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  #1  
Old 11-10-2012
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Question A 25-year-old military serviceman & his mother!

A 25-year-old military serviceman reports having respiratory difficulty along with red-tinged sputum, chest pain, chills, and fever for the past 2 days. He then passes dark urine. He goes to see the base physician. Vital signs are recorded as: T 37.9 C, P 83/min, RR 15/min, and BP 145/90 mm Hg. Physical examination findings include crackles over lung bases.

Urine dipstick examination shows 1+ protein and 4+ blood.

Additional laboratory findings include serum creatinine 2.8 mg/dL, urea nitrogen 30 mg/dL, glucose 74 mg/dL, total protein 6.1 g/dL, and albumin 3.6 g/dL

Two days later is serum creatinine is 4 mg/dL and urea nitrogen 43 mg/dL. Further history reveals that he works in a military fuel depot.

A renal biopsy on light microscopy shows crescents in the glomeruli, filling Bowman's space and compressing the residual glomerular tufts.

With immunofluorescence staining for fibrinogen, the crescents within Bowman's space stain for fibrinogen, consistent with severe glomerular injury leading to leakage of fibrinogen that stimulates epithelial cell proliferation and crescent formation.

The immunofluorescence show with staining for IgG shows a linear pattern of staining along the glomerular basement membrane with antibody to IgG. In most cases of Goodpasture syndrome with rapidly progressive glomerulonephritis there is linear staining with IgG, but staining with IgA and IgM can also be present.

He than visits his 49-year-old mother and tells her about the biopsy and the results. Her mother remarked, "You know, maybe I should go and see my doctor, because my aunt died of breast cancer about my age." She sees her doctor, who palpates a large irregular firm fixed mass in the right breast as well as overlying skin with a rough, reddened appearance. There are enlarged, nontender axillary lymph nodes. Mammographically, the mass has irregular borders. A fine needle aspirate is performed of the mass and then a mastectomy is done. The lesional tissue is tested for estrogen-progesterone receptors and HER2.

The breast mass has irregular borders. The cut surface of the mass has a central irregular whitish scar. There are scattered foci of yellow to white necrosis and calcification. Axillary lymph nodes were also found to be enlarged and firm with similar cut surfaces. A frozen section confirms the diagnosis of malignancy

Microscopic sections of this neoplasm with overlying breast skin show intralymphatic cancer cells. The stroma around the tumor-cell nests is mildly desmoplastic. Metastatic breast cancer is present in an axillary lymph node.

What is the most likely diagnosis?

A. Paget’s disease of the breast
B. Infiltrating ductal carcinoma of breast
C. Hyalinized fibroadenoma
D. Intraductal papilloma
E. Duct ectasia
F. Fibrocystic disease
G. Breast lymphoma
H. Traumatic fat necrosis
I. Breast abscess
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Last edited by Novobiocin; 11-10-2012 at 08:40 PM.
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Old 11-11-2012
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haha what a question!!!
B. Infiltrating ductal carcinoma of breast
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Old 11-11-2012
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yes B ..........

looks like a real step 2 qs ......
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I loved the beginning with the military recruit who will die ASAP
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lol..............nice family story.

my pick....B
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Matched!!!
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Quote:
Originally Posted by Hitman View Post
looks like a real step 2 qs ......
Yeah.........spent a lot of time constructing this question to make it like a real step 2 Q
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