A 54-year-old woman with breast cancer in her right breast recently underwent surgical lumpectomy with axillary lymph node dissection


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A 54-year-old woman with breast cancer in her right breast recently underwent surgical lumpectomy with axillary lymph node dissection. Several weeks into her subsequent radiation treatment, she presents with a swollen right arm and fingers, right facial edema that is most pronounced around the orbit, and shortness of breath. X-ray of the chest reveals some accumulation of fluid in the right pleural cavity. Which of the following is the most likely cause of these findings?

  • (A) Deep venous thrombosis of the right cephalic vein
  • (B) Disruption of the right lymphatic duct
  • © Disruption of the thoracic duct
  • (D) Metastatic disease to the humerus
  • (E) Normal adverse effect of radiation

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A medical oncologist is seeing a patient who has been diagnosed with breast cancer. As he begins to take the patient’s history, she interrupts and states, “I can’t stand Dr. Smith. He is a lousy surgeon and he doesn’t know how to treat people. Next time you see him, tell him he has made his patients extremely angry and should learn how to become a better doctor.” What would be the most suitable response to this patient?

  • (A) “Do you think I have treated you appropriately?”
  • (B) “I will bring up the issues with Dr. Smith in our next meeting.”
  • © “Dr. Smith is an excellent doctor. He does a great job with all of my patients.”
  • (D) “I understand you are upset, but I suggest you speak directly to Dr. Smith regarding your concerns.”

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