A 23-year-old man is evaluated because of a painless right-sided scrotal mass. Ciprofloxacin, 500 mg every 12 hours, is administered for 10 days, but he notes little improvement in the swelling. His serum α-fetoprotein level is elevated at 100 ng/mL, and his 13-human chorionic gonadotropin level is 64 m/UImL. Testicular ultrasound examination reveals a hypoechoic mass. Which of the following would be the most appropriate next step in his treatment?

Related MCQs

• A 30-year-old man presented with a swelling in the testis and an ultrasound scan confirmed the presence of a malignant mass. Following orchidectomy, he was found to have a 40-mm seminomatous germ cell tumour without non-seminomatous components. There was evidence of vascular invasion within the testis.Investigations: serum lactate dehydrogenase (LDH) 1250 U/L (10–250) serum α-fetoprotein normal serum β-human chorionic gonadotrophin (HCG) 700 U/L (<5) A CT scan of body showed retroperitoneal lymphadenopathy of up to 7 cm in size, a 3- cm mediastinal lymph node and over 30 pulmonary metastases. There were no signs of liver, brain or bone metastases. What is the most appropriate International Germ Cell Cancer Collaborative Group classification?
• A 64-year-old man is evaluated because of fatigue and shortness of breath on exertion. He has had three episodes of urinary tract infection in the past 7 months. On physical examination, he has pallor but is otherwise normal. He denies blood loss, and his stool is negative for occult blood on three measurements. He is anemic (hemoglobin 8.4 g/dL) with normochromic, normocytic indices, and his serum creatinine level is 2.9 mg/dL. The total serum protein level is elevated, and the serum albumin level is low normal. His serum calcium level is 11.8 mg/dL.What is the most likely cause of his symptoms?
• A 69-year old black man is evaluated because of a history of steadily increasing upper abdominal pain, loss of appetite, and a 4.6-kg (1 0-Ib) weight loss over the past several months. He recently noticed that the color of his urine was darker than usual. The patient had a 40-pack-year history of cigarette smoking, but quit smoking 4 years ago. He has hypertension that is controlled by medical management. Laboratory studies: Hemoglobin 11.5 g/dL Serum total bilirubin 3.3 g/dL Serum albumin 3.2 g/dL Serum aspartate aminotransferase 105 U/L Serum alanine aminotransferase 95 U/L Urinalysis shows elevated bilirubin. CT scan of the abdomen shows dilation of the common bile and pancreatic ducts, a 5.2-cm mass in the head of the pancreas, and compression of the superior mesenteric vein. A fine-needle aspirate of the mass reveals atypical cells that are suspicious for malignancy. What is the most appropriate course of action?
• A 32-year-old woman is evaluated because of a painless swelling in her lower neck. She noted the swelling about 3 weeks ago and now thinks it is getting larger. She has no history of foreign travel. She smokes but does not drink alcohol. She owns a cat. She has not had fever or unexplained weight loss, but has had night sweats twice in the past week. She has been feeling fatigued lately and has noted dyspnea on exertion. On physical examination, a 3 X 5-cm left supraclavicular lymph node is palpable. It is firm but not rock-hard and is nontender. The remainder of her physical examination and results of a complete blood count are normal. What is the best next step in this patient‟s management?
• A 63-year-old man is evaluated because of a several-month history of increasing fatigue and some vague upper abdominal discomfort. His medical history includes gastroesophageal reflux disease, coronary artery disease, and clinical depression, all of which are well controlled with medications. The patient has been working full time. On physical examination, he has mild hepatomegaly. His hemoglobin is 12.2 g/dL, serum alkaline phosphatase level 280 U/L, and serum aspartate aminotransferase level 65 U/L. CT scan of the abdomen and pelvis shows multiple hepatic lesions ranging in size from 1 cm to 4 cm; mesenteric, para-aortic, and paracaval lymphadenopathy, and a colonic mass at the splenic flexure. Colonoscopy reveals a nonobstructing, non bleeding lesion; biopsy shows it to be poorly differentiated adenocarcinoma. Fine- needle aspiration of one of the liver lesions confirms the presence of malignant cells consistent with a primary colon cancer. What is the most appropriate next step in
• A 50-year-old perimenopausal woman is evaluated because of abdominal swelling. CT scan of the chest, abdomen, and pelvis shows mesenteric lymphadenopathy and a small amount of ascites but no ovarian masses. Needle biopsy specimen shows adenocarcinoma; the tumor is found to be negative for hormone receptors. The serum carcinoembryonic antigen level is normal at 2.0 ng/mL and the serum CA-125 is 1200 ng/mL (elevated). What is the best next step in her treatment?
• A 28-year-old woman was found to have stage IV Burkitt‟s lymphoma. Her renal function was normal and a staging CT scan had shown no abnormality of the renal tract. Three days later, when she was about to start chemotherapy, she developed a temperature of 39.0°C with rigors and was treated with imipenem. Investigations (the following day): serum sodium 138 mmol/L (137–144) serum potassium 6.2 mmol/L (3.5–4.9) serum creatinine 215 μmol/L (60–110) serum corrected calcium 1.60 mmol/L (2.20–2.60) serum phosphate 1.52 mmol/L (0.8–1.4) serum lactate dehydrogenase 1238 U/L (10–250) serum urate 0.69 mmol/L (0.19–0.36) What is the most likely cause of the renal impairment?
• A 29-year-old man was diagnosed with stage II (that is, spread from the primary tumor to retroperitoneal lymph nodes) nonseminomatous germ cell tumor 1 year ago. Treatment included orchiectomy and retroperitoneal lymph node dissection. He now presents with an elevated level of β-human chorionic gonadotropin hormone and multiple pulmonary lesions ranging in size from 0.61 to 3.22 cm. Needle biopsy specimen of the largest lesion reveals a germ cell tumor consistent with the initial diagnosis. He is asymptomatic. What is the best treatment for this patient?
• A 72-year-old man is evaluated because of back pain and fatigue. Laboratory values indicate he is anemic, with normal leukocyte count and platelet count. He has mild hypercalcemia and a normal serum creatinine level. His gamma globulins are elevated, and serum protein electrophoresis shows the presence of a monoclonal protein, an IgG- K light chain containing immunoglobulin at 4.4 g/dL. His bone marrow contains 20% plasma cells. A skeletal survey reveals multiple osteolytic lesions in the spine, ribs, and skull. Therapy with melphalan and prednisone is initiated. Which of the following agents would NOT be routinely used in his management?
• A 71-year-old man with mild chronic obstructive pulmonary disease and mild hypertension is evaluated during an annual routine visit. Review of systems is notable for intermittent cough, increasing dyspnea on exertion, a 2.3-kg (5 Ib) weight loss, and fatigue. The patient takes aspirin, 81 mg/d, and hydrochlorothiazide, 50 mg/d orally. He smoked one pack of cigarettes per day for 49 years but quit smoking 2 years ago. On physical examination, distant breath sounds are audible in both lungs and there are scattered rhonchi. Chest radiograph shows a perihilar mass. Abnormal laboratory results include hemoglobin of 12.5 g/dL and a serum sodium of 127 meq/L. Endobronchial biopsy reveals small-cell lung cancer. Further staging studies suggest that the disease is limited-stage. What is the most appropriate treatment for this patient‟s hyponatremia?