A 68-Year-Old Woman Comes to the Office Due to Increasing

question 105

Multiple Choice

A 68-year-old woman comes to the office due to increasing low back pain.  The pain is constant and worsens at night.  She has also had a 6.8-kg (15-lb) weight loss over the past 3 months.  Medical history is significant for osteoporosis and hypothyroidism.  Family history is significant for breast cancer in her mother.  She has smoked 1 pack of cigarettes daily for 30 years and drinks 1 or 2 glasses of wine every day.  The patient immigrated to the United States from China 30 years ago; she mainly eats food she cooks herself.  Vital signs are within normal limits.  Physical examination shows point tenderness over the L3 and L4 vertebrae.  MRI reveals lytic bone lesions in the corresponding vertebrae and also a right lower pole kidney mass.  Histologic examination of the mass is shown below: Which of the following risk factors most likely contributed to this patient's current condition?

• A)Alcohol use
• B)Diet
• C)Ethnicity
• D)Family history
• E)Smoking

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Definitions:

Tetrahedral Geometry

A shape formed when a central atom is surrounded by four atoms at the corners of a tetrahedron.

Phenol

An organic compound consisting of a benzene ring bonded to a hydroxyl group, used in the manufacture of plastics and pharmaceuticals.

Tetrahedral Geometry

Tetrahedral geometry describes a molecular shape where a central atom is bonded to four other atoms, all at the corners of a tetrahedron, with bond angles of approximately 109.5°.

Nicotine

An addictive chemical found in tobacco that stimulates the brain's reward system.