
ngt
hyr
oidne
opl
asms
:
Hürthlecel
lcarcinoma
Papill
arycar
cinoma
Squa mouscarci
noma
Me dull
arycarci
noma
Ana pla
sti
ccarci
noma

Whic hoft hef ollowingst

ate
mentsregar
dingpapi
ll
arythyroi
dcarc
inomaa retrue
:
Seventyt o80%ofne wcas
esofthyroi
dcarci
nomaareofthepapil
lar
ytype
Totalips i
late
rall obe
c t
omyandisthmusrese
cti
onareadequat
ether
apyf orminimalt
hyr
oidc
arc
inoma
Microsc opicevi denceofmult
ic
entricdi
seas
eispr
esentin70%t o80%ofc as e
s
Nearlya llpati
e ntsle
s st
han15yea r
sofagehavemetas
tati
cdise
aseinlocallymphnode
s
Аlloft hea bove

WhatisTrous s
eausigninapat
ie
ntwi
thpa
ncr
eat
icc
anc
er:
Depr
essivesymptoms
Pa
inl
e s
sobs t
ructi
vejaundic
e
Migr
atorythrombophlebit
is
Pa
lpablegall
bladder
Pa
lpableli
ver

WhatisCour voi
siers
igninapa
ti
entwi
thpa
ncr
eat
icc
anc
er:
Depr
essivesymptoms
Pa
inl
e s
sobs t
ructi
vejaundic
e
Migr
atorythrombophlebit
is
Pa
lpablegall
bladder
Pa
lpablepancreat
icgland

Par
aumbilic
alsubcut
aneousme
tas
tas
esi
npa
ncr
eat
icc
anc
era
rec
all
ed:
Osler
’snodes
Ja
newa yles
ions
Si
sterMaryJosephnodule
Vir
chow'snode
Bil
rot’
snodes

Whi chistheprimar
ymodeoft
rea
tme
ntf
orpa
ncr
eat
icc
anc
er:
Surgery
Cheothera
py
Radiother
a py
Hormonet herapy
 10
I
mmun
othe
rapy

Pancre
aticcancerl
esscommonlyspr
eadst
othef
oll
owi
ngor
gans
:
Regionallymphnode sandli
ver
Lungs,brainandbone
Duodenum,s tomach,andcol
on
Abdomi nalcavi
ty
Skin

Themos tcommone nvi

ron
ment
alr
iskf
act
orf
orpa
ncr
eat
icc
arc
inomai
s:
Alc
oholism
Dia
betesMe l
li
tus
Die
tar
yf actor
s
Smoking
Pol
uti
on

Whichi sthemostc ha
r a
cte
ris
ti
csi
gnofpa
ncr
eat
icc
arc
inomaoft
hehe
adoft
hepa
ncr
eas
:
Pa
in
Pa
inl
es sobs t
ruc
tivejaundi
ce
Naus
eaa ndVomi ti
ng
Bl
eeding
Al
loft hea bove

Radiat
ionoft
hepai
ntothemi
dba
ckorl
owe
r-ba
ckr
egi
oni
npa
ncr
eat
icc
anc
erma
yindi
cat
espr
eadt
o:
Splanc
hnicne
rvepl
exus
Liver
Colon
Abdomi na
lca
vit
y
Chest

Ifpa
ncr
eat
ict
umors
pre
adst
othec
eli
aca
xisors
upe
riorme
sent
eri
car
ter
ies
,thes
tagi
nggi
veni
s:
T1
T2
T3
T4
T0

Pancr
eati
coduodenect
omy(Whippl
ePr
oce
dur
e)i
sthes
urgi
cala
ppr
oac
hfor
:
Tumorinthehe adofthepa
ncr
eas
Pancr
eati
cdu ct
altumors
Cholan
giocarci
noma
Duodenalma s
ses
Alloft
hea bove

Me a
suresforpaincontr
oli
npa nc
rea
ti
ccar
cinomainc
lude
:
Narcot
icanalges
ics
Combinati
onofna r
c ot
icanal
gesi
cswit
htr
icycl
ica
nti
depr
ess
ant
sora
nti
eme
ti
cs
Neurol
ysisofthecelia
cgangli
a
Radiat
ionthera
py
Alloftheabove
 11
Quest
Name :
Whi chofthefol
lowingfact
orspl
ayst
hel
eas
trol
efors
urvi
vali
nmus
cle
-inva
sivebl
add
erc
anc
er:
Age 
Lymphnodeme ta
s t
ase
s
Thepat
hoa natomicalst
ageofthedise
ase
Therat
ioinfil
trat
ed:removedl ymphnodes
Donotchoos ethisone

Ques
tName :
Thebe stt
imeperi
odf
orass
ess
ingmor
tal
it
yandc
ompl
ic
ati
onsa
fte
rra
dic
alc
yst
ect
omyi
s:
30daysaf
terradi
calcyst
ect
omy
60daysaf
terradi
calcyst
ect
omy
90daysaf
terradi
calcyst
ect
omy
Thr
oughoutthepat
ient'
shos
pit
als
tay
Donotchoosethi
sone

QuestName :
Whi c
hoft hefol
lowi
ngc
ompl
ica
ti
onsoc
cur
smor
eof
tenf
oll
owi
ngc
yst
ect
omy:
Haemorrhage
Uri
narytracti
nfect
ion(UTI )
Par
alyti
cileus 
Sur
gicalwoundde his
ce nc
e
Donotc hoosethi
sone

Quest
Na me :
Theus eofphot
odynami
cdi
agnos
isi
nmus
cle
-inva
sivebl
adde
rca
nce
rre
duc
es:
Theprogress
ionr at
eofthedi
seas
e
Therel
aps er
ate≥20%
Therel
aps er
ate <10%
Noneoft heabove
Donotc hoosethisone

Quest
Na me :
Thebestt
rea
tmentforbl
adde
rade
noc
arc
inomai
s:
Radi
othe r
apy
Cyst
ectomy
Chemothe r
apy
TUR+i ntr
aves
ica
lBCGi nf
usions
Donotc hooset
hisone

Quest
Name :
Removingpe r
ire
nalfa
tinapa
ti
entwi
thRCC:
I
ncrea
sestheperi
opera
ti
vemor t
ali
ty
Reduce
stheris
kforlocalre
laps
es
I
ncrea
sesthe r
ela
pserisk
I
ncrea
sespost
operat
ivemo r
bidi
ty
Donotchoosethi
sone

Quest
Na me :I
nradicalnephr
ectomyf
or 
RCC,r
out
inel
ymph-
nodedi
sse
cti
on:
I
sabsolutelyusel
ess
I
sperforme donlyforstagi
ng
I
sessentia
lonlyinaf ewpa t
ients
I
salwa ysindic
ated 
Donotc hoosethisone  

Ques
tName:
Woma n(53year
sol
d)a ni
li
nepai
ntsindus
trywor
kerhasacomplai
ntsoft
hefr
equentur
get
ouri
nat
e,
bl
oodint
heuri
ne.Anobje
cti
veandi
nst
rument
al(ult
ras
onogr
aphy)pr
ese
ntat
ionofthea
bdomina
lcavi
tyi
snot
 12
al
tered-t hekidneysofnormalshapeandst
ructur
e.Duri
ngcyst
osc
opyont
hepos
ter
iorbl
adde
rwa l
l,bet
weenthe
or
ifice
soft heureter
stherei
spolli
poidgrowthsfoundonabroa
dbasi
swit
hul
cer
ati
on.Whatist
hed i
agnos
is:
Bladdercancer
Bladderpolyps
Me t
astat
ictumor sofunknownlocati
on
Chroniccysti
tis
Erosi
vec ysti
ti
s

Que s
tName :Thepa ti
ent(46year
sold)istranspor
te dtothehospit
alwit
hcomplaintsofshar
p,par
oxysmalpai
nin
theri
ghtlumba rr e
gion,thepai
nirr
adi
ate
st othegroina r
eaa ndtothei
nnert
highs.Thepa i
ncamesuddenl
yafew
daysago.Pr e vious l
ythepa t
ie
nthadfe
ltprofusepainle
sshe matur
iawit
hwa r
ml i
kec lot
s.Aboutwhi
chdisea
seyou
shouldbet hinki nga bout
:
Urolit
hia
s i
s ,kidne ys t
one
Tumoroft hebl a dder
Ne cr
oti
singpa pilli
tis
Ac ut
eglome rulone phri
ti
s
Kidneyca nc er

Que st
Name :Thepa ti
ent(
63yearsold)t
hereisat
otalhematur
iadur
indthr
eedayperi
odwithsha
pel
essc
lot
s.12
hoursagos henotedtenes
mus,urineexcre
tedbydrops,bl
oody.Pai
nintheabdomen.Bl
adderpa
lpa
ti
onand
percuss
ionisde t
e r
minedby3fingersabovethes
ymphi si
s.
Yourprevi
ousdi
agnosi
s:
Paradoxic
ali s
churia
Ruptureoft hebl
a dder
Bladdertampona de
Chronicischuri
a
Anur i
a

