Lung Cancer Small group questions – Flashcards
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1. Mr. Gonzalez is a 56 yo Hispanic male who presents with chest pain, hemoptysis, chronic cough, and SOB. His PMH is significant for a 30-pack year history, emphysema. Physical exam shows a Hispanic male in moderate distress, who appears confused and drowsy throughout the exam, normal skin turgor, no edema. What is the most likely treatment?
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Chemotherapy
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2. A 67 yo male has been complaining of increasing SOB over the past year. His PMH is significant for a 30 pack year history of smoking. Physical exam is unremarkable. His social history includes currently a retired plumber. A chest x-rays shows a plaque in the pleura. What would most likely be seen if a biopsy was performed
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d. Brown dumbbell shaped rods and macrophages: ferruginous bodies are seen in mesothelioma
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The most appropriate treatment for Mrs. B has the following mechanism of action:
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d. Inhibition of NKCC2 in the thick ascending limb: loop diuretics are a good choice for rapid sx relief of her fluid overload
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A tall, thin, basketball player presents to the Emergency Department after having severe shortness of breath starting 30 minutes ago. He has a pneumothorax caused by right bronchial obstruction due to a mass. He is starting to appear cyanotic and is in obvious distress. He is known to have inactivated RB1 and p53 tumor suppression genes. What other finding(s) would you most likely find during a physical exam, history, and lab review of this patient?
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d.) Dilutional Hyponatremia
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A 55 year old man who has been smoking over 30 packs/year for 20 years comes into your office for a routine physical. He does not have any symptoms of cough, dyspnea, chest pain, or hemoptysis. Due to his history and risk factors for lung cancer, you decide to get a CT to screen for lung cancer. His CT is abnormal. What findings on a CT would make you the most concerned and want to refer to an oncologist as soon as possible?
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c.) A part solid nodule that is over 3cm that has increased in size since his previous CT scan last year
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4. 76yo Caucasian male presents to clinic with hemoptysis that began one week ago. He has smoked 1 PPD for 35 years. He admits to dropping 3 pant sizes and chest pain in the last month. Physical examination reveals a cachectic man in mild distress. His vitals are: 130/85 mmHg, 94 beats per minute, 22 breaths per minute, and 99.0°F. He has decreased breath sounds on the left side of the chest. What's the next appropriate step in the management of this patient?
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C. CT of the chest
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5. A 60-year-old male presents with hemoptysis and a persistent cough. He has a 20-pack year history. On physical exam he appears run down and having no energy with swollen fingertips and decreased breath sounds. A 16 mm solid nodule is seen in the lung with CT scan. Which of the following would consist of the best next steps for his suspected condition?
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C. PET scan, TTNBx, surgical resection
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Case 1: 75y/o male with 80pack-year smoking history is evaluated for 3 month hx of night sweats, weight loss & progressive SOB. He has been complaining of a dull ache in the left chest for the past 3 months. He has occasional coughing with mucoid sputum. On physical exam he is afebrile, pulse 112/min, RR 26/min, BP 100/80. His trachea is shifted to right. There is dullness to percussion & decrease breath sounds throughout his right chest. His abdomen is scaphoid with no organomegaly & no peripheral edema. His laboratory test reveals the following: WBC 6800, hemoglobin 8mg/dl and hematocrit of 30. His electrolytes, LFT & renal functions are normal, Serum Protein 5.9g/dl, LDH 1880U/LA. Thoracentesis is performed which reveals the following information: •Cell count-RBC 150,000; WBC 980 with 20% neutrophils, 55% lymphocytes, 10% mesothelial cells & 15% eosinophils •Total protein 4.5 mg/dl •LDH 1200U/L •Glucose 45 mg/dl •pH 7.2 •Pleural fluid gram stain is negative, cultures & cytology pending
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C. Exudative
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A 50 y/o male presents to clinic with abdominal pain and bone pain. He is a smoker. CXR reveals a central necrotic cavitation. What could be causing the abdominal and bone pain.
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High PTH:
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1. A 62 year-old male with a 60 pack-year smoking history presents to the clinic with complaints of new onset difficulty in climbing stairs. Neurologic exam reveals hyporeflexia in the lower extremities. EMG shows increasing electrical potential. Chest X-ray shows a central lung mass. Which of the following histologic features would be most apparent on biopsy?
