A 70-Year-Old Man Comes to the Office Due to 3

question 61

Multiple Choice

A 70-year-old man comes to the office due to 3 weeks of unrelenting low back pain.  He was grocery shopping when he first noticed the pain.  The patient reports no trauma or leg weakness but describes having to strain to urinate.  He has a history of hypertension and hyperlipidemia and has not seen a doctor in the past 5 years.  His wife died a year ago, and he now lives alone.  The patient is a retired construction worker and has a history of tobacco and marijuana use.  There is tenderness in the lower vertebral area.  Imaging study of the spine reveals several osteoblastic lesions in the lumbar vertebrae.  Which of the following structures was most likely involved during the spread of this patient's disease?

• A)Azygos veins
• B)Internal iliac lymph nodes
• C)Pampiniform plexus
• D)Paraaortic lymph nodes
• E)Prostatic venous plexus
• F)Vertebral artery

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Definitions:

Lowest Energy

Pertains to the state of a system in which it possesses the minimum possible energy, often corresponding to the most stable state.

Molecular Orbital

A theoretical construct that describes the wave-like behavior of electrons in molecules.

S-cis Conformation

A specific arrangement of molecular geometry where substituents on a double bond are positioned in the same plane, allowing potential for certain reactions.

Relative Energies

The comparative energy levels of molecules or states, used to predict stability, reactivity, and the distribution of products in chemical reactions.