Que stNa me :Ama n( 57ye arsold)dur ingt he6mont hperiods eve ra

ltime sexper
ience dshor tgr osshe ma tur
ia.
Achingpa ini nt her i
ghtlumba rr e gion,hype rt
ensionupt o170/ 100mmHg.Theki dneysa renotpa l pable.
Contra stur ogr am:r i
ghtki dneyi se nlarged.One xcret
oryur ogr amsl eftkidneywa snorma l,int her ightki dney
contrastf l
ui di snotde f
ined.Inr e nala rt
eriogra
mi ntheuppe rpol eoft her i
ghtkidneytor t
uous ,di lat
e dve ssel
s.
Wha ti syourdi agnos i
s:
Tumoroft her i
ghtki dne y
Cystoft her ightki dne y
Cave rnoust ube rculosis
Righth ydr one phr os i
s
Polycy s tos is
Que stNa me :Pa tient(53ye a r
sol d),wa sha vingtotalrecur
re ntgr osshe maturiadur
ingt heoneye arpe riod,
some time swa rml ikec l
ots,Ul t
ras ounda ndX- ra
ys tudiesshowi nganode6x7c m,i nthemi ddles egme nto ft
he
ri
ghtk idne y,f ea t
ur esofthenodea r
ec ha r
acter
ist
ict oma l
igna ntt umor.Re gionall
ymphnode swe r
en otenlar
ged.
Me tastas eswe renotf oundr adiogr aphica l
lyinthel ungs.Whi c hi sthebe s
ttimeoft re
atme ntoft hispa t
ient:
Hormona lt he rapy
Resec tionoft heki dne y
Radiot he ra py,ne phr ect
omy
Nephr e ctomy
Che mo t he ra py
Que stNa me :Pa tient( 60ye arsol d)ha sthec omplaintsoft hei nc re
a s
ei nvolumeoft hel e
ftt est
ic le
, b l
oodi nthe
uri
ne .Thepa tients uffe
rsfromobe s
ity.For mati
oni ntheabdomi nalcavityisnotpa l
pable.Yourdi a gnos is
:
Kidne yc a nc er
Hydr opsoft het e sti
cle
Varicoc e le
 13
Or c hiepi di dymi tis
Tube r
c ulos isoft het e sticle
Que s t
Na me :Pa tient( 60ye arsold)ha sc ompl a i
nesofhe maturi
a,dys uri
a .Ultr
as oundoft hepe lvi
ss howe donthe
rights i
deoft hebl adde rhe teroge ne ousf orma ti
onofupt o3c mi ndiame t
er.Dur inge xcretoryur ographyfunct
ion
oft her ightki dne yi sa bs ent.Yourdi agnos i
s:
Tube r
c ulos isoft her ightki dne y
Tube r
c ulos isoft hebl a dde r
Bl adde rc a nc erwi tht hebl oc koft her ightur eter
Bl adde rpol yp
Ri ghtu re ters tone
Que s t
Na me :Mos tof te nhe ma turiai npa ti
e ntsaged20- 40yearsisama nifesta
ti
onof :
Or thos ta tiche ma t
ur i
a
Wi lliamst umor
Conge ni tal( her editary)a noma l
ie soft heur inarytract
Tumor soft heur ina rybl adde r
Pos t
s t
re pt occ oc algl ome rulone phr iti
s
Que s t
Na me :Pa tient,66ye arsol d,a ppe aledf orhelpbe ca
useofa cuteur i
naryr et
e nt
ion.I tisnotpos sibl
etoput
ca the t
e ri ntot hebl adde r.Youra ctions :
Ca pi llarypunc tur eoft hebl adde r
Pr esc ri
bt ionofdi uretic s
Pr esc ri
bt ionoft hehe ateronbe lly
Pr esc pibt ionoft hea nt ispa smodi cdr ugs
Pr esc ri
bt ionofa lphar ecept orbl ocki ngdr ugs
Que s t
Na me :Thepa tient(5 2ye arsol d)f orthef i
rstti
mei nl if
eha smonos ympt oma t
iche ma t
ur i
a.Wh i
chdise
ase
phys icia ns houl dc ons i
de rpr ima rily:
Ac utegl ome rul one phr itis
Ki dne yt ube r culos is
Ur ol it
h ias is
Ac utec ys tit
is
Tumoroft heur ina ryt ract
Que s t
Na me :Wha tdoe sthet e r
m" s igna lhe ma turi
a"me a
n:
Gr os she ma turia ,mi c rohe ma turia
Mi crohe ma t
ur ia
Gr os she ma turia ,mi c rohe ma turia,pr ot einur i
a
Mi crohe ma t
ur ia,l eukoc yturia
Gr os she ma turia
Que s t
Na me :Ont heba ckgr oundoft heki dne ycancerdista
ntme tastasesmor efr e
que ntlya refoundi n:
Li ve r
Lungs
Cont rala teralki dne y
Br a i
n
Adr ena lgl and
Que s t
Na me :Wha tist hef irstc li
nic als ympt omi nthee arl
ystagesofc ervicalca ncer:
Cont ac tbl ood ydi scha rge
Inde pende ntbl oodydi scha rge
Pus -li
kedi scha rgewi thaf oulodor
Pa in
Chyl orr he a
Que s t
Na me :Wha taret hema ine xoge nousf ac t
orsthatcontr
ibutetoc anc e
roft hec er
vi x:
Simpl ehe rpe svi rusI I
Huma nPa pi ll
oma virus
 14
Ca rcinoge nsf oodf a ctor s
Chl amydi a
Tric homoni asis
Que stNa me :
Indi ca tet her esearchme thodus edt ospe ci
f yt hes tatusofa dja centor ga
nsi npatientswithc er
vica
l
canc eri nge ne ralme di ca lpra cti
c e:
Ultra sound
Bima nua le xa mi na tion
Cys tos copy,s igmoi dos copy
Exc re t
or yur ogr a
phy
Col ono s copy
Que stNa me :
Wha tist hema inf a ctortha tde terminest hevol umeofs ur geryi nt hec aseofc ervicalcancer:
Preva le nc eoft hepr oc ess
Comor bi dities
Tumordi f ferent i
ation
Age
Cons ti
tut ionoft hepa tient
Que stNa me :
Wha tist hec r
iterionf ors eparationoft hef irsts t
ageofc ervic alca ncerintot wos ubgroupsI aandIb:
Initialle siondi ame te r
Thei nte gr ityoft heba seme ntme mbr a ne
De pt hofi nva sivegr owt h,hor izont als prea d
Thepr e se nc eoft ypi c alc ompl a i
nt s
Donotc hoos et hisone
Que stNa me :
Wha tinc lude sini tselfs urge rybyme thod ol ogyf orWe rtheim:
Hys te r
e ct omywi t
ha ppe nda ges
Hys te r
e ct omywi t
ha ppe nda gesa nduppe rthirdofva gina
Hys te r
e ct omywi t
ha ppe nda gesa nduppe rthirdofva gina ,pe l
vicl ympha dene ctomy
Hys te r
e ct omywi t
ha ppe nda gesa nduppe rthirdofva gina ,pe l
vicl ympha dene ctomya ndt unne l
ingoft heuret
ers
Hys te r
e ct omywi t
houta dnexaa nduppe rt hirdofva gina ,pe lviclympha de nectomy
Que stNa me :
Whi c hme thodi sthepr efe rre
dt reatme ntforc ance roft hec e rvixi nwome nT1bN0M0o ftheyoung
andmi ddl ea ge :
Combi ne d
Compl ex
Ra dia t
iont hera py
Sur ge r
y
Che mo the rapy
Que stNa me :
Indi ca tet hena tureofme nstrualf uncti
ondi sor dersinc a nc e
roft heut er
ine :
Hype rpol yme nor rhoe a
Me nor r ha gi a
Me nome trorrh agia ,me t
rorrha gia
Hype rme nor rhe a
Me nome trorrh agia
Que stNa me :
Pa t
ientK.( 58ye arsol d),a ppea ledtothea ntena t
a lc l
inicbe caus eoft hebl eedingt hatappearedonthe
bac kgr oundof6ye arsofme nopa us e.Ut er i
nec ance riss uspe cted.Se l
e ctthebe stme dicaltactics:
Pres cribet hedr ugst ha ts hrinkt heut erus
Func t
iona ldi a gnos tict e sts
Re -exa mi na ti
oni namont h
Hor monepr esc ri
bt ion
Hys te r
os copyf oll
owe dbyf ractiona lc urettage
Que stNa me :
Ont he18t hda yoft heme ns t
rua lcycledi agnos t
icc urettagewa spe rfor
me d.Histologica
lly:
prolifer ationofe ndome trialgla nds ,atypi cale pit
heliale leme nts,c ellpol ymor phism,hype rc
hr oma t
osisofthe
nuc lei.Di a gnos is:
 15
Endome trialc arcinoma
Cys tice ndome t
r i
a lhype r
pla si
a
Ade noma toushype rpl asi
aoft hee ndome trium
Ade nomyos isoft heut erus
Squa mousc e llca rcinoma
Que s tNa me :Tr eatme ntofs tageI Iendome trialcance
r:
Expa nd edpa nhys tere ctomy
Ext ende dpa nhys te rec t
omya ndc hemot her apy
Ext ende dpa nhys te rec t
omya ndr adiotherapy
Panhys terec tomy
Ra diot herapy
Que s tNa me :Mut ationofBRCA- 1ge nec ont ri
butest
othede velopmentof:
Bre astc anc e r
Ova r i
a nc anc er
Col ore ctalc a nce r
Alloft hea bove
Not hin glis ted
Que s tNa me :Sympt omsc har acte
rist
icofpa tient
swi t
huterinecancerwithpat
hogeni
cvar
iantnumbe
rI:
Hype rtension
Obe s it
y
Dia be tes
Alloft hea bove
Not hin glis ted
Que s tNa me :Wha ti sr elatedtopr ecanc e
roft heendome tr
ium:
Endome trialpol yps
Gla ndul are ndome trialhype rplasia
Atypi c alendome tria lhype rplasi
a
Alloft hea bove
Noneoft hel i
s t
e d
Que s tNa me :Ut erinea rter
yi sabr anc hof :
Aor ta
Umbi licala rtery
Re na la r
tery
Ext erna liliaca rtery
Interna liliaca rtery
Que s tNa me :Ova ri
a na r
teryi sabr anchof :
Re na la r
teryo fa orta
Aor ticorc ommoni liacartery
Ge ne ralori nt ernali liaca rt
e r
y
Ext erna liliaca rtery
Interna liliaca rtery
Que s tNa me :Whi cht ypicalloc at
ionsofc anc erl
inkwithHPVi nfect
ion:
Ca nc eroft hec ervi x,vul va
Ca nc eroft hea na la rea,vul va
Ce rvic alca nc e r
,a na la rea,vul va
Stoma c hc anc er,c olonc ancer
Ce rvic alandut erinec a
nc er
Que s tNa me :Wha ti st hemos trati
ona lme a nsoftreat
me ntformode rat
eandsever
edyspl
asiaoft
heect
oce
rvi
x:
Dia the rmoc oa gul ation
Elec troconi z ation
Cons ervativet re atme nt
 16
Cryos urge ry
La serc oa gul ati
on
Que s tNa me :Whi cha ret hec linic alma nifest
ationsoft hei ntraepithe l
ia lca ncer:
Noma nife station
Abdomi na lpa in
Bloodydi sc harge
Chyl or rhe a
Va gina ldi scha rge
Que s tNa me :Af ters urge rybyWe rt
he imi napa tientt he rewa sde te ctedmi cr
ome tasta
s e
si ni l
iacl y
mphn odeson
boths ide s,t umoroft hee ctoc ervi xwi t
ht heinva sioni ntot hel eftfor nix.I denti
fythes tage:
Т2а N1Mo
T2bN1Mo
T2a N1M1
T2a NoMo
T2bNoMo
Que s tNa me :Wha tonc oma rke rsa reus edtodi agnos eova rianc anc er:
СА–15- 3,СА–125
CEA,AFP
CA-125,i nd.ROMA
СА–19- 9,SCC
СА–125,SCC
Que s tNa me :Ma scul inizationova ri
ant umor sar e:
Adr enobl a stoma
Pseudobl a stoma
The coma
Folic uloma
Pseudomyxoma
Que s tNa me :Woma n( 45ye a rsol d)i ss howi ngc ompl aintsofr e curre ntpa i
na ndf e e
lingsofhe avine s
si nt he
abdome n,l ow- gra def ever.Me ns t
rua ti
oni sno rma l.Twopr egna ncie sinhi s
tory.Pul se76b/mi n.Pr essure120/ 70
mmHg Va ginale xa mina tion:pa l pationr e
ve a l
edbi late raltumor soft hea ppenda ge soft heut erus,l
a rgerthana
fi
st,t umor sa renotmovi ng,f il