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C. Mitotically active cells with necrosis
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2. A 43 female non-smoker presents with new onset hemoptysis. Pulmonary CT shows diffuse, bilateral nodules. Which of the following sites is the LEAST likely source of the metastasis?
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E. Brain
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8. (Question 1 of 2) Case 1: A 65 y/o Caucasian male presents for 2 month history of cough and hemoptysis. He experiences chest pain every time he coughs. Over the last month, he has felt fatigue and has lost 10 pounds. Past medical history includes: HTN, T2DM, resection of a squamous cell carcinoma from his nose, and a 2 pack-per-day smoker since he was 25 y/o. On physical exam, the patient appears cachetic and fatigue, with decreased breath sounds on the left side of the chest. CXR is depicted a large left mass close to the hilum with cavitation. The most likely diagnosis is:
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A. Squamous cell carcinoma of the lung
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8. (Question 1 of 2) Case 1: A 65 y/o Caucasian male presents for 2 month history of cough and hemoptysis. He experiences chest pain every time he coughs. Over the last month, he has felt fatigue and has lost 10 pounds. Past medical history includes: HTN, T2DM, resection of a squamous cell carcinoma from his nose, and a 2 pack-per-day smoker since he was 25 y/o. On physical exam, the patient appears cachetic and fatigue, with decreased breath sounds on the left side of the chest. CXR is depicted a large left mass close to the hilum with cavitation. The most likely mutation
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A. p53
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1. A 54 y/o Russian female with a hx of asthma complains of wt loss. PMH of DM2 dx in 2005 and controlled on inhaled corticosteriods. She worked in a factory at the age of 25 where she extracted Uranium isotopes for nuclear energy. Which of the following is not a risk factor for lung cancer?
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C. Cyanide
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2. Which of the following is not a local effect of lung cancer?
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E. Diaphoresis
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75 yo male with a 90 pack per year smoking history presents to urgent care complaining about coughing up blood for the past week. On physical exam, he is cachectic and struggling to breathe. Our patient also complains of muscle weakness and has trouble going to the bathroom. Upon genetic analysis, the patient as an amplification of myc onca genes. He has a 4 year history of small cell carcinoma of the lung which was 5 mm 1 year ago. On CT there is a 14 mm mass centrally near the hilum. The patient has not had a PET scan performed yet but is scheduled for one in 2 weeks. Which of the following is a reason to do a lung biopsy?
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B. The mass showed demonstrated growth
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2. (2/2) Which of the following para-neoplastic syndromes is most common with the prior case?
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A. Horner's Syndrome B. Cushing's Syndrome C. Hyperparathyroidism D. SIADH E. **Both B and D**
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1. A 45 year old female presents to the office with a 5 month history of weight loss, fatigue, cough, and shortness of breath. She has been a smoker since 15 years old, and smokes 1 ppd. Doctor performed a lung biopsy and obtained the following image:
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B. Chemotherapy
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2. 69 y/o Asian male presents to ED with cough and shoulder pain that radiates down the inside of the arm. He said he had the cough for 8+ years but the shoulder pain is recent onset. He is a recent migrant from Beijing province of China and was a cart runner near the factory districts. Also presents with a history of constipation and kidney stones. No palliative nor provocative factors. Describes cough as dry and non-productive. Describes shoulder pain as tingly with marked weakness. Troponin negative and ECG shows hypercalcemia. Chest xray was positive for centrally located lesions. What is on the top of your differential diagnosis?
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E. Squamous Cell Carcinoma
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1. A 56-year-old male smoker presents to the emergency department with dyspnea at rest and a cough for 1 month. Two weeks ago, he started having headaches and noticed swelling of his face. Physical examination reveals JVP +10 and edema of the upper limbs. A chest radiograph is ordered and shows a nodule near the right hilar region. Which of the following types of lung cancer is most commonly associated with the signs and symptoms this patient is experiencing?
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(D) Small cell lung cancer (SCLC)
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2. A 53-year-old male smoker presents to the emergency department with exertional dyspnea that has progressed to dyspnea at rest and a cough for 1 month. Two weeks ago, he started having headaches and noticed swelling of his face. Physical examination reveals
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B. Diabetes Insipidus - SIADH would be more likely.
