A 32-year-old man comes to the emergency department because of a wound in his foot. Four days ago, he stepped on a nail while barefoot at the beach. Examination of the plantar surface of his right foot shows a purulent puncture wound at the base of his second toe with erythema and tenderness of the surrounding skin. The afferent lymphatic vessels from the site of the lesion drain directly into which of the following groups of regional lymph nodes?
APopliteal
BDeep inguinal
CAnterior tibial
DSuperficial inguinal
EExternal iliac
A 29-year-old woman, gravida 1, para 1, comes to the physician for the evaluation of a painful mass in her left breast for several days. She has no fevers or chills. She has not noticed any changes in the right breast. She has no history of serious illness. Her last menstrual period was 3 weeks ago. She appears anxious. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 13/min, and blood pressure is 130/75 mm Hg. Examination shows a palpable, mobile, tender mass in the left upper quadrant of the breast. Ultrasound shows a 1.75-cm, well-circumscribed anechoic mass with posterior acoustic enhancement. The patient says that she is very concerned that she may have breast cancer and wishes further diagnostic testing. Which of the following is the most appropriate next step in the management of this patient?
ACore needle biopsy
BMRI scan of the left breast
CReassurance and clinical follow-up
DFine needle aspiration
EMammogram
A 59-year-old woman presents to her primary care provider with a 6-month history of progressive left-arm swelling. Two years ago she had a partial mastectomy and axillary lymph node dissection for left breast cancer. She was also treated with radiotherapy at the time. Upon further questioning, she denies fever, pain, or skin changes, but reports difficulty with daily tasks because her hand feels heavy and weak. She is bothered by the appearance of her enlarged extremity and has stopped playing tennis. On physical examination, nonpitting edema of the left arm is noted with hyperkeratosis, papillomatosis, and induration of the skin. Limb elevation, exercise, and static compression bandaging are started. If the patient has no improvement, which of the following will be the best next step?
ADiethylcarbamazine
BLow molecular weight heparin
CEndovascular stenting
DVascularized lymph node transfer
EAntibiotics
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