Billy Step 1 Questions # 26 - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-13-2012
billy's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 444
Threads: 109
Thanked 369 Times in 208 Posts
Reputation: 379
Arrow Billy Step 1 Questions # 26

An 85-year-old man comes to the physician because he had experienced urinary hesitancy and nocturia for the past
year. He has had increasing back pain for the past 6 months. On digital rectal examination, there is a hard, irregular
prostate gland. A bone scan shows increased areas of uptake in the thoracic and lumbar vertebrae. Laboratory studies
show a serum alkaline phosphatase level of 300 U/L, serum prostatic acid phosphatase level of 8 ng/mL, and serum
prostate-specific antigen (PSA) level of 72 ng/mL. The blood urea nitrogen concentration is 44 mg/dL, and the serum
creatinine level is 3.8 mg/dL. Transrectal biopsy specimens of all lobes of the prostate are obtained. Microscopic
examination shows that more than 90% of the tissue has a pattern of cords and sheets of cells with hyperchromatic
pleomorphic nuclei, prominent nuclei, and scant cytoplasm. Which of the following is the best classification for this patient's
disease?


Stage Gleason grade
□ (A) A1 1, 1
□ (B) A2 1, 2
□ (C) B1 2, 3
□ (D) B2 3, 3
□ (E) C1 3, 4
□ (F) C2 4, 4
□ (G) D1 4, 5
□ (H) D2 5, 5
Reply With Quote Quick reply to this message



  #2  
Old 10-13-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 307
Threads: 36
Thanked 127 Times in 61 Posts
Reputation: 137
Default


Pure guess work. Dissemination to kidney and verterbra, so I'll choose the highest score on the scale? So will go with H.
Reply With Quote Quick reply to this message
  #3  
Old 10-13-2012
billy's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 444
Threads: 109
Thanked 369 Times in 208 Posts
Reputation: 379
Default

uhhhh
Reply With Quote Quick reply to this message
  #4  
Old 10-13-2012
venky2600's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,186
Threads: 119
Thanked 815 Times in 434 Posts
Reputation: 825
Send a message via Yahoo to venky2600
Post

my guess C) B1 2,3

do they also aks staging Q's in step 1?? i'm scared now.........i'm thinking they are asked in step2 ck(surgery)....
Reply With Quote Quick reply to this message
  #5  
Old 10-13-2012
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 307
Threads: 36
Thanked 127 Times in 61 Posts
Reputation: 137
Default

Lol, I take back the guess!!
Reply With Quote Quick reply to this message
  #6  
Old 10-13-2012
billy's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 444
Threads: 109
Thanked 369 Times in 208 Posts
Reputation: 379
Correct Answer H is correct

The presence of a hard irregular nodule, along with the extremely high prostate-specific antigen (PSA) level, points
most clearly to prostate carcinoma. Modest elevations of the PSA concentration can occur in nodular hyperplasia of the
prostate and prostatitis. Symptoms of urinary obstruction are more prominent in nodular hyperplasia because the nodules
are in the periurethral region, but this sign is insufficient to distinguish cancer from hyperplasia. Similarly, renal failure
owing to obstruction or infiltration is most common with nodular hyperplasia, but can occur with cancer as well. Levels of
alkaline phosphatase are elevated when prostate carcinoma gives rise to osteoblastic metastases. Although staging and
grading schemes for malignant disease seem daunting, they are applied intuitively. The lowest stage is the smallest, most
localized tumor; higher stages represent larger tumors or spread of the disease inside or outside of the primary organ site.
Grading schemes also start with the lowest, most well-differentiated tumor, as seen with the microscope. Higher grade
tumors have increasingly abnormal-appearing cells and structures so poorly differentiated that they hardly resemble their
site of origin. In this case, the prostate cancer has the highest grade (it does not have glandular structures) and the
highest stage (it has metastasized to the spine).
Reply With Quote Quick reply to this message
The above post was thanked by:
DrSK (10-13-2012), Saiyeda (10-13-2012)



Reply

Tags
Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Billy Step 1 Questions #13 billy USMLE Step 1 Forum 5 10-09-2012 01:32 PM
Billy Step 1 Questions # 19 billy USMLE Step 1 Forum 5 10-09-2012 01:27 PM
Billy Step 1 Questions #8 billy USMLE Step 1 Forum 5 10-06-2012 06:06 AM
Billy Step 1 Questions #7 billy USMLE Step 1 Forum 9 10-05-2012 10:26 AM
Billy Step 1 Questions #5 billy USMLE Step 1 Forum 5 10-03-2012 08:47 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)