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5. A 66-year-old woman, who has a 30 pack year history, sees her physician because she had a cough and 8-kg weight loss over the past 3 months. She has a history of breast cancer. Physical examination shows cyanosis and clubbing of the fingers. She is afebrile. A chest radiograph shows no hilar adenopathy, but there is cavitation within a 3-cm lesion near the right hilum. Laboratory studies are unremarkable except for a calcium level of 12.3 mg/dL, phosphorus concentration of 2.4 mg/dL, and albumin level of 3.9 g/dL. Based on these findings, what is the most likely diagnosis?
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B. small cell carcinoma
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F. A 66-year-old woman, who has a 30 pack year history, sees her physician because she had a cough and 8-kg weight loss over the past 3 months. She has a history of breast cancer. Physical examination shows cyanosis and clubbing of the fingers. She is afebrile. A chest radiograph shows no hilar adenopathy, but there is cavitation within a 3-cm lesion near the right hilum. Laboratory studies are unremarkable except for a calcium level of 12.3 mg/dL, phosphorus concentration of 2.4 mg/dL, and albumin level of 3.9 g/dL. Based on these findings, what is the most appropriate next step?
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D. Bronchoscopy
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Q1: A 67 year-old Caucasian woman with PMHx of COPD, HTN presents to your office with 2 month history of dry non-productive cough and 4.5 kg unintentional weight loss. She denies fevers, chills, dyspnea, sore throat or hemoptysis. Pt is current smoker and has smoked PPD for the past 40 years. Family hx is unremarkable. Pt's current medication regimen includes HCTZ, Ipratropium and Albuterol PRN. Pt's VS are BP 139/88, HR 92, RR 20, T 98.6. Pt's physical exam shows an obese woman with diminished breath sounds in all lung fields, no rales or wheezing, poor dentition and gross discoloration of teeth with gingival swelling and cotton wool spots on fundoscopic exam. The rest of the physical exam is unremarkable. A CXR is ordered and shows a peripherally located solitary pulmonary nodule.
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A. Adenocarcinoma of the lung
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Q2: What is the most likely etiology leading to this patient's condition?
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C. K-RAS oncogene mutation
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1. 55yo Caucasian male with a 30 pack year history of cigarette smoking presents to the clinic with weight gain of 20 pounds in the last 6 months, abdominal striae and swelling of the face on physical examination. The patient complains of a 4 week history of progressively worsening cough and fatigue. He states that he has a difficult time breathing with physical activity, and as stopped his daily jogging routine as a result. Which of the following BEST describes the pathogenesis of this patient's disease?
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A. Ectopic cortisol production secondary to small cell carcinoma
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2. A 64 year old female presents to your office with chest pain and hemoptysis. She is a heavy smoker of 35 years. Imaging and biopsy was performed, which revealed a solitary nodule located peripherally and abnormalities in the glandular structures. Which of the following do you suspect the patient has based on the information provided?
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Adenocarinoma
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1. A 60 yo male Caucasian patient presents with a headache and cough. He has smoked 1 pack/day for the past 30 years. A CT scan of the lungs reveals a part solid mass in the right lung. Patient also has SOB. Physical exam finding reveals a barrel chested thorax, wheezing, rhonchi and rales. What is the next best step for this patient?
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C. Surgical resection if possible and further treatment with chemotherapy/radiation therapy if positive lymph nodes
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2. A 78 year old African American male coal miner and a current IV drug user with a history of smoking since age 18, presents with shortness of breath, dyspnea, hemoptysis, cough, chest pain, oliguria, headache, vision changes, and bone pain. Lab results shown below. EKG was normal. Examinations of legs do not show any edema. The chest x-ray and CT scan of brain shows the following: what is your most likely diagnosis?
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B. small cell carcinoma
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9. A 40 yo male, non-smoker presents with shortness of breath. Which type of lung cancer does he most likely have?
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A. adenocarcinoma
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10. When should a biopsy be performed if lung cancer is suspected?
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A. If diameter > 1.5 cm at baseline B. If PET is positive C. If there is a demonstrated growth on serial CT D. **All of the above** E. None of the above
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A 48 y/o Caucasian male comes in for an office physical. He states that he smoked in college but subsequently quit and has stayed tobacco-free since then. Physical exam yields no significant findings and the patient has had no complaints. He has no significant past medical history and had a tonsillectomy at 7 years old. After imaging, you note a 3 cm lesion on his left lung. What is the best choice of care at this time?