lingt hewhol es ma llpe lvis.Pos t
eriorf or nixisbul bous .Bl ooda nalysi
sESR-60
mm/h. ,mode r
a t
el ymphope ni a,slighte osinophi li
a .Di agnos is:
Ova ria nCa nc er,I Is tage
Bilate ralova ri
a ltumor sofi nf l
amma toryge nes is
Fibroi d soft heut e rus
Ec t
o picpr egna nc y
Donotc hoos et hisone
Que s tNa me :Pa tient( 55ye ar sol d),hos pit
alizedt ot hegyne c ologi calde pa r
tme ntwi thc ompl aintsofl o
w- grade
feve r,ge ne ralwe akne ss,fa tigue ,di scomf ortinl owe ra bdome n,pa ini nt hea bdome n.Me nopa use5ye a r
s.Int he
historyi sac hr onici nflamma ti
onoft heut eru sa ppe nda ges.One xa mi na t
ion,thea bdome ni sinaf ormo f"frog"
ascites .Dur ingbi ma nua lexa mi na ti
on:t heuterusi ss ma ll,shi f
tedt ot her ight.Li mi t
e droll
i ngt hicklumpyl esionis
palpa bl eont hel efti ndi ame terupt o15c m,pa inful.Wha tisthel ike l
ydi agnosis:
Ova ria nc ys t
Cys tomaoft hel eftova ry
Fibroi d soft heut e rus
Sarc os alpynx
Ova ria nc anc er
Que s tNa me :Pa tient( 56ye arsol d)c ompl ainsofg ene ralwe akne ss ,dul la bdomi nalpa in,bl oa t
ing,i ncreased
abdome n.Me nopa us e5ye ar s.One xa minati
on,ma rke da scites.Dur ingbi ma nuale xa mina tiontheu t
erusi ss ma l
l
ins izes hi ftedt ot her i
ght ,ont hel efta ndbe hindofi tpa lpabler oc ky,de nse,unmova blet umorf orma t
ion,size
10x12c m.Di agnos i s
:
 17
Tuboova rialabs c ess
Subs e r
ousut e
rinef ibroi ds
Ova rianc anc er
Ge nitale ndome triosis
Tumoroft hec olon
Que stNa me :Wha tist hebe stme thodf ormor ph ologicalconfirmationofova ri
anc arc
inoma:
Hys teros copy
Col pos copy
Lapa ros copywi th biops y
Dopunc tur ethr ought hepos teri
orva ginalva ult
Hys teros alpingogr aphy
Que stNa me :Whi c hc anc e risnumbe ronei ns tr
uc t
ureoff e
ma leincide nceinUkra ine
:
Ca nce rofs toma c h
Lungc anc er 
Ca nce rofs kin
Ova rialc anc er 
Bre astc anc er
Que stNa me :Wha tdoe sKr ukenbe rg’sme tastasisme an:
Me tas t
a si
si nl ive r 
Me tas t
a si
si nova ry
Tumorde pos i
tsi nDugl as’spouc h
Me tas t
a si
si numbi l
ica la rea
Me tas t
a si
si nl e f
ts upr a clavi c
ulare slympha ticnode
Que stNa me :Ri skf ac torsf o rova ri
a nc ance rincludewhi choft hefollowi ng:
Younga ge
Nul li
pa rity
Mul tiplepr egna nc ies
Prolonge dus eofor a lc ont r
a cceptivepi ll
s
Smoki ng
Que stNa me :Whi c hoft hef ollowi ngs ympt omsi sanunc ommonpr ese ntat
ionofova r
ianc ance
r :
Abdomi na lpa in
We i
ghtl os s
Che stp ain
Abdomi na ldiste ns i
on
Donotc hoos et hisone
Que stNa me :A56- ye ar-ol dma nisc onc erne da bouts oresont hemuc ousme mbra
neoft hec heeksontherightin
placewhe rei tist rauma t
iz ewi ththepr osthe s
is.Theul cerexistsfora boutaye ar
,me dicalt
reat
me ntisnota nopt
ion;
itha sd oubl e di ns i
z ef ort hel ast3mont hs .Thes izeo ftheulceris2- 2.5c m;it
sbot t
omi snecroti
c.Regional
lymphnode s-s ubma ndi bularto2c m,s ofte lasti
c,limi t
edinmovi ng,t herear
ea pproximatel
y3oft hem:
Leukop laki a
As pirinul ce r
De cubi talul cer
Ca nce rsor es
Ca nce rofor almuc os a
Que stNa me :A46- ye ar-ol dma nc amet ot hes urgeon,wi thapa inlessul cersi
ze0,5x0,5c mont helowerlip.
Dur ingt hel astye a rheobs e r
veds c alesont hel owe rlipthatoc ca
siona ll
yf al
lawa y.Ulcerappeared2mont hsago.
Thel eftsubma xillarya reaha ssomede nsel ymphnode0, 5x1,0c mi nsize:
He rpe slabi ali
s
Leukop laki a
Cha nc reoft hel owe rl ip
Rode ntul ce roft hel owe rlip
 18
Lowe rli
pc a nce rha ss pr ea
dt ot hes ubma ndi bul arlymphnode s
Que s tNa me :Toyou,at he r
apistoft hedi str
ic th ospitalc amea42- year-oldpatie nt
,wi thc ompl a intsofs olidi
ficat
ion
inthea re aof​ ski nt hel owe reye lidont hel e ft.Fr omt hec as
ehi storyyoul earne dtha tthisforma ti
ona ppea r
eda
yeara go.Dur inge xa mi nat
ionont hel owe re ye li
dt o3mmbe lowt hee dgeoft hei nte rma r
gina le dget hereisa
newl yf or me dt issue5x6mmi ns izewi tht hic ke dge s,excessiveke rat
iniz
ation,a ndc overedwi t
hc rust.Af t
er
remova li tss urfa cei sbl eeding.Ma keadi agnos i
s:
Ne opl asmont hes ki n
Blepha riti
s
Cha la zi
on
Abs c ess
Ba rley
Que s tNa me :Dur ingt het r
eatme ntoft hel owe rlipc anc eroftheIs t
agea reuse d:
Sys temi cc he mot he ra py
Dista ntr adiot he rapy
Intraa rt
er i
a lc he mot he rapy
Cryode struc tion
Clos ef oc alr adi ogr aphy
Que s tNa me :Le ukopl aki areferst of acul tati
vepr ecanc ancersoft heor a
lmuc os a.Iti sapr oces sinwhi cht hereare
suchf eatur esa s :
Flatwh itisha rea sofmuc osa,s moot ha nds oftonpa lpa t
ion
Va riousi ns izea nds ha pewhi t
isha reast ha ts tandouta bovethes urfaceofthemuc os aThes urfa ceha sawa r
ty
appe a ra
nc e ,pos siblec ra c
ksa nde ros i
on
Sore sorc ra ck s
Papi llarygr owt hsofwhi t
ishc olor,t endt oke rati
ni zation,oft
ena c c
ompa ni
edbyi nfla mma t
ion,ul cerati
ona nd
necr os i
s
Donotc hoos ethi sone
Que s tNa me :Wha tl oc ationoft heor alc a nceri st hemos tcommon:
Muc ousme mbr a neofc heeks
Themuc ousme mbr aneoft hef looroft hemout h
Themuc ousme mbr aneoft hea lve ol a
re dge so ftheup perandl owe rjaw
Tongue
Donotc hoos ethi sone
Que s tNa me :Thepa tientha sac ytol ogic allyc onf irme dt onguec a ncer.Primaryt umori supt o4c mi ngr eates
t
dime nsion.The rea ree nlar
ge dr egiona llymphnode s,mor ethan6c mi ns i
ze,a ndnodi sta
ntme tasta
s es
.Cl assi
fy
thi
spa t
hol ogya cc ordi ngt oTNM s ys tem:
T2N2M0
T2N3M1
T2N3M1
T2N3M0
T3N3M0
Que s tNa me :Bowe n'sdi sea
sei s:
Inne repide rmi als qua mousc ellski nc anc e r
Fac ultativepr ec anc e roft heor almuc os a
Notr elatedt opr ecanc erousl esi
ons
Donotc hoos ethi sone
Donotc hoos ethi sone
Que s tNa me :A57- ye ar-oldpa ti
e ntc amet othedoc torwi thcompl aintsofthepr ese nc eofpa inf uls oresont he
muc ousoft hel e ftc he ek.Anul c erwa st heref ora bouts i
xmont hs,a ndtendst oi nc rea se
.Obj ective l
yt heul ceri
s
rounde dwi thde ns ef ounda ti
onsa nds uppor t
ingma rgi nsto2c mi ndi ame t
er,c ove redwi thne c roti
ct iss
uet hatis
easilyr emove d.Thes ur faceoft heul ce rble edswhe nt ouched,t hebot tomr ese mbl e sgr anulationt issue.Wha t
me thodofe xami na ti
ona rer ecomme nde dt oe s t
ablisht hediagnos i
s:
 19
Infrar edstudy
As pirationbi opsy
Exc isionbi ops y
Incisiona lbi opsy
Perc uta neousbi ops y
Que s tNa me :Ina63- ye ar-oldpa t
ientont hemuc os aoft hea nteriorf l
ooroft hemout hwa sf ounda nuna t
tr
a ct
ive
ulcerofc ra
te r-
for mwi tht hicke dge sofc us hionf orm. Thebot tomi scove redwi thf ibrinousc oa tinga ndc rust
s,
unde rwhi chonec anf i
ndgr anula -
liker e dt i
s s
uet ha tbl eedse asily.Fort heul cerofwha tge nesisi stypicalthis
cli
ni calpi ctur e:
Tube rculous
Ac tynomyc otic
Syphi l
is
Pos tt r
a uma tic
Ca nc er
Que s tNa me :Re movi ngofme tastaticc ongl ome r
ateoft hel ymphnode swi t
ht her es ec t
ionoft henoddi ngmus c
le,
interna ljugul arve ina nda dditiona lne rvei s:
Bohma n’ s
We rtheim’ sope ration.
Ha rtma n’sope ration
Cra ilope ration
Donotc hoos ethi sone
Que s tNa me :Onwha ts urfac edoe sof tende ve l
o ptonguec anc er:
La t
e ral
Top
Tonguer oot s
Ba ck
Donotc hoos ethi sone
Que s tNa me :Wha ti st hetr eatme ntoft heI Is tagec anc eroft heor almuc os a:
Che mo the r
a py
Che mo the r
a py,s ur gical
Ra dia t
ion,c he mot he rapy
Ra dia t
ion,op erative
Sympt oma tic
Que s tNa me :In71ye aroldpa tientt hreemont hsa goh ada ppe are dac onsta ntpa inbe hindt hebr e ast
bonea ndthe
hea rt.Het r
e atedhi ms elfinde pe nde ntlya ndvi si
tedadi strictdoc t
ora ndus ed" c ardia c"dr ugs.The rewa sa
tempor a r
ya ndi ns igni ficante ffec t
.Obj ectivea nde l
e ctroc ardiogr aphice xa mi nationsdi dn’treve ala nys i
gni f
icant
cardi aca bnor ma litie s.Wha tma ligna ntne opl asmmor eof tenc anc auset hea boveme ntione dsympt oms :
Periphe rallungc anc er
Col or ectalca ncer
Ca nc eroft hee sopha gusc ardia
Nodul arl i
ve rc anc e r
Ta i
loft hepa ncre asc ance r
Que s tNa me :Ana mbul ancede li
ve redapa ti
e nta42- yea r-oldpa tie
ntintot hehos pita l,whowa sc ompl a i
ningof
gene ralwe akne ss,c offee-gr oundsvomi ting,me lanor rha gia .Asobs erveddur inga ne xa mina t
ion,t hes kina nd
visiblemuc ou sme mbr ane sa repa le.Abdome ni ssof t;the rewa smuc hpa i
ni nt hee piga st
ricregi on.Pe rrektum-
rectuma mpoul ef illedwi thl iquidf e ces,re ctalmuc ousi smobi l
e .Atthehe ightoft hef inge rwi thoutpa t
hological
entities.The reisas ignoft hebl acks toolont hegl ov e.Bl ooda nalysisHb80g/l ,e p.2. 1h1012/l ,ESR20mm/
h.Fibe ropt i
cga stroduode no scopy-ont hel e ssercur vatur eoft hes toma cht he reisa nul cerwi t
hhor ny- headede dge
s
about2c mi ndi ame te r
.Thebot tomoft heul cerisc ov ere dwi thabl oodc l
ot .The rei snoe vide nceofc ontinued
bleedi ng.Thebi ops ywa sc arri
ed.PHZ-hi gh lydiff erentia teda denoc ar
c inoma .Thes urgent’st acticsoft he
eme r genc yc a r
ehos pital:
 20
Se ndt oa nonc ol ogi st
