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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
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Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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Scenario 3. Chart Note A 26-year-old woman is referred for

Resolved Question:

Scenario 3. Chart Note
A 26-year-old woman is referred for Graves disease. The patient was first found to be hyperthyroid shortly after she became pregnant. She has a tremor in her hands, a sensation of being hot, insomnia, weakness in her legs, and exophthalmos.

Physical examination reveals thyromegaly; the gland is rather mushy and soft. No nodules were noted. T3 and T4 levels were ordered and an appointment was made to have an uptake scan.

1) What is the cause of Graves disease?
A. The thyroid gland is slow to function
B. The pancreas is hyperfunctioning
C. The thyroid gland is oversecreting
D. Hyperactive ovarian function

2) Why were T3 and T4 levels ordered?
A. To measure the extent of eyelid prolapse
B. To assess the function of the thyroid gland
C. To measure the size of the thyroid gland
D. To assess heart function

Scenario 4: Case Study
The patient is a 63-year-old woman with a history (10 years ago) of squamous cell carcinoma in situ of the cervix, which was treated with a total abdominal hysterectomy. Three years ago a pelvic mass was palpated, and exploratory laparotomy revealed a multinodular solid cystic mass of 10 to 12 cm. The mass arose from the right ovary and was adherent to the right pelvic wall. The patient underwent resection of the mass, and the pathology revealed squamous cell carcinoma of the ovary. She subsequently had combined modality treatment with chemotherapy (cisplatin and 5-fluorouracil) and radiation therapy to the pelvis. The latest CT scan of the abdomen revealed a new right retroperitoneal lymph node. CT-guided fine needle aspiration was consistent with metastatic ovarian squamous cell carcinoma.

1) What best describes the patient’s original diagnosis?
A. Endometrial and cervical carcinoma
B. Localized cancer of the lower portion of the uterus
C. Cervical cancer that spread to the abdomen
D. Ovarian cancer

2) What was the initial primary treatment?
A. Drug treatment
B. Radiation treatment
C. Drug and radiation treatment
D. Surgical removal of the entire uterus

3) What procedure identified the new pelvic mass?
A. Incision of the abdomen
B. Radiation therapy
C. Total abdominal hysterectomy
D. CT scan of the abdomen

4) Which treatment modalities were used for the patient’s ovarian carcinoma?
A. Computed tomography of the abdomen
B. Fine-needle aspiration of the ovary
C. Drug and radiation therapy in addition to surgical removal
D. Surgical resection of the mass

5) How would you characterize the disease in the patient’s retroperitoneal lymph node?
A. Cancer of the lymphatic system
B. Cervical cancer that had spread
C. Primary ovarian cancer
D. Ovarian cancer that had spread
Submitted: 5 years ago.
Category: Health
Expert:  Julia Kizhner replied 5 years ago.

Hello and thank you for using JustAnswer,


Scenario 3:

Question 1: answer is C - thyroid is over-secreting

Question 2: answer is B - to evaluate thyroid function


Scenario 4:

Question 1: answer is D - ovarian cancer


Question 2: this question is confusing - if they are asking what the initial primary treatment was for cancer of the cervix 10 years ago, the answer is D - removal of uterus (hysterectomy); if they are asking about the initial treatment for ovarian cancer (which was found 3 years ago), the treatment was drug and radiation treatment but she also had resection of that mass so if they are looking for answer how was ovarian cancer treated, it should really say "surgery, drug and radiation"


Question 3: this one is also confusing - are they referring to the lymph node as a new pelvic mass - if yes, the answer is D - CT scan; if they are referring to the mass which was found 3 years ago, the answer is not there because it was found by laparotomy. so I am pretty sure they are referring to the newest lymph node, in which case, answer

is D.


Question 4: answer is C - drug, radiation and surgical therapy

Question 5: answer is D - ovarian cancer which spread


Hope this helps. Please let me know if you have any questions.

If you are satisfied with the answers, please do click 'Accept' button so that I may get credit for my work.


Best wishes and good luck,


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