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C.) Surgical Resection
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A 58 year old male presents complaining of hemoptysis and cough for the past 2 months. He has lost 10 pounds in the last 2 months unintentionally. A CT scan has been obtained by his previous physician and shows a suspicious mass. You perform a biopsy and find nests of polygonal cells with pink cytoplasm and distinct cell borders. The nuclei are hyperchromatic and angular. Which of the following is true regarding this type of cancer?
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A. Most commonly found in men than in women B. Occurs most commonly in nonsmokers C. Highest mutation in the p53 mutation D. **Both A and C** E. May develop in association with a peripheral scar
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13. 57 yo white male with history of smoking 50 pack years presents for his annual physical exam. Given his history, his primary care physician elects to perform a Low dose CT screening lung cancer. On CT, a 1.5 cm non-solid nodule was found in the left lower lobe. What would be the most appropriate treatment for this patient?
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D. Surgical Resection
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14. 68 yo white female with history of smoking 60 pack years presented to ED with hemoptysis, dyspnea, chest pain and clubbing. CT scan of the chest was ordered and showed a 4 cm nodule was found in the right middle lobe. PET scan was performed and confirmed a solitary nodule in the right middle lobe. Her previous CT showed a 10 mm mass in the right middle lobe. The nodule was biopsied and subsequent treatment was performed. Based on the patients' history, what is the carcinogen most closely linked with her condition?
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B. BPDE
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1. 64 y/o male smoker presents to the emergency room with exertional dyspnea that has progressed to dyspnea at rest and a cough for 1 month. One weeks ago, he started having headaches and noticed swelling of his face. Physical examination reveals a blood pressure of 150/90 with prominent neck veins and edema of the upper limbs. A chest radiograph demonstrates a suspicious nodule in the right central region. Which of the following types of lung cancer is most commonly associated with the signs and symptoms this patient is experiencing?
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D. Small cell carcinoma
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2. 45 y/o female non-smoker presents to the doctor's office complaining of cough, weight loss, dyspnea, chest pain, clubbing of fingers that started about 1 month ago. X-ray of lung shows well-defined ground-glass opacity, along with areas of increased density and cystic spaces. On histology, you see:
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C. K-RAS & EGFR mutation (genetic predisposition due to mutations leading to adenocarcinoma most often in non-smokers & women)
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1. Which of the following is a true statement about the lung carcinoma depicted in the picture below?
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18. It involves a mutation of the KRAS gene
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2. A 63-year-old man came to the clinic with worsening cough and weight gain. He has history of smoking 1.5 pack per day for 35 years. On physical exam he has thin extremities, with waist circumference increased compared to before. The patient also had pad of adipose tissue on the back of his neck. He had purple striae on his abdomen. His vital are stable and chest x-ray shows right middle lobe mass. His vitals are stable. Cytology would most likely confirm which of the following.
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A. Small Cell Lung Carcinoma
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1. A 51-year-old obese women presents to urgent care with complaints of dyspnea and a non-productive cough for the past 4 weeks. She reports a 30-year pack history of smoking. Physical exam shows truncal obesity and abdominal striae. Blood pressure is 160/100. Chest x-ray shows a 3-cm mass in the upper lobe of the left lung. CT-guided biopsy reveals undifferentiated, dark blue cells. What is the most likely diagnosis?
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B. Small Cell Carcinoma
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2. A 72-year-old man presents to his primary care physician with complaints of hemoptysis, persistent cough, and an unexpected 15 pound weight loss over the past 3 months. He reports a 20-year pack history of smoking. A CT-guided biopsy reveals keratin pearls and intercellular bridges. What is the most likely pathogenesis of his symptoms?
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E. Exposure to polycyclic aromatic hydrocarbons
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1. You're following a patient with a previously discovered nodule in the right lung on CT screening for lung cancer. At what point should you biopsy this patient's lung?
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A. A 0.7mm nodule that is PET negative B. A 0.7mm nodule that is PET positive which has not changed size in the last year C. 1.5cm nodule that is PET positive D. The nodule has demonstrated growth on serial CT E. **Either C or D**
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2. A 67-year-old male with a 40-year pack history presents complaining of chest pain and SOB for 2 weeks. This morning he noticed blood in his sputum, which is why he came in. After imaging and diagnostic testing, he is diagnosed with NSCLC. Unfortunately, metastasis is discovered in his right femur and right adrenal. Which other location would you most likely find another metastasis?