Re s e
c tionoft he2/ 3oft hes toma ch
Ga s t
re ctomy
Che mo t
he rapy
Sympt oma ti
ct re atme nt
Que stNa me :The59- ye ar-oldpa tientc ompl ai
nsofdi ffic ult
ywi ths wa llowing,whi cha ppea redaf ewwe eka go,
firstwi ths wa ll owi ngs ol i
df ooda ndt he nwi t
hl iqui df ooda swe ll.Adoc t
orwhi che xamini ne dapa ti
e ntma dea
dia gnos isofe sopha ge alca nce r
.Wha tde gr eeo fme ch a nicaldys pha gi
adoe sthepa ti
entha ve :
1
2
4
0
3
Que stNa me :Whi lee xa mi ningt he49- yea r-oldpa tientwi tht hehe l
poff ibroga s
troscopywa sfoundapol ypont he
gre aterc ur va tur eoft hes t
o ma c
ha ntrumonab roadba set o2c mi ndi ame ter.Wha tres
e archi sne cessarytoc l
ari
fy
thet rea tme nts tra tegyf ort h epa ti
ent :
Endos c opicbi ops y
Intraope rativebi ops y
Ga s t
ricj uic ec ultur eonhe licoba c
ter
Ga s t
ricj uic ea na lysis
Ra diog raphi cs tudyoft hes t
oma c
h
Que stNa me :The62- ye ar- oldwoma nha dwe akne ssa nddi z zine ss.Thebl oods tudyr e
ve ale dhypoc hromi ca nemia.
Wha ta ddi tiona lr ese archh ast obeunde rtake ni nt hef ir stplac e:
Irrigos copy
He pa tolienogr a phy
Sc rapi ngt heut erus
X- raysoft hes toma ch
Bonema rr
owpunc ture
Que stNa me :68ye arol dma l
e ,whoha sbe e ns ufferingf romc hronicga str
iti
sf or10ye ars
,a ppe aledwi thc ompl ai
nts
ofwe akne ss ,we i
ght los s,los sofa ppe tit
e ,pa inst ha tshootupt heba ck.Pa lpa t
ionoft hea bdome nha sma r
k ed
tende rne ssi nt hee piga strium.X- raysr eve aledga stricni c he4c mi ndi ame terwi th"elevete d"e dges.The
fibroga st
ros c opys howe du lcerwi thundul ati
nge dge s .Wha tist hedi agnos is
:
Stoma chul c er
Ga s t
ricc anc er
Pa ncr eatitis
Ga s t
ritis
Pe net rati
ngul c erofs t
oma c h
Que stNa me :Iti sa42- ye ar-oldpa ti
e ntwi thdys pha gia .Asac hildha da ccidenta l
lydrunkvi ne garandbur ntthe
esopha gus .Ac ons e rvativet re a
tme nt- gul letbo ugi na gewa sc conduc t
ed.Foral ongt i
mea ni mpa iredf oodp a
tency
wa snotobs e rve d.Anx- rayde termi ne dc onc e ntricna rrowi ngoft hee s ophagusi nt hemi ddl ethird,thec ont r
asti
s
notc omi ngbe l ow.Pr oba bledi agnos is:
Es opha gea la cha lasia
Re fluxe sopha gitis
Es opha gea lle iomyoma
Ci catricials te nos is
Es opha gea lc anc eronaba c kgroundofpos tbu rninge sopha ge als t
rict
ur e
Que stNa me :Pa tientS.64- yea r
-old,f or6mont hsha sdul lpa ini nthee pigastri
cr egion,na us ea,belchinga nd
anor exi a.Fa tigue ,pr ogr essivewe ight los s,me ntalf atiguea reobs erved.I nthel eftsupra cl
a vicularregiona ppeare
d
de nse ,immova ble ,pa inlesst umorf orma tionwi thi ndi stinctc ont oursof2, 5x3, 5c m.Theses ympt omsa re
cha rac teristi
c :
Hodgki ndi s ea se
 21
Stoma c hc anc e r
La ter alne c kc ys t
Pul mona ryt ube rculosis
Duode na lul ce r
Que stNa me :Dur ingaf ibroga strosc opyi napa tientwi t
ht hec linicofga strointestinalble edingi nt hel esser
cur va tur eoft hes t
oma chi ns ubc ardia cpa rtwa sfoundi rr
egul a r
lys hape dul cerationwi thi rregul arc ontours,bumpy
bot tom,r igide dge s,wi t
hdi ame ter3. 5x4. 5c m,s urr oundi ngf oldsofmuc os aa retwi st
e d,ofgr a yishc olor,
diffus e lymode ratebl eedin g.Ga st
ros copicpi cturei s:
Stoma c hc anc e r
Er os ivega stritis
Me ne trier’sdi s ea se
Ma llor y-We isss yndr ome
Ga s tricul c erc ompl icatedbybl eeding
Que stNa me :A40ye arol dma le,ent eredt her ec eptionwa rdwi thc ompl a i
ntsofvomi ti
ngofl ar genumbe rofred
blood, whi chwa spr ec ededbyna us eaa ndr epe ated,unc ontrol l
edvomi ting,wi t
houtbl ood.Vomi t i
ngoc c
urred
afte rc o nsumi ngl argea mo unt sofa lcohola ndf a t
tyf oodsonaba ckgroundoff ullhe alth.Wha ti syourpr el
iminary
dia gnos is:
Hi ata lhe rnia
Stoma c hc anc e r
Bl ee dingf rome sopha ge alva r
ices
Ma llor y-We isss yndr ome
Duode na lul ce r,bl eeding
Que stNa me :Pa ti
e ntN. ,60ye a
rol dc ompl a i
ne dofpa inbe hindt hebr e astboneofape rma nentna ture,whi chwa s
inc rea singwi tht hepa ssa geoff ood.Wha ti sthemos tlikelydi agnos is:
Angi na
Stoma c hul cer
Es opha ge alc a nc er
Che sts c i
a ti
c a
Re fluxe sopha gitis
Que stNa me :Ai n52ye arol df ema lepa t
ie ntforal ongt imes ufferedf romc ons tanthe artburnoft hebot t
omt hir
dof
thes ternum,abi t t
ert ast
ei nt hemout h,inc rea seds aliva ti
ona ndmuc us .Cons ume ss odaa nda lma gel,butitdoes
notr ed uc ehe a rtbur n.Ra diol ogicalf indings :vi olation sofe s
opha gusr eliefandc ardialoc a
tiona renotf ound.The
endos c opi ce xa mi na t
ionr eveale dtha tthel owe rthirdoft hee s opha gusi sc ove redwi thf ibri
n,t he rea r
es ome
isola tede rosio ns ,ca r
dioc l
os esnotc ompl etely;s toma chi sful lofbi l
e ,therea res ignsoff ocala troph i
cga stri
ti
s,
duode numi snor ma l.Wha ti syourdi agnos i
s:
Di aphr agma tiche rnia
Ul ce r
Es opha ge alc a nc er
Es opha ge ala c ha lasia
Ca rdi ai ns ufficie ncy,r efluxe s
opha gitis
Que stNa me :Pa ti
e ntsove rt hel ast2ye arsha sd iffi
cul twi thswa ll
owi ngf ood( espe cial
lyl iquid)i nt hemout hther
e
isc ons tantlyal otoff oamys aliva,muc us ,freque ntvomi ti
ngwi t
hba r elyc hange df ood.Thee ndos copic
exa mi na t
ions howe dtha tlo we rthirdoft hee so pha gusi sshar plyna rrowe d(clea r
a nce-upt o3mm)a boveitthe
esopha gusi ss igni f
icantlye xtende d.X- ray-as ympt omof" goos ef eathe r"int hel owe rt hir
dt hee sopha gusis
sha rpl yna rrowe d,ove rthiss ection-gr ea t
lye xpa nde d.Eva cua t
ionofX- rayc ontrastint othes toma cha lmost
doe s n’tha ppe n.Af tert akinga nt i
spa smodi cst her adi ologicalpi cturedoe snotc hange .Yourpr e li
mi na rydiagnosi
s:
Es opha ge aldi ve rticulum
Re fluxe sopha gitis
Es opha ge alc a nc er
Es opha ge ala c ha lasia
Fa ilur ec ardi a
 22
Que stNa me :Pa tientB. ,60ye arol d.Hec ompl ainsofpa ini ne piga str
ia.I nthel e f
ts upr aclavi cula rregiont he r
ei sa
de ns el ymphnodet o2c mi ndi ame ter.
Thega stros c
op ys howe dul cerwi thja gge dunde rline de dge sa ndbot tomt o
5c mi ndi ame teront hel e sserc urva t
ur e.Wha ti syourdi a gnos i
s :
Ul ce r
Ga s trics yphi li
s
Stoma chc a nc er
Ga s tricl eiomyoma
Stre ssul ce r
Que stNa me :Inpa tient swi thduode nalul c erdi se asewi thc ompl a i
nt sofpa i
n,na usea,vomi ting,f eeli
ngoff ullness
int hel eftuppe rqua dr a ntb yX- raye xa mi na tionwa sr eve ale dc ont rastfluidr etentioni nt hes toma chf orupt o24
hour s.Forwha tt ypeofpe p ti
cul cerc ompl ic ationa rethe s ec linica lma ni f
estationsa ndr a diologi calpic turetypi ca
l:
Ste nos isoft hes t
oma ch
Pa nga stratis
Pe rfor atedul cer
Ul ce rma li gna nc y
Pe ne trationul cers
Que stNa me :A45ye arol dpa tientha sde la ye ds tool( cons tipa ti
on,di a rrhea)dur i
ngt hel ast5mont hs,di schargeof
muc usmi xe dwi thbl oodf romt hef eces,l os ta bout20kg.Na us eaa ndvomi tinga renotpr esent.Wha tre search
shoul dbedonei nt hef irstpl ace,toma keadi agnos is:
Di gita lr ec tale xa mi na tion
R- sc oryofga stroi nte stina ltract
Col ono fibe rscopy
Irrigos c opy
Donotc hoos et hisone
Que stNa me :Ina62ye a rol dpa t
ientdur ings urge r yfora c utei nt estinalobs tr
uc tionwa sde t
ec t
e dat umorof
rec t
os i
gmoi da ngl etha tc ompl et
elybl oc kst hei nte s
tinel ume n.Ci rcumf l
exi ntes t
ine proxi ma lofa nobs tacleis
ext ende d,f ul lfe ce s
,a ndga se
s .Loopsofs ma llint esti
nea renotc ha nge d.Int hepe l
vi sa ndl a t
e r
a lc analst herei sa
sma lla mountofs erousf lui dofl i
ghtc olor .Wha ttypeofs ur ge ryi smos tsuitablei nt hisc a se:
Sigmoi dos tomy
Abdomi na l -ana lre sec tiono fthes igmoi dr ele ga tion
Ant e rio rre se ctionoft her ectum
Ke nny- Mi le sope ration
Obs truc tivepul mona r yr es ecti
onbyHa rtma n
Que stNa me :A52ye arol dpa tientforal ongt imeha sbe e ns uf fe r
ingf romc hroni cc ol i
tis,andi sunde rt he
supe rvisionofa ne nte rologi st.Dur ingt hel as te xa mina tionwi tht heirrigoscopywa sr eve aleds ur veyt hef ill
ing
de fec tint hea sce ndi ngc ol onwi t
houts i
gnsofs trict
ur efor ma tion.Col onof ibers copywi thbi ops yc onf i
r me dthe
pre se nceofc anc e roft hea scendingc olon,hi s tologi callyi tishi ghlydi fferentiateda denoc arcinoma .Wha tme thod
oft re atme ntc anbepr es cribedt othepa tient :
Sur ge ry
Sur ge ry+r adiot he rapy
Ra di othe ra py
Che mo the ra py
Ra di othe ra py+ope ration
Que stNa me :A64ye arol dpa tientc ompl a insofc onstantdul lpa ini nther ighti liacre gion,s heha slossof20kg
ove rt h el as t6mont hs ,pe r si
stentc ons t
ipa tion,l ac kofa ppe tite.Obj ectivelye arthyc oloroft hes kin,itst urgori s
lowe red.I nt h er ighti lia cr egioni nfil
tration6x8c mt hicki spa lpable;it’sde nse ,slight l
ymobi l
e ,andpa inless.Free
fluidi nt hea bdomi na lc avi tyisnotde f
ine d.Aus cultations howe da ni nc re
as edi ntes t
ina lnoi ses.I nbl ood:
Hb- 80g/l .Gr ege rse n’ sre actionispos iti
ve .Wha tisthemos tlike lydia gnos i
s:
