每日一题_2023.03.11

A 68-year-old retired furniture mover comes to the doctor for the first time in years because of constant backaches that radiate down his legs. He also reports fatigue, a 9.1-kg (20-lb) weight loss over the past few months, and trouble urinating, including decreased force of stream, hesitancy, and intermittency. He smokes two packs of cigarettes per day and drinks at least three beers per day, and has done so for the past 15 years. Laboratory tests show: Hemoglobin: 10.1 g/dL, Hematocrit: 28%, WBC count: 8500/mm3, Platelet count: 240,000/mm3 Na+: 135 mEq/L, K+: 4.2 mEq/L, HCO3-: 24 mEq/L, Cl-: 101 mEq/L, Blood urea nitrogen: 18 mg/dL Creatinine: 1.3 mg/dL. A radionucleotide bone scan was also per- formed; results are shown in the image. What is the most important risk factor for this patient’s most likely current condition?

一位68岁的退休家具搬运工多年来第一次来找医生，因为他的背痛一直蔓延到腿上。他还报告了疲劳，过去几个月体重减轻了9.1 kg(20磅)，排尿困难，包括尿流力下降、排尿犹豫和排尿间歇。他每天抽两包烟，每天至少喝三瓶啤酒，这样已经持续了15年。实验室检查:血红蛋白10.1 g/dL，红细胞压积28%，白细胞计数8500/mm3，血小板计数24万/mm3, Na+: 135 mEq/L, K+: 4.2 mEq/L, HCO3-: 24 mEq/L, Cl-: 101 mEq/L，尿素氮:18 mg/dL，肌酐:1.3 mg/dL。同时进行放射性核素骨扫描;结果显示于图像中。对于该患者目前最有可能的病情，最重要的危险因素是什么?

(A) Advanced age 高龄

(B) Alcohol use饮酒

(C) History of physical labor 体力劳动史

(D) Lack of regular primary care 缺乏正规的初级保健

(E) Smoking history 吸烟史

答案解析：

年龄增长是前列腺癌最重要的危险因素。它是成年男性中最常见的癌症，也是成年男性因癌症死亡的第二大常见原因。这种情况在非裔美国男性中更为常见，通常无症状，直到进展。高龄、家族史、种族和吸烟都是危险因素。前列腺癌的筛查试验是前列腺特异性抗原水平(PSA)和随后的活检。恶性肿瘤可以局部侵袭或通过淋巴管或血流扩散到骨、肺和肝。该患者的骨扫描显示弥漫性骨转移。

正确答案：A