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D. Adrenals
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1. Which is false in regards to lung tumors?
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A. Doubling growth time remains constant
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4. A 45 year old male with 35 pack history of smoking presents with 6 month history of cough and 10lb weight loss over the same period of time. On CT-Scan, a 2 cm solitary nodule in the periphery with ground glass opacity is found. Which of the following is true?
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b. Adenocarcinoma is the most common cancer in smokers
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1. 65 y/o caucasian male presents to your clinic c/o SOB and hemoptysis which is worsening over the past 7 months. He has smoked 2 packs of tobacco cigarettes per day for the past 45 years. He takes an inhaled coroticosteroid daily which was prescribed based on his PFT results in the past which showed FEV1: 65% of predicted, FEV1/FVC: 62%. He admits to unintentional weight loss of 20 pounds over the past 6 months. Physical exam shows cachectic male in no acute distress. Neck without masses, no JVD. RRR, normal S1 and S2. Auscultation reveals prominent wheeze over the right middle lung field. Abdomen is soft and nontender. Clubbing noted to bilateral fingers. CXR shows 8cm solitary nodule in right middle lobe. What is the BEST next clinical step for diagnosing this patient's problem?
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C. Needle Biopsy of lesion
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2. 65 y/o caucasian male presents to your clinic c/o SOB and hemoptysis which is worsening over the past 7 months. He has smoked 2 packs of tobacco cigarettes per day for the past 45 years. He takes an inhaled coroticosteroid daily which was prescribed based on his PFT results in the past which showed FEV1: 65% of predicted, FEV1/FVC: 62%. He admits to unintentional weight loss of 20 pounds over the past 6 months. Physical exam shows cachectic male in no acute distress. Neck without masses, no JVD. RRR, normal S1 and S2. Auscultation reveals prominent wheeze over the right middle lung field. Abdomen is soft and nontender. Clubbing noted to bilateral fingers. CXR shows "coin lesion" in right middle lobe. Your top differential diagnosis is Squamous Cell Carcinoma of the lung. What would you expect to see on histology for this diagnosis?
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E. Keratin Pearls and Intracellular Bridges
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A 50 year-old Hispanic man with a 30 year pack history and a PMHx of HTN and diabetes presents with a dry productive cough for the past 2 months and increasing dyspnea. His coughs are generally non-productive but for the past 2 weeks he has noticed blood in his sputum. Patients current medication regimen includes propranolol, HCTZ and metformin. Patients vital signs are 155/100, HR 79, RR 24, and T 98.6. Labs are Na 120 mmol/L K 4.0 mEq/L and Cl 100 and serum osmolality 265 mOsm/kg H20. Urine osmolality is 500 mOsm/kg H2O. Chest x-ray is taken and the results are shown below.
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E.) Small Cell carcinoma
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5. 85 year old Caucasian man with a 50 pack year history of smoking presents to the clinic complaining of oliguria for 1 week. The patient reports that his urine is dark yellow, but denies dysuria, problems starting a stream, incontinence, and hematuria. Review of systems reveals that he also has a non-productive cough. In general, he is a thin male who appears older than his stated age. On lung exam, you hear ronchi located on the right lobe. Chest X ray reveals a 4 cm solidified mass in the right middle lobe.
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E. Overproduction of ADH
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85 year old Caucasian man with a 50 pack year history of smoking presents to the clinic complaining of oliguria for 1 week. The patient reports that his urine is dark yellow, but denies dysuria, problems starting a stream, incontinence, and hematuria. Review of systems reveals that he also has a non-productive cough. In general, he is a thin male who appears older than his stated age. On lung exam, you hear ronchi located on the right lobe. Chest X ray reveals a 4 cm solidified mass in the right middle lobe. You suspect a lung cancer. Which type of lung cancer is most probable in this patient?
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E. Small cell
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1. A 56 yo male presents with depression over his sister's recent death from lung cancer. Given his own 30 pack-year smoking history, he is also worried about his own risk for lung cancer. Based on Japanese studies regarding lung cancer screening, which next step is most appropriate?
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E. Perform a thoracic CT scan.
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2. Which of the following oncogenes or tumor suppressants is LEAST affected by smoking cigarette?