Re trope ritone altumor
Ca nc e roft hec e cum
Ca nc e roft her ightki dne y
 23
Ma lign antt umor soft hes ma llint estine
Appe ndi cul ari nf il
trate
Que stNa me :Di s
tric tphys i
cians e nta59ye a rol dpa ti
e ntt othei ns ur gica lhos pit
a lwi t
hs uspe c tedtumoroft he
asc endi ngc olon.Whi chme thodofr e searchwi llha ves ignifi
c anc ef orma kingac orrectdi a gnos is:
Irrigos copy
Col ono sc opywi thbi ops y
Obs erva tiona lRt g-gra phyoft hea bdomi na lca vity
Sigmoi dos cop y
Ca sehi stor ya ndphys ic alme t
hodsofr e search
Que stNa me :A64ye arol dpa t
ient ,wa shos pitalize di nt hee me rge ncypr oc edur ewi ththec ompl ai
ne sofc onstant
intens epa ini nt hel efti l
iacr egion.Wi thin6mont hsc ons ti
pa tion,bl oa t
ings toma ch,muc ousa ndbl oo dydi scha r
ge
fromt hea na lc analha sbe e nbot he ringhe r.Obj e cti
ve ly- therea repos it
ives ympt omsofpe ri
tone alirri
ta t
ion,a nd
mus c l
et e ns ionoft hea nteriora bdomi na lwa lli nt hel ef tili
ac .Ra diogr aphys howe df r
eega si nthea bdomi nal
ca vity.Choos eapr oba bled iagnos i
s :
Chr on’ sdi sea se
Me se nter icve s s
e lst r
ombos is
Cys toft hel eftova r y
Ur ol it
h ias is,r ena lc olic
Tumoroft hes igmoi dc olonwi t
hpe rfor at
ion,a ndpe ritoni t
is
Que stNa me :A50ye arol dpa t
ientc ompl aintso fde layi ndi scha rgingt hati ntercha ngewi t
hdi a r
rhe aa ndbl oodi n
stool .Ac irc ula rtumor ,t hatna rrowst hel ume noft hei nt es
tinewa sf ounddur ingt hesigmoi dos copywi t
hin12c m
fromt hea nus .Hi stologi calexa mi na tionofbi ops ys howe dtha ti tisa denoc arcinoma .Wi tht hehe lpofwha t
addi tiona lme thodswec anf i
ndoutope rabilit
yoft het umor :
La pa ros copy
Di agnos ticl a p arotomy
Ul tras onogr a phyoft hea bd ome n
Immun ol ogi ca lma rker soft umorgr owt h
Pne umope r
itone um,x- raye xa mi na ti
on
Que stNa me :A54ye arol dpa t
ientc ompl aine dofdi s comf orta ndpa ini nt hea na lc anal,inc re asingdur i nga nda ft
er
de fec ation,di s cha rgeoff reshbl ooda fterabowe lmove me nt.Whi cht estisne cessarya tf i
rs t,shoul dbepe r
for med
fort hi spa tien t:
Di gita le xa mi nationoft her ectum,a nos copy
Anos copy
Irrigogr a phy
Re c tos copy
Di gita le xa mi nationoft her ectum,a nos copy,r ec tosco py
Que stNa me :A60ye arol dpa t
ient ,whos uf fersf romd ive rt
icula rdis e aseoft hes igmoi dc ol on,ha dpr of useintesti
nal
ble edi ngf ort hel ast5mont hs.Appl iedr ese archme thods( rec t
os kopy,c olonos copy,i rrigigr aphy,a ngiogr aphy,
fibroga stroduode nos copy)di dn’ tf i
nda nyot he rpa t
hol ogyoft hega s trointestinaltr a
ct,whi chc oul dbet hec auseof
intes tinalbl ee ding.Wha ttreat
me nts houl dbea ppl i
e di nt hisc ase :
Exc isionofdi ve rti
c ula
Longi tudi na lmyot omy
Re se ctionoft hes i
gmoi dc olon
Obs erva tion
Ea tingf oodhi ghonf i
be rdiet,swe llingl axa ti
ve s
Que stNa me :A65ye arol dpa t
ientha sc onstipa tion,bl oa t i
ngs toma c h,pe r i
odicc r amping,a ndami xtureofbl oodin
thes tool .Af terc l
ea nsinge ne ma sort a kingl ax ative shenot e ss omei mpr ove me nt.Onpa lpa tionoft hea bdome nin
thel e ftilia cr e gionat umorf orma tionupt o6c mi nd iame t
e r,de nse ,a ndmobi leisde fine d.Wha ti syourdi agnosis
:
Spa s ticc ol itis
Sigmoi dc olonc anc er
Copr os tas ia
 24
Vol vul usofs igmoi dc olon
Not -s pe c i
ficul c
e rativec olitis
Que stNa me :Thepa tie ntc ompl ainsofr ecurre nta cutea bdomi na lpa i
n,vomi ting,l a ckofs t
ool.Int hec asehi story
per siste ntc ons tipationa rea ssoc iatedwi t
hdol ichos i
gmoi d,t ha twa sr a diologic a l
lydi a
gnos ed5ye a r
sa go.X- ra
y
exa mi na ti
ons howe dhi ghKl oibe r’sc upsi nt hel a
te r
a la bdomi na lpa r
ts,fluidmove me ntfr
omonel oopt oa nother;
colondr op.Wha ti syourd ia gnos is:
Me cha nica lo bstruc tionoft hec ol on
Ische mi ce nt eropa thy
Me cha nica lo bstruc tionoft hes ma llint es
tine
Dyna mi cc olonobs truc tion
Dyna mi ci nt esti
na lobs t
r uc ti
on
Que stNa me :A65ye arol dpa tienti shos pitalizedwi t
ha na cutea tta
ck-likepa i
ni nt hel eftabdome n,de la
ye d
disc ha rgeoff e c
e sa ndga ses.Dur i
ngt heye ar,Heha sbe e nnot i
c ingwe ight l
os s,f reque ntcons ti
pa ti
on,di sch ar
geof
sma lla mountofbl oodwi ths t
oolf ort hel astye a r
.Wha tist hemos tproba blec aus eofobs tructi
oni nt hepa t i
ent:
Di ve rticul iti
s
Sigmoi di t
is
Di ve rticul os i
s
Tumor
Ul ce rativec olitis
Que stNa me :A65ye arol dma nc ompl a i
nsofgr owi nga bdomi na lpainint hel owe rle f
ta bdome ns qua r
e,tha t
occ ur se ve ry3- 4hour sdur ingt hel a st3da ys.Hedoe sn’tha vena useaorvomi ting.Ane xami nat
ions howe ds oft
belly,s light lypa i
nf ulpa lpa bl ef orma tioni nthel e
f tingui na lre gion.Thenumbe rofl eukoc ytesis10, 000/mm3.
Amyl a sea c ti
vi t
yi nt henor ma lr a nge .Fe caloc cultbloodt e stisne gat
ive .Thet imeoft hepos tde feca t
ionis
unknown:
Abdomi na la or t
ica ne urys m
Pa nc re atiti
s
Me se nte rya rte r
yt hr ombos is
Stonei nt heki dne y
Col or e ctalc anc er
Que stNa me :Dur ingt hec ol onos c opyi na60ye arol dpa tientwa sremove dapol ypofs igmoi dc olona tadi s
tance
of35c mf romt hea nus .Hi stologi ca le xami na t
ionoft her emove dpolyponi tstopdi scoveredmi croinvasivec a ncer
,
buti nt heba seoft hepol ypc anc erc ellswe renotf ou nd.Wha tisyourt actics:
Se ndt oc he mot he rapy
Of fers igmoi dr ese ction
Se ndt or adiationt he ra py
Obs erva ti
oni nt hec l
ini c
Obs erva ti
onsi ne ndos c opi cof fi
c ewi thr epetitivee ndos c opye ve ry3mont hs.
Que stNa me :A58ye arol da ddr es sedt hephys ic i
anwi thc ompl aintsofs udde nbl oa ting,paini nthea bdome n,
per siste ntc ons tipation.Thepa tient'sc ondi ti
onde te r
io ratedove rthepa st2mont hs .Thepa ti
entre ceivesr egula r
laxa tive ,ma ke se ne ma s.Hi sa ppe ti
teha sdi sappe ared .Ats igmoi doscopypr oc tos copepus he dfor15c ma butson
thec ircul arna rr
owi ng;bi ops yi sdone .Wha ti syourpr eviousdi a gnosi
s :
Vol vul usofs igmoi dc olon
Ca nc e roft hes i
gmoi dc olon
Ca nc e roft her ec t
o-s igmoi dpa rtoft her ectum
Copr os ta si
a
Pol ypi na mp.oft her ec tum
Que stNa me :A45-ye a r-ol dpa tie nt,ha sbe e ne xpe rienc i
ngadul lpa i
ni nt her ightuppe rhypohondr ium,i nt hea rea
ofe pi g as t
rium,i tching,dys pe ptics ympt oms ,da r
kur inea ndf e ces,lackofa ppe tite ,signif
icantwe ightloss ,general
we a kne ss,f eve r
.Obj e c tive lythes ki na ndvi siblemuc ousa r
eye llowish.Pa l
pa tionoft heabdome ns howe d
pos itiv eCour voi s
ie r'
ss ympt om.Anul tra
sonog raphice xa mi na t
iondi dn’ tfindc onc ret
ionsi nthega l
lbladde rand
bileduc ts.Wh atist hemos tlike lydi a gnos i
s :
 25
Chr oni cpa nc re atitis
Chr oni cc hol angi tis
Chol e lithias i
s
Chr oni che pa titis
Ca nc eroft hehe a doft hep ancre as
Que s tNa me :A55ye a roldma l
ewi t
hs toma chc anc er,ha ds urgerya ndc he mot herapy1. 5ye ara go.Heha sbe en
not icinghe a vine s si nt herightuppe rhypohondr ium,na usea,bi t
terta st
ei nt hemout h,s ome time svo mi tingwi th
bile ,low- gr adef e ve rint hee veni ngf ort hela stthe4mont hs.Wi tht hehe lpoft heul t
ra soundmul tiplevol ume tri
c
for ma tioni nt hel i verwe rede t
ec ted.Ga llbladde ra ndpa nc r
ea sarenotc ha nge d.Prelimi na r
ydi agnos i
si sme tastat
ic
live rdi s ea se.De fini t
ionofwha ts ubs tanc ewi thther adioimmunoa ssayc anc onfirmt hisdi agnos is
:
Ins ulin
Ga strin
Thebe ta-2mi crogl obul in
CA- 19- 9
Pr ola ktin
Que s tNa me :A65ye a roldf e
ma lepa tients ufferedf roma na t
tackofi ntens epa ininther ighthypohondr ium,na usea,
repe a tedvomi ting.Af tertakingofa nt i
spa smodi c sthepa ina lmos tdis appe ared,butj aundi cea ppearedada yafter
thea ttac k.Th eur inebe cameda rk,a ndt hes tooli swhi te.Ane nlarged,t ens e,painfulga llbladderc anbepa l
pa t
ed.
Li ve r+3c m.Le ukoc yt e
s-10x10*9/l ,bi l
irubinl eve l-64mmol/l ,mos t
lys tra
ight.Wha tdiagnos isismos t
like lyt oma tc ht hi spi cture:
Chol e lithias i
s
Ci rrhos is
Vi ra lHe pa titis
He mol yt i
cj a undi c e
Ca nc eroft hehe a doft hep ancre as
Que s tNa me :A53ye a roldwoma nwa sdi agnos e
dwi t
hpr i
ma ryl i
ve rc ance r.Anoda ltumora bout7c mi ndi a
me t
er
int her ightha lf;i nc r
e asedbi li
rubi n( 38mmol/L) ,anda ct
ivea lkalinephos pha tase,fi
br inoge n;redu ct
ionofpr otein,
amode r atei nc rea seoft ransami na sel eve l,as ignificanti ncreas eofa lfafetopr otei
nofbl oodwe r
ef oundwi ththe
he lpofddi tiona lme thodsofe xa mi na ti
on.Forwha thistologica lf
or moft umora r
ec ha rac t
erist
icc hange sinbl ood
tests :
Undi f fere ntiatedc anc er
Ade noc a rcinoma
He pa toc ellula rc a nc er
Fa t-e pithe lialc e llsc anc er
Chol a ngi oc ellula rc anc e
r
Que s tNa me :A53ye a roldpa ti
e ntc ompl a inedofpa i
ni nt her i
ghthypohondr ium,we akne ss
,we ightloss ,lossof
appe tite,t empe r atur e38. 2int hee ve nings .Ane xa mi na t
ionr eve a
