A 66-year-old man with newly diagnosed lymphoma 

presents to your office before his first scheduled 

chemotherapy treatment by his oncologist. His past 

medical history is notable for hypertension, chronic 

renal insufficiency with a baseline creatinine of 

1.9 mg/dL, and gout. Which of the following is not an 

appropriate step in preventing the development of 

tumor lysis syndrome? 

You follow a 35-year-old woman who has a family his- 

tory of breast cancer in her mother at the age of 

42 years. She recently found out that a maternal 

aunt was diagnosed with ovarian cancer at the age 

of 60 years. She is concerned about her risk of 

developing cancer. Which of the following do you 

recommend? 

A 56-year-old woman presents to your office complain- 

ing of cough and weight loss. A chest x-ray reveals a 

peripheral lung mass that does not abut the pleura. She 

has no history of asbestos or cigarette exposure. If this 

patient turns out to have a lung cancer, what is the 

most likely histologic type? 

Which one of the following recommendations for 

screening for gastrointestinal cancers has been associ- 

ated with improved survival? 

You are examining a 55-year-old gentleman with a 1- 

year history of multiple myeloma. He complains of a 

fever to 101 °F shaking chills, and a nonproductive 

cough. Chest x-ray reveals a right lower lobe infiltrate. 

What is the most likely organism to be causing his dif- 

ficulty?