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C. CHEK2
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1. 62 years old white male presents to the clinic with severe pain in the right shoulder region radiating toward the axilla and scapular for the last 8 month. On physical exam atrophy of hand and arm muscles is appreciated along with miosis, ptosis and loss of hemifacial sweating. Based on the clinical presentation CT scan is performed and 10 mm solitary nodule is noted in the apex of the right lung. Biopsy reveled neoplasia that is characterized by the presence of keratinious pearls and intercellular bridges. Which lab finding is more likely to be present in this patient?
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C. Increase in PTHrP
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2. 62 years old white male presents to the clinic with severe pain in the right shoulder region radiating toward the axilla and scapular for the last 8 month. On physical exam atrophy of hand and arm muscles is appreciated along with miosis, ptosis and loss of hemifacial sweating. Based on the clinical presentation CT scan is performed and 10 mm solitary nodule is noted in the apex of the right lung. Biopsy reveled neoplasia that is characterized by glandular formation and mucin production. What gene mutation is associated with this cancer?
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KRAS
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1. 65 year-old man presents with recurrent fever, chest pain and difficulty breathing. Patients symptoms come and go. Patient worked as a shipbuilder for 25 years. Patient also has a 40 year history of smoking 1 PPD. CT is shown below. What would be the MOST LIKELY changes seen in the pulmonary function tests (PFTs)?
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C. FEV1 ↓↓ ; FVC ↓↓ (restrictive lung disease is most commonly seen in patients with malignant mesothelioma)
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2. 72 year old female presents with polyuria, polydipsia, and a 10 lb unintentional weight loss within the last 4 weeks. She states that she has not changed her diet recently and has smoked a pack per day for last 50 years. Upon physical exam she was confused and had digital clubbing noted B/L. There were no skin changes, rashes, or joint pain. Chest X-Ray is shown below. Which of the following is the MOST LIKELY diagnosis?
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D. Small Cell Lung CA
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1. A 57 y/o female presents to your clinic with a 76 pack year history of smoking. She states that she has been constantly short of breath for 2 months and an intractable cough with hemoptysis. She also has complaints of difficulty swallowing and fatigue. A chest x-ray shows multiple large nodular opacities near the hilum of each lung. A bronchoscopy is performed and histological stains are done. The histological structures visualized are shown below. What is/are the mutation(s)/deletion(s) most likely found in this carcinoma?
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C. p53 mutation and 3p/ 9p/17p deletion - this answer is correct as this mutation and these deletions are more commonly found in squamous cell lung cancers.
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2. Anxious 65 y.o. male presents to the clinic with complaints of dyspnea on exertion, fatigue, polyuria, joint pain, insomnia, hemoptysis, and cachexia. He is concerned about his 3 ppd smoking habit and would like help trying to quit. As part of your work-up you perform a CXR. CXR reveals a mass located in the hilum of the left main bronchus. PMHx reveals three episodes of nephrolithiasis in the last year. FmHx reveals father with schizophrenia. He is taking fluoxetine for his depression, a multivitamin, chondroitin, and ibuprofen for pain. VS: Temp 99.7˚ BP: 135/75 mmHg HR: 67 bpm RR: 20 rpm Weight: 60 kg H: 71" Based on this presentation what would you MOST LIKELY expect to find on biopsy of the hilar mass? Patient has a paraneoplastic syndrome from the history, the nephrolithiasis points to hypercalcemia. Two syndromes have paraneoplastic syndromes, squamous cell carcinoma, and small cell carcinoma. Hypercalcemia and PTH related peptide are associated with squamous cell carcinoma. Below are the histological findings for various lung pathologies:
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B. Dysplasia, Keratin pearls and intercellular bridges This histological pattern is pathognomonic for squamous cell carcinoma. Also the patient is a male smoker which further is more likely for squamous cell carcinoma. See above for explanation on paraneoplastic syndrome.
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1. A 65 y/old female presents with worsening cough and 5 kg unintentional weight loss. On CXR there are multiple densities that were not present on previous CXR taken 5 years ago. The pulmonologist has a high suspicion for lung cancer. If a lung biopsy was performed what would be most likely seen on a histological slide assuming this is cancer.
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B. Glandular structures with mucin clearings
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2. 62 year old male presents with truncal obesity, abdominal striae, and hump on the back of his neck with dyspnea and SOB. He is correctly diagnosed with small cell carcinoma, which oncogene is commonly associated with the incidence of this cancer?