le de nlarge dundul atedl iver.X- raya nd
endos copi ce xa mi na tionoft hea bdomi na lc avitydi dn’ treve a
la nyt umor s.Wi ththehe lpoft heul trasoundaf i
re
of reduc e de choge nicityofi rregul ars ha pe ,size5х6c mwa sfoundi nl i
ve r.Wha tisthedi agnos i
s:
Pr ima ryl ive rc a nc er
Li ve ra bs c ess
Li ve rEc hi noc oc c us
Li ve rc irrhos is
Li ve rhe ma ngi oma
Que s tNa me :A55ye a roldpa ti
e ntha sbe ene xha usted ,ane mic,wi tht hepr e senceofs e ver ejaundicef ormo rethan3
mont hs .Heha sl os t18kg. Jaundi c ei sinc reas i
nggr adua ll
y.Abdome ni snots wollen,s oft,ands li
ght l
yt end erin
thee pi ga strium.Thel iverands ple ena renote nlarged,t hega llbladde risnotpa l
pable.Anx- raye xami na tionof
ga stro- inte stina ltr actr evealedade ployhor seshoeofduode num,c ir
c ularna rrowingofi t
sdownt urnde pa r
t ment .
Wha ti syourdi agnos is:
Ca nc eroft hega llbl adde r
Chr oni ci ndur ativepa ncreati
tis
 26
Ca nc eroft hehe adoft hep anc reas
Ca lculousc hol ec ys ti
tis
Ca nc eroft hea nt rum
Que s t
Na me :A55ye arol dma nha da na cut epa nc rea ti
tis4mont hsa go.Re centlydys pe pticdisor der sandj a
undi ce
havea ppe a red.I nt hel efts ectionofhypohondr iuma lmos tmove l
ess,pa lpa ble,pa inles s,smoot h,a nde la
sti
c
forma tioni spa lpa bl e.Se l
ec tthemos tlikelydi agnos is
:
Panc rea t
icc a nc er
Panc rea t
icps eudoc ys ts
Chr onicps e udot umor ouspa nc reatitis
Cys toft hel e ftlive rlobe
Para sit
icc ys toft hepa nc r
e as
Que s t
Na me :A55ye arol dpa tientA. ,ishos pitalize dwi tht hec l
inicaljaundi c e(bilirubi n192, 5-136, 5-
56).Ha sbe en
sickf or2we e ks,c ompl a i
nsofwe a kne ss,indi s pos ition.Pa ins yndr omei sa bs ent.Inf ectiouse tiologyofj aundiceis
exc l
ude d.Dur ingt hepa l
pa ti
onoft hea bdome na tKe r
’spoi nti snot i
cedde termi nedi nt ense,notpa infulga l
lbladder
bottom,s ympt omsofi rrit
ationoft hepe ritone uma r ea bs ent.St ooli sachol ic.As ma lla mountoff re eflui
di nthe
abdomi na lc a vityi sde termi neddur ingt hepe rcus sion.Suc hs ympt omsa ret ypi calfor :
Opi sthor chi as i
s
Chol elithia sis
Live re chinoc oc c us
Biliarydys kine s i
a
Panc rea t
icc a nc er
Que s t
Na me :A64ye arol dpa tient,c ompl a ine dofa ppe ar anc eofj aundic e
,s ki nitching,a ndl ossof8kg2we e
ks
ago.I nt her ightuppe rhypohondr iume lastic ,s lightlypa inf ul,ova lforma tionc a
nbepa lpated.Ge ne ra
lbilir
ubini s
268mmol/l( nor ma li s3, 4-22, 2mmol/l ),di r ect-196mmol/l( norma l0- 5,1mmol/l )
,ALT- 72I U/L( norma lis
7-53I U/l ),AST- 54I U/L( nor ma lis11- 47I U/l ),a l
ka linephos pha t
ase356I U/L( nor ma lis38- 126I U/l )
.The
urinei sofi nt ens eye l
lowc olor,a ndt hes tooli sdi sc olor ed.Wha ti syourpr elimina rydi agnos i
s :
Ca nc eroft hehe adoft hep anc reas
Bot kin'sdi s ea se
Tumoroft hega llbl adde r
Hydr opsoft hega llbladde r
Me ta st
a sesi nl ymphnode soft hepor t
alfis sur e
Que s t
Na me :A49ye arol dpa tientc ont actedadoc torwi thc ompl a
intsofj aundi c
ef or3we eks,itchi ng,lossof6kg.
Live rbor de rsbyKur lov15x12x10c m,l i
ve re dgei ss light lyr ounde d,unde rt hee dgeofc os ta
ll obeoft heliver
ti
ghte lastic,ma lobol i
cf orma tionofova ls ha pet o7x4c mi spa lpable.Stooli sclay- gra y.Tot albi li
rubin-2 56mg/
dL,di re ct-96mmol/l ,coa gul ationf or7mi nut e s.Wha ti syourdi agnosis :
Hydr opsofga llbla dde r
Tumoroft hega llbl adde r
Bot kin'sdi s ea se
Tumorofpa nc rea ti
c -duode na lz one
Tumororc ys toft her ighthe pa ti
cl obe
Que s t
Na me :Ina67ye a rol dpa ti
enta nultra sounde xa mi nationr eve al
edal ive rtumor .Pr eli
mi na rydi agnosisis
canc eroft hel ive r.Wha tme thodc anobt ainmor phol ogi c alve r
ifi
c ati
onoft hedi agnos is:
Ne edlebi ops yoft hel ive rtumorunde rul t
r asoundc ontr ol
Ne edlebi ops y
Endos copi cr e trogr a depa nc reatic-c hol angiogr aphy
Ra dion ucli del ive rs can
He pa t
ica ngi ogr a phy
Que s t
Na me :A49ye arol dpa tientha sbe ens uf f
e ri
ngf roma ppetit
el ossfora boutamont h,a nddul lpa i
ni nther i
ght
hypohondr iuma ftere a ting,ye llowne ssofs ki n,da r ku rine .Obj ecti
ve l
ys kin,s cleras ubi creti
c,s toma chi spainful
inthee piga strica re a,l iveri sne art hec os t
a la rc h,de nsebutnotpa inful.Bi li
rubi nl eve lis52mmol/l ,increasedto
conj uga t
e d,ma rke rsofvi ralhe patitiswe renotf ound.Wha ti syourpr el
imi na rydi agnos is
:
 27
Canc e roft hega l
lbladde r
Chol elithiasis
Live rc anc er
Chr onica ctivehe pa t
itis
Canc e roft hehe a
doft hep ancreas
Que stNa me :Wha tonc oma r
kersa reusedtodiagnoselivercancer:
CA- 125
CEA
CA- 15B
Alpha -
fe t
opr ot ein
Donotc hoos et hisone
Que stNa me :A49- yea r
-ol dpati
e ntcontact
edthene urol
ogistatthepolycli
nicaboutthepai
ninthelumba rspi
ne,
whi chi ntens ifiedi nthes up i
nepos it
ion,especi
allyatnight.Duringa natt
ackofpa i
nthepati
enti
stakingaf or
ced
position,l ea ningf orwa rd,c l
utchingapi l
lowtohi ss t
oma ch.Inthisposit
ion,t
hepa i
ngradual
lysubsi
de s
.Overthe
past2mont hs ,thepa ti
e nthaslos t12kg.Wha tisyourdi agnosis:
Live rtumor s
Panc rea t
itis
Tumoroft hepa nc r
ea s
Oste ochondr os is
Ulc erofduode num
Que stNa me :Whi chlive rtumorsbe l
ongtobe ni
gn:
Car cinos arcoma
Chol an gioc arc i
noma
Ha ma rtoma
Ade noc a r
c inoma
He pa t
oc ellula rc a
rc i
noma
Que stNa me :Wh atisthec l
ini
cals ymptomc har
acteri
sti
cf ordif
fusema st
opathy:
Blo odyd isch argef ro
mt hen i
pple
Ass ymme t
ryo ft hema mma ryg l
a nd
Gre end isch ar gefro mth en ip
ple
Mi croc rackso na reola
Paini nt hema mma ryg landb ef
o reme ns
truat
ion
Que stNa me :Wh atisthemo stco mmo nlocali
zat
iono ftheb r
eastcancerofnodularf
orm:
Up pe rinn erq uadrant
Nip plea nda reo l
a
Up pe ro uterq uadrant
Tran sit
io nalf old
Lowe r-inne rq ua d
ra nt
Que stNa me :Wh atresea rchshouldb eapplie
dinth epresenceofd i
scharg
ef romthenippl
e:
Palpa ti
o nint hes upinep o si
ti
on+wi thoutcont
rastma mmo graphy
Ne edleb i
o psy+p neumo cyst
ogra phy
Cy tolog yd isc harge+d uc t
ograph y
Cy tolog yd isc harge+p ne umocy st
ography
Donotc hoos et hisone
Que stNa me :Ina n1 8y ea roldgirlintherightbr
eastun de
ra re
olac anbepalpate
dd en
semo bi
lenodeupt o1c min
diame ter, wi thc le
a rcon tours
,no tfixe
dtot hesur
round i
ngt i
ssues.Shefoundithers
elfbyaccid
entwhil
et aki
nga
showe r.Wh a tisthep reliminaryd iagnos
is:
Bre astlipo ma
Fibro ade nomao ftheb rea s
t
Bre astc ysts
Int
ra du ctalp ap i
llomao ftheb r
ea st
 28
Breastcancer
Que s
tNa me :Wh icho fth eselis
te deffectsarerelat
edtoa ro mataseinhibi
tor
s:
Dec r
easeint hec oncen trat
iono fe st
rogeni ntheb l
o odan dint hetumo r
In
h ib
iti
ono fg o nad otropins ecretion
Blockingo fthet umo rh ormo ner eceptors
Dep r
essi
o no fa dren oco rt
icotropich or
mo nesecret
ion
Dec r
easeint hec oncen trat
iono fp rola
c t
ininth eblood
Que s
tNa me :Wh atgro upo flymp hn odesi nc
ludeZo rhius’n ode:
Parast
ernally mp hn o de s
Frontbreastn od es
Axill
aryly mp hn odes
In
terpectoraln od es
Subclavi
a nly mp hn o de s
Que s
tNa me :A5 6y earo ldp ati
e nthadar adi
calma stect
o my .Finalhis
tolo
g i
calres
po nsewa s
:lowd i
fferent
iat
ed
br
e as
tc a
n cer,me t
a st
a sesina xillar
yl ymp hn odes.Wh atisthef urt
herma nageme n
to ft
h epati
ent:
Hormo nethera py
Adjuvantc hemo radiatiothe r
apywi t
himmu notherapy
Adjuvantc hemo therap ywi t
hh ormo neth er
apy
Postoper
a t
iver a di
o t
h erap y
Adjuvantc hemo radiatiothe r
apywi t
hh ormo netherapy
Que s
tNa me :Spe cifyth ec orrectsequen ceofd i
ag nost
icp r
o ceduresforscr
ee n
ingforb r
eastcancer:
Cli
n i
calbrea ste xams ,s el
fe xam, ul
tra
s ound,ma mmo gr
a phy
Selfexam, ma mmo grap hy ,cl
inicalexa minati
on
Ma mmo grap hy ,selfe xam, cl
inicalexami nati
on
Selfexam, ultrasou nd, ma mmo graph y,clin
icalexamin ati
on
Selfexam, clinicale xami n at
ion ,ma mmo gr
aphy
Que s
tNa me :Wh atan atomi calstructur
est ober emo vedd urin
gPa t
ey’ssurger
y:
Breast,l
argea n ds ma llp ector
almu scl
e s,axi
llary,subcl
a vian,l
y m.n .
Breast,s
ma llp ec t
o r
almu s cl
e,a xil
lary,subclavian
, s
u bscapularlym. n.
Qua dr
anto fth eb reast,a xil
lary,subc l
avian,subscapularly mn odes
Breastwithr ibf asciaa ndp a
rasternallymp hn odes
Add i
tionalsliceso fth eb reastan dax i
ll
a rylymp hn o
d es
Que s
tNa me :A6 0y earo ldp ati
e ntinme n opause.3mo n thsagod isc
o ver
edb re
astlumpi ntheleftb r
east,whichdoes
notbotherh er.Sh ed idn ’ta ppl
yf orme d i
c a
ltreat
me ntorme dicalcare
.Ob jec
tivel
yinth euppero uterquadrantoft
he
l
eftbreastpa lpationi sn otc l
ear,v aguen eoplas
m, wh ichd imensionsa r
ediffi
cultt
od et
e r
mineb ec au
s eofvagueness
anda mbiguityo fthec o ntours.Th elastg r
aduallytrans
fo r
mei nt
on ormaltiss
uec a
nce r
.Inthelefts u
b in
g ui
nalarea
enl
a r
gedl ymp hn ode swe rerevea l
ed.Ne edleb i
opsyr evealedca nce
rc el
