37.A clinical study involves patients diagnosed with carcinoma and whose tumor stage is T4NIMI.The patients'survival rate 5y ears from the time of diagnosis is less than regardless of therapy.Which of the lowing clinical findings is most likely to be characteristic of this group of patients?( A.Cachexia B.Cardiac murmur C.Ieterus D.Loss of sensation E.Splenomegaly 38.A previously healthy 20 year old man develops heart failure over a period of several days. He is febrile and complains to his friends that he has chest pain,but he does not seek medical attention.He dies and an autopsy is performed.Examination of the heart shows that both ventricles are dilated but otherwise the myocardium appears normal by gross visua inspection.An H&E-stained histologic section shows numerous inflammatory cells in the myocardium,more than 80%lymphocytes,which expand the interstitial spaces between individual mvocytes and surround mvocytes.Most of the mvocytes are structurally intact and appear viable,although scattered individual myocytes are necrotic.The most likely explan on for this finding is( A.Acute fungal myocarditis B.Acute myocardial infarction C.Acute rheumatic fever D.Marantic endocarditis E.Viral myocarditis 39.A57-year-old woman comes to the physician because she recently noticed a pale area of discoloration on the labia.The area is painful and itchy.Pelvic examination shows the presence of a 0.7-cm flat,white area on the right labia majora.A biopsy specimen shows dysplastie cel that ocupyabout half the thickness of the squam with minimal underlying chronic infammation. In situ hybridization shows uman papill mavirus type 16 DNA in the epithelial cells.Which of the following is the most likely diagnosis？?（ A Contart dermatitis Condylomaacuminatum Sq amous hyperplasi Vulvar intraepithelial neoplasia E.Chronic vulvitis 40.An epidemiologic study of cancer deaths recorded in the last half of the 20th conducted. number of deaths for one type of cancer Which of the following neoplasms was most likely to be identified by this study?( A.Angiosarcoma of the liver B.Carcinoma of the lung37. A clinical study involves patients diagnosed with carcinoma and whose tumor stage is T4N1M1. The patients’ survival rate 5 years from the time of diagnosis is less than 50%, regardless of therapy. Which of the following clinical findings is most likely to be characteristic of this group of patients? （ ） A. Cachexia B. Cardiac murmur C. Icterus D. Loss of sensation E. Splenomegaly 38. A previously healthy 20 year old man develops heart failure over a period of several days. He is febrile and complains to his friends that he has chest pain, but he does not seek medical attention. He dies and an autopsy is performed. Examination of the heart shows that both ventricles are dilated but otherwise the myocardium appears normal by gross visual inspection. An H&E-stained histologic section shows numerous inflammatory cells in the myocardium, more than 80% lymphocytes, which expand the interstitial spaces between individual myocytes and surround myocytes. Most of the myocytes are structurally intact and appear viable, although scattered individual myocytes are necrotic. The most likely explanation for this finding is（ ） A. Acute fungal myocarditis B. Acute myocardial infarction C. Acute rheumatic fever D. Marantic endocarditis E. Viral myocarditis 39. A 57-year-old woman comes to the physician because she recently noticed a pale area of discoloration on the labia. The area is painful and itchy. Pelvic examination shows the presence of a 0.7-cm flat, white area on the right labia majora. A biopsy specimen shows dysplastic cells that occupy about half the thickness of the squamous epithelium, with minimal underlying chronic inflammation. In situ hybridization shows human papillo￾mavirus type 16 DNA in the epithelial cells. Which of the following is the most likely diagnosis? （ ） A. Contact dermatitis B. Condylomaacuminatum C. Squamous hyperplasia D. Vulvar intraepithelial neoplasia E. Chronic vulvitis 40. An epidemiologic study of cancer deaths recorded in the last half of the 20th century is conducted. The number of deaths for one particular type of cancer has been increasing in developed nations. Which of the following neoplasms was most likely to be identified by this study? （ ） A. Angiosarcoma of the liver B. Carcinoma of the lung