ls
. Youmu stde t
ermineth emo steff
ecti
ve
t
reatmentt acti
c s:
Adjuvantma intena ncec h emo t
h erapyan dHTT+r adicalma ste
ctomy
Neo a
d j
uva ntma i
n t
en anc echemo t
h er
ap y+HTT+r adicalma stect
omy
Adjuvantc hemo therap y+ma s
tec t
omya ccordingtoPa tey ’
sme t
hod
Rad i
calma stecto my+h ormo net herapywi thtamo xif
en
HTT+a d j
u van tradica lma stectomy
Que s
tNa me :A4 4y earo ldp ati
e ntcomp lainsofp ai
n,thep resenceo falumpa ndincreaseinsizeo ftherightbre
ast.
Objecti
velyt her i
g htb reastiss wollen,flushed,thenippleisthickeneda ndsucked.Fuzz ypai
nfu linfi
lt
rati
onc a
nb e
pal
p at
ed,wh icho ccu piest helowe rq uadrant
s:
Chronicma s t
itisc ase
Right-a
cu t
ema s ti
tis
Sarcomao ft her ightb reast
Tub e
rculosiso fth erigh tb re
ast
Edema tousin fi
ltrati
v ec arcinomao fther i
ghtb r
east
 29
Que s
tNa me :A2 9y earoldwo ma nc amet othed i
stri
c tp ol
y cli
nicwithc omplai
ntso fdrya n
dwe e pi
ngc r
ustsint he
peri
pap i
llaryar eao ntheleft,redne ssa n
dt hi
cke n
ingo fthen ipple
.Ly mp hnodeo f1 .
5c misp al
p abl
einthe
subin
g uinalare a.Wh atisth emo s
tp robablediagno s
is:
Breastcan cer
Leftnipplee czema
Ch r
onicma st
itiso ntheleft
Aller
g i
cd e r
ma titi
s
Lymp h omao ft hel ef
tb r
ea st
Que s
tNa me :A4 8y earoldwo ma nf oundint herightb reastalump ,wh ic
hd oesno tbringanyd i
scomf o
rt.Shec amet o
t
h edoc t
ora ft
er3mo nthsd uetot hei ncre
asedma s
s .Ane xami nat
ions h
owe dthatthet u
mo risden s
e2 .
5x3c m,
clea
rlyp alpablei ntheh ori
z ontalpo si
tion,withoutclea rbou ndari
es,notp a
inful
,wi thskinandn i
p pl
eisno tco n
ne c
ted
.
Inther i
gh tsubin guin
a lareatherei sa nenlarg
e dlymp hn ode2c m, ofthickconsi
sten cy.Wh a
tisy ourdi
ag nosis:
Breastcy s
t
Breastcan cer
Ch r
onicma st
itis
Fibro
a deno mao ftheb re
ast
Fibro
-c yst
icb reastd i
sease
Que s
tNa me :A4 2y earoldf emalec o mp l
aint
so fthep resenc eoflesi
o ninthelef
tb reast
.Sh edis
co ve
redit2mo nths
ago.Inth eleftsu binguinalarea, t
hel ymp hn odeoftig htela s
ti
cc onsis
tencycanb ep alpat
ed,to1.5cmi nd iame t
er.I
n
t
h eupp er-
o ut
e rq uadrantofth eleftb rea
stthereisad e nselu mpys welli
nga ss
ociat
e dwi t
hs ki
n3 x4cmi ns iz
e .Wh at
i
sy ourd iagnos i
s:
Breastcan cer
Cy s
to ftheleftb reast
Ma st
iti
s
No da
lma stopathy
Fibro
a deno mao ftheb re
ast
Que s
tNa me :A7 5y earoldf emalet urnedtot hecan c
e rd i
sp ensa
ryc l
iniccomp l
ainingo flongnot-heal
ingu l
ce rofthe
l
e f
tbreasta ndt hep resenceo fde n
s e,mo bil
en odesint h eleftarmpit
. Thed oc
torma d e​
ad i
agnosis-cancero fthelef
t
breas
twi thu l
c erati
o n,st
ag eIV. Wh ichofthes t
udiesme ntionedb el
o wtob edonet oresolvetheissueofma stect
o my:
Ultr
aso und
Thermo gra phy
Ma mmo graphy
Palpat
ion
Mo rpholog i
cal( cytol
o gi
cala ndh istologi
cal)
Que s
tNa me :A7 0-year-ol
dwo ma nh a sundergoner adicalma s
tect
omyf orbre
astca r
c i
nomap T2 N2M0 G3 ,ER( –).
Theb estch oi
c eo fadjuvan ttrea
tme n two ul
db e:
Ad j
uva ntc h
emo therapy
Ad j
uva ntradiationtherapy
Ho r
mo no t
h er
a py
Biotherapy
Foll
owu p
Que s
tNa me :Wh ichfactoris 
p ro
mi n entforthed evel
o pme n tof 
breastcancer
:
Highle vel e
strog ene
Smo king
Ob es
ity
Poll
utiono fen vironme nt
Usingo fc ontr
a ception
Que s
tNa me :Wh atisthelev elofinc i
d ent
so fbreastcan cerinUk r
aine:
1–1 0,0o /oooo
11-2 0,0o /ooo o
21-3 0,0o /ooo o
 30
31-40 ,
0o /o
ooo
41-50 ,
0o /o
ooo
Quest
Na me :
Wh atdo esTruasi
e’sme t
ast
asismea n
:
Metast
a s
isinli
ver 
Metast
a s
isinovary
Tumor’sd epos
iti
nDu glas’
spouch
Metast
a s
isinnavel
Metast
a s
isinsupracl
a vi
cular
eslymp ha
ti
cn odes
Quest
Na me :
Wh ichp l
aceisb r
eastcance
rtakesins t
ruc
tureo fgen
e r
ali n
cidenc
ema l
ign
anttumorsinUkra
ine:
Fi
rst
Second
Thir
d
Four
th
Fi
fth
Quest
Na me :
Wh icho fthefol
lowinganatomys t
ructur
esistargetnumb eroneformet
asta
sisofbr
eastca
ncer:
Lymphn o de
s
Lung
Scel
eton
Live
r 
Ovary
Quest
Na me :
Wh atdo esPaget’
sca nc
erme an:
Lobul
a rcarc
inomao fb re
ast
Cancerofthen i
pple
In
tra
du ct
alcancerofb rea
st
Extr
adu c
talcancerofb r
east
In
fla
mma tor
yc ance
ro fbreast
Quest
Na me :
Awo ma n6 0-
year-
oldwithab re
astcancerT1 N0 M0.Th eb e
stchoi
ceoftr
eat
h men
two ul
d be
:
Radi
calma stec
tomy
Radi
cal quadr
antect
omy
Ovari
ec t
omy
Amp ut
a t
ionofb r
east
Sect
oralresec
tion
Quest
Na me :
Th ewo ma n60-year
-old,pr
esent
swi t
hp al
pablet umorinl e
ftbre
ast.
Diagnos
isunknown.
Wh ic
hme t
hod
i
sd i
st
inguishedforco nf
irmati
ono fbre
astcancer:
Mammo graphy
Ult
rasaundexamin a
tion
Exci
sionb i
opsy
In
cisi
onb iopsy
Fi
nen eedlebiops
y
Quest
Na me :
Wh ichco untr
yh a
sth ehi
ghestle
ve lofinc
idenceo fbr
eas tcan
cer:
Ukrai
ne
Fra
nce
USA
Aust
ralia
Ja
pan
Quest
Na me :
Wh ichco untr
yh a
sth el
owe s
tlevelofinci
denc eofbreastcancer
:
Ukrai
ne
Fra
nce
USA
Aust
ralia
Ja
pan
 31
Que s tNa me :Wh ic ho fth ef oll
owi ngs tateme ntsisc orrectr egard in gtrea tme nto fe arlys t
a geb reastc ancer:
Ma ste cto myh a ss h ownab e t
tersu rvi
v alc omp aredwi t
hb re astc on serva tives urge rya ndr ad ia
tiont herapy
Adj uva nthor monet he rapyi nER/ PRne ga t
ivebr e astcanc err educ est her i
skofr ecur rence
Axi llaryl ymp hnodea ssess me ntisimpor tantt ogui dea dj uva ntt he rapy
Adj uva ntt r
a stuz uma br edu cesbr eastc anc ermor talityirrespe ctiveoft umorHER2pr ote i
ns tatus
Donotc hoos et hi sone
Que s tNa me :Ama rkerofi ncrea s
e driskofi nva sivebr eas tcanc e ri ne ithe rbre ast:
Duc ta lc a rcinomai ns itu
Page t’sdi sea se
Lobul arc a rcinomai ns itu
Duc ta le c tas i
a
Int
ra duc ta lpa pi lloma
Que s tNa me :Mos tf reque ntc aus eofbl oodyni ppledi scha rgewi thouta na ssoc i
a tedma ssbye xa mi nat
ion:
Duc ta le c tas i
a
Int
ra duc ta lpa pi lloma
Brea stc anc er
Duc ta lc a rcinomai ns itu
Phyl loide st umor
Que s tNa me :A24ye aroldwoma npr ese ntswi t
ha ni solated1. 5c mbr ea stma ss .Thena t
ur eoft hema ssisunc lear
atthet imeofe xa mi na t
ion.Whi choft hef ollowi ngi sthemos tr e asona blene xts tep:
Ma mmogr aphy
MRI
Ultra soundoft hema ss
Ope nbi ops y
Donotc hoos et hi sone
Que s tNa me :Ina45-ye ar-oldpa tientwhos moke sa ndof te ns uff ersfr ompne umoni adur ingage ne r
alradio graphy
ofthec he s tint her ightl un gwa sfoundat riangul areclips ewi tht hea pe xdi rec tedt other ootoft helunga ndt he
shi
f tings ha dowsoft hehe arta ndme dias t
inumt owa rdde struc tion.Wha tisthemos tli
ke lydi agnos i
s:
Pulmona rya telec tasis
Perife rall ungc a nc er
Lunga bs ces s
Cent ra ll ungc anc e r
Lungc ys t
Que s tNa me :A65-ye a r-
ol dpa tientcompl a i
nsofc onstantmi ldpa ini nbot hhi ps ,legs,hi pa ndkne ejoint
s .First
paina ttac hhef e ltpa in2mont hsa go.Hewa strea t
e dwi tha na lge sicst ha treli
e ve dpa inf or3- 5hour s.Obj ec t
ive
exami na tionoft hel owe re xtremitiesdi dn’ tfinda ppa rentpa thol ogy.Lungx- ra ysr evea ledpe riphe r
alseala round5
cmi ngr e a t
e stdi me nsionwi thoutc learc ont ourswi ththepa tht ot her ootf romt hel e f
t.Wha ti smos tlikelyt oc a
use
suchpa ini nt hel owe re xtre mitiesoft hepa tient:
Oste oa rthr i
tis
Age -r ela tedc ha nge s
Para ne opl astics yndr ome
Neur ol ogi ca ldi sea se
We a the rorc os mi cimpa ct
Que s tNa me :A57-ye a r-
ol dpa tientishos pitalizedi ntotheonc oc linicwi thc ompl aintsofwe akness ,
dryc ough.
Obj ec tivee xa mi na ti
onr e ve al
ednopa thol ogy.The r
ea ref eatur esofc e ntralc anc eront hel eftsidea tthera diograph
ofthec he s t.Endos copi ce xami na t
ions howe dtha tthele ftc ente rbr onc husi sna rrowe dbyha lf,flushed,mu cous
me mbr a nei si nfiltra t
ed,a nde dema tous .Lowe rma inont hel e fta ndr ight -sidedbr onc hia rewi thouts evere
pathol ogi e s.Hi stol ogic alstudyofbi ops yma terialreveale doa t
- celllungc anc er.De te
rmi net heopt i
ma lme dica l
tac
tic s:
Radi c als ur ge rya nda djuva ntc hemot he rapy+HTT(He ma toge ni cTi s sueTr ans plantation)
Left-s ideuppe rl obe ctomya nda djuva ntma i
nt enanc eche mot he rapy
 32
Ne oa djuva ntc he mot he rapya ndr a dicals ur ge ry+HTT
Ra dic als ur ge ry+ma inte nanc ec he mot he rapy
Lef t
-s i
deuppe rl obe ct omy
Que s tNa me :Int he rapyde pa rtme ntwa shos pi t
a li
z edapa tientswi t
hc ompl a i
ntsofi ntermi t
te ntincreasingpa i
nin
thel efts ideoft hec he st,dr yc ough,l ossofa ppe t
ite,we a kne ss,we ightl os s,pe r
iodi cs we ating.Heh asbe ens i
ckfor
about4mont hs .Punc tur eofpl e ur alcavi tyf orf ourt ime ss howe d1500- 2500mloff lui
dwi thoutbl oodi mpur i
ti
es.
Obj ec t
ive lyt hel eftha lfoft hec he stisbe hindi nbr ea t
hi ng,a tt hes ames pothe r
eont hele f
tadul lsoundi she ar
d
duringpe rc us sion.Aus cul tati
ons howe dt hebr eathingi sba r
e lya udible.Punc tureoft hel eftpl e
ur a
lc avityrecei
ved
2000mloft rans pa r
e ntye llowi shl iquid.Wha tdi sea sewi llgi vet hisc li
nic alpicturemor eof ten:
Me di ast ina lt umor
Pleur alme s ot he lioma
Pulmona ryt ube rcul os is
Lungc a nc e r
Ac utepne umoni a
Que s tNa me :A50- ye ar-ol dpa ti
e ntwa sdi agnos edwi thc a ncerofpe riphe raluppe rlobeoft her i
ghtlungT2N1M0.
His t
ol ogi c a llyi ti shor nys qua mousc ellc a r
c inoma .Conc omi tantdi s
e aseswe ref ound.Wha tme thodoft r
eatment
shoul dbeus e d:
Ga mmat he rapy+l obe ctomy
Ga mma - the ra py+c he mot he r
a py
Lobe ctomy
Pulmone ctomy
Preope ra tiveg amma -the rapy+pul mone ctomy
Que s tNa me :A60- ye ar-ol df ema lea gainstaba c kgr oundofc ompl et
ehe altha trests udde nlys t
artedcoughi ng,and
coughe dupas ma l
lbl oodc lot.Anobj ec t
ivee xa mi na t
iondi dn’ treve alanypa t
hol ogi calcha nge s.Wha tdi a
gnosti
c
me as ure ss houl dbeunde r t
ake nf irst:
X-r ayoft hec he st
CToft hor a cicor gans
Fluor ogr aphyoft hec he st
Bronc hos copy
Ana lys isofphl egmona typi c
a lc e ll
sa ndKoc hba cte ria
Que s tNa me :A67-ye a r-ol dpa t
ie nti scompl ai ningofs hor tnes sofbr ea t
h,c he stpa in,f e
ve r,c oughwi thpur ulent
sputum.Dur ingt hea us c ultationi nt her ightl ungi sf elts harp,we ake nedbr eathing,i nt helowe rdivisi
onsi tc a
n
hardl yl is ten.Anx- ra ysoft hel ungsi ndi recta ndl a t
e ralpr oje cti
onsi sr educ edt rans parenc y,r e
duc ti
onoft he
volumeoft hel owe ra ndmi ddlel obe soft her i
ghtl un g,me dia sti
na lshiftt other ight .Wha tdi seasecanbe
suspe cte d:
Me di ast ina lt umor
Chr oni cpne umoni a
Ac utepne umoni a
Ce ntralc a nc e roft her ightl ung
Tube rcul os isoft her ightl ung
Que s tNa me :A50- ye ar-ol dpa ti
e ntwa sde live redt ot hes ur gica ldepa rtme ntwi the de maa ndc yanosisoff aceand
uppe re xtr emi ties .Thepa tients moke s,ha sbe endi a gnos edwi thc ance r
sofuppe r-lobeoft her i
ghtlung.
Compl aint soft hepa tient arei nte ns ehe ada c he ,na us ea ,vomi ting,pr esenc eof' 've il
''inf r
ontoft hee yes .Makea
diagnos isa nda ss ignt hea ppropr iatetre atme nt:
Lungr es ec tion
Punc tu reofpe rica rdium
Ra diothe ra py
Thr ombe c tomy
Dra ina geoft hea bdomi na lc a
vi ty
Que s tNa me :Ina60- ye a r-oldpa tie ntdur ingt heX- raye xa mina tionwa sobs ervedi nhomoge ne ouse cl
ips eatthe
bottomoft her ightl ung.He mopt ys iswa sobs ervedt wi ce .Br onc hoscopys howe dc ompr essi onont heout si
deoft he
 33
righti nterloba lbr onc hus .Wha ti syourdi agnos is:
Fibr osis
Ca nc eroft her i
ghtl ung
Tube rculos is
Ri ght -
side dpne umoni a
Chr oni cobs tr
uc ti
vebr onc hi t
is
Que stNa me :
Dur ingt hee xa mi ni nga49- year-oldpa t
ientwa sdiagnos edt her ightlungc a
nce rII
As tage.
Wha t
combi nationofTNM c orrespondst ot hissta ge:
T1N1M0
T2N2M0
T1N2M0
T2NXM0
T2N0M0
Que stNa me :
A40-ye ar-oldpa t
ie ntwa sde l
ive r
e dtot hes ur gica
lde partme ntwithhe mopt ysis,andcontinuo us
strainedc ough.I nt hec linict hepa ti
e ntwa sa ssigne dcode inea ndbe dr egi me n,andwhi chc oughpas s
ed,a ndt he
ble edings toppe d.Whi c hoft hef ollowi ngpr oce duress houl dbepe rforme da tthemome nt:
Bi ops yofc ervica llymphnode s
Thor acosc opy
Br onc hos copy
Br onhogr aphy
Endot rache alintuba t
iona ndve ntilation
Que stNa me :
Int hepa tientwa sr e ve aledi nfil
tr a
tives hadowi ntherightl unga tthele ve lofthe4t hri
bdur ingt he
fluor ography.Thepa ti
e ntha snoc ompl aints.Toc lari
fyt hena t
ureoft hel esi
onwa sc onducteda naddit
iona l
exa mi nation.Ont hel at
e ralra diogr a phoft hec he stthea bnor malshadowt akesat riangul arshapea ndcor r
es ponds
tot he6t hs egme ntr e duc edi nvol ume .OnCTs c anreve aledbr onchibr ea kage (
"cult") .Wha tisyourdi a
gnos is:
Ce nt ra
llungc anc er
Loba rpne umoni a
Pe riphe r
a llungc anc e r
Pul mona rye mbol ism
Pul mona ryt ube rculos isint hepha s eofi nfi
ltration
Que stNa me :
A60- yea r
-ol dpa tientc ompl ai
ne dofs hortnessofbr eath,low- gradef eve r,coughwi t
hmi xtureofbl ood.
Af terac our seofa ntibiotict he rapyhi sc onditioni mpr ove d,howe ve r
,t heX- raytha tde scri
be stheradic
a lec li
psein
ther ightl ung ,ha snotc hange d.Wha tdi seases houl dwet hinkof :
Ce nt ra
llungc anc er
Pne umoni a
Pul mona ryt ube rculos is
ARD
Exa c erbationofc hr oni cbr onc hitis
Que stNa me :
A60- yea r
-ol dpa tientc ompl ai
ne dofs hortnessofbr eath,low- gradef eve r,coughwi t
hmi xtureofbl ood.
Af terac our seofa ntibiotict he rapyc ondi t
iont hei mpr ove d,howe ve r,theX- raypi ctur ethatdescri
besther a dica
l
ec l
ips eint her ightl ung,ha snotc ha nge d.Wha tresearc hs houldbec onduc t
ed:
Punc ture
Br onc hos copy
Ge ne ralbl oodt e st
CTs can
Ba cte r
iologi cale xa mi na t
ionofs put um
Que stNa me :
A52- yea r
-ol dpa tientM. ,wa sdi agnos edwi t
hl ungcance rofI I
IBs t
a ge ,T3N2M0.Che mot hera pywas
orde red.Wha thi stologi cva ria ntofl ungc anc eri sthemos ts ensi
ti
vet oc he mothera py:
Squa mousc ell
La rgec e
ll
Sma llc e
l l
 34
Ade noc arc inoma
Ac ombi na tionofs ma ll-ands qua mousc el
l
Que stNa me :Whi c hpl acei slungc a nc e rs i
tuatedins t
ructureofi ncidencema li
gnanttumor sinUkraine:
First
Sec ond
Thi rd
Four th
Fifth
Que stNa me :Choos emor ehi ghr iskf ac torofd e
ve l
opme ntofl ungc anc er
:
He re dity
Chr oni cobs truc t
ivepul mona r
ydi sea s e
Smoki ng
Sca rsi nt hel ung
Tube rculos is
Que stNa me :Ifc anc erde velopedi nt hel obula rbronc hus.Choos ethec orr
e ctdia
gnosis:
Penc ost’sc anc er 
Page t’sca nc e r 
Ce ntr al 
br onc hoge nicc a rci
noma
Periphe r
a lbr onc hoge nicc arci
noma
Me di a st
ina lf o rmofl ungc ance r
Que stNa me :Ifc anc erde velopedi nt hel obula rbronc hus.Choos ethec orr
e ctdia
gnosis:
Penc ost’sc anc er 
Page t’sca nc e r 
Ce ntr al 
br onc hoge nicc a rci
noma
Periphe r
a lbr onc hoge nicc arci
noma
Me di a st
ina lf o rmofl ungc ance r
Que stNa me :APa ti
e nt66- ye ar
-ol dc ompl ianceonpa i
ni nrights upraclavicular
esregion,c ough,
shoul de r 
 pa in, pa r
as t
he sia,
 we akne ss  of arm. Ptosis, 
mi osi
s, enopht a
lmus  was r
evealed at 
on ti
meexaminat
ion.
Choos ethec orrec t
 diagnos is:
Penc ost’sc anc er
Page t’sca nc e r 
Ce ntr albr onc hoge nicc a rci
noma
Periphe r
a lbr onc hoge nicc arci
noma
Me di a st
ina lf o rmofl ungc ance r
Que stNa me :Thema n67- year-old,wa sa dmittedwi t
hr eccurentobs tr
uc t
ivepne umoni a.Hec omplai
ned
of  
pe rsi
ste ntc ough,  hemop tysis, expe ctora t
ionofs putum,e xertionaldys pnea,decre
a seda ppet
it
e.Choosethemost
proba bledi a gnos is
:
Chr oni cobs truc t
ive  
pulmona r
y di sea s e
Chr oni cf ibr os i
soft hel ung
Periphe r
a lbr onc hoge nicc arci
noma
Ce ntr al 
br onc hoge nic  
ca rci
noma
Penc ost’sc anc er
Que stNa me :Thema n63- year-old,wa sa dmittedtot hehos pital.Hec ompl ai
nedofpe rsist
e nt
cough, hemopt ys is,
 expe c t
ora t
ionof  s put um, exertional dyspne a,
 decreased appet
ite
. 
Themos t
approp
riat
etestf
or
conf irma tionc entralbr onc hoge nicc a rcinomawoul dbe :
Compu t
edt omogr aphys canoft hor a x c avity
Bronc hos c opywi thbi ops y
X-Ra ye xa mi na tionoft hora xc avity
Bronc hogr aphy  with cont rast 
me dium
Cyt ol ogyce xa mi nationoft hes put um
Que stNa me :Choos ethemo stproba bl et estfordi agnos ti
cpe ri
phe ralbronc hogeni
cc arcinoma :
 35
Spirogr aphy
Bronc hos copy  withbi opsy
X- Raye xami nationof  t
hor axc avity
Bronc hogr aphy  with 
c ontras t
 me dium
Cyt ologyce xa mi nati
onoft hes put um
Que stNa me :Lungc anc erisl e
sst he n3c mindi ame ter.Whi choneoft hefollowi ngs ignsi s
corres
pondingthis:
T1
T2
T3
T4
T0
Que stNa me :Thet umorofl ungc a ncerinvadesvi sceralpleura.Whi c honeoft hef ollowi ngsignsisc
orres
ponding
this:
T1
T2
T3
T4
T0
Que stNa me :Thet umorofl ungc a ncer 
invadesoe sopha geus.Whi choneoft hef ollowi ngs i
gnsiscorr
espondingthi
s:
T1
T2
T3
T4
T0
Que stNa me :Thema l
igna ntc el
lsde t
erminate
di ns putumorbr onc hialwa shings,but  tumourc annotbevisual
izedby
ima gingorbr onc hoscopy. Whi choneof  t
hefollowi ngs i
gnsi sc orr
e spondingt his:
T1
T2
T3
T4
Tx
Que stNa me :Thepa ti
ent58- year-oldwi thgoodge neralconditionsha spe ri
phe ralbr onc hogeniccarc
inomai nupper
louber ightl ungT2N0M0.Thebe stchoiceofs urgicaltreatme ntwoul dbe :
Lobe ctomy( resec t
ionofal oube )
Segme ntec t
omy
Pne umone ctomy
Pne umone ctomywi thl i
mphodi ss ecti
on
We dger esectionoft hel obe
Que stNa me :ASmoke r58- ye ar-
ol dwi thgoodge neralconditi
onsha sc ent
ralbr onc hoge niccarci
nomai nlower
loubel eftlungT3N1M0.Thebe s tchoiceofsu rgicaltreat
me ntwoul dbe :
Lobe ctomy( resec t
ionofal oube )
Segme ntec t
omy
Pne umone ctomy
Pne umone ctomywi th li
mphodi ss ecti
on
We dger esectionoft hel obe
Que stNa me :Choos et hene c essa
ryc hemotherape uti
cme dici
nef orc hemot herapyl ungc ancer:
Platinc ontaininga gent
Ant it
umour sa nti
biotic
Ant ime tabolit
sa gent
Alkyl atinga gent
Hor monot herapy