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C. c-MYC
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1. A male smoker presents with cough, hemoptysis, bronchial obstruction, and wheezing. Labs show a central, large necrotic cavitation and PTHrP levels are high. What characteristic findings would histology most likely show?
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A. Keratin pearls
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2. 65 y/o female presents with cough, hemoptysis, and recent unintentional weight loss. She has never smoked. Subsequently, she dies. Autopsy reveals peripheral scarring and metastasis to adrenals & liver. What is the most likely mutation associated with her underlying disease?
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B. KRAS
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1. Which of the following is FALSE regarding adenocarcinoma?
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D. Most develop in association with a central fibrotic scar
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2. A 58yo female who has smoked one pack of cigarettes per day for 35 years presents for her annual well-woman exam. According to he American College of Chest Physicians recommendations what screening should this patient receive?
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D. Low-dose Chest CT
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1. Which of the following statements is true regarding pulmonary cancers
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B. NSCLC progresses from non-solid to solid, growth rate may increase dramatically
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2. All of the following are true in regards to the progression of lung cancer, except
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D. If the primary tumor extends locally and initial growth slow, the neoplasm is most likely non-lethal
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1. A male nonsmoker presents with 6 month hx of headache, has lost 10 lbs in past 6 months, and a 2 week hx of chest pain and cough. Chest CT shows a peripheral mass that upon biopsy has a glandular structure and is associated with a peripheral scar. Activation of which gene is associated with a worse prognosis for this tumor?
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A. K-RAS
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2. A 62 year old male who has a 24 pack year history of smoking, but quit 8 years ago presents for early screening for lung cancer. A non-contrast spiral CT is performed and a 1cm mass is noted in the right upper lobe. Based upon the Early Lung Cancer Action Project guidelines, what is the next appropriate management step?
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C. Follow up screening CT in 6 months
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1. Which of the following is not a criterion for when to perform a lung biopsy for suspected lung cancer?
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D. Mass within 1 cm of SVC
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2. 65 y/o male presents to your clinic with cough and hemoptysis that presented within the last 3 months. He also admits to 10lb unintentional weight loss. He denies past smoking or tobacco exposure. He denies chest pain or fever or any recent infections.
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D. Adenocarcinoma
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1. A 43-year old caucasian female presents to the clinic with cough and hemoptysis. Patient has a 25 pack year smoking history and admits to a 10lb weight loss in the past 2 months. Chest X-ray shows a peripheral lesion, and lung biopsy reveals glandular structures and mucin. Which of the following mutations is most likely to be contributing to this patient's pathology?
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C. KRAS
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2. 63 year old male with a 20 year history of smoking a pack of cigarettes per day presents with cough, weight loss, abdominal pain and history of kidney stones. His chest X-Ray reveals a central coin lesion mass in the left lung. Which of the following cancers could this patient most likely have?
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C. Squamous Cell Lung Cancer
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A 68 year-old patient receives a chest X-ray for an unrelated complaint which reveals multiple centrally-located neoplasms. What is the most likely etiology of these neoplasms?
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D. Metastatic cancer - #1 overall lung cancer incidence (ahead of primary lung cancers), multiple lesions
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Rupert Heimelstein, 85 yo German retired military officer, presents at the ED with dyspnea, fatigue, and a non-productive cough for the past 2 months. He denies fever, chills, recent infections. He has come to the hospital because his voice is now becoming hoarse and he can't sing his favorite Boyz II Men hits in the shower anymore. He has smoked a pack per day for the past 30 years. A chest radiograph was done and a small "coin" lesion was found. What is the next appropriate step in diagnosis?
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A. Check past CXR films for evidence of lesions - According to Harrison's, the best diagnostic approach for suspected cancerous nodule is to look at past radiographs
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1. 50 year old male shipyard engine room worker, with 20 year pack smoking history experienced a recent femur fracture. He was also found to have a central lung lesion. Genetic testing shows a p16 INK4A mutation. This was identified as Stage 2 Lung Cancer. Which of these sites is NOT a common site for metastasis for this cancer?
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C. Myocardium
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2. The above patient develops a pericardial effusion. What would you expect to find in the thoracentesis fluid?
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A. pleural fluid protein/serum protein ratio 0.7, pleural fluid LDH/serum LDH ratio 0.9
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3. A 55 year old female with a 35 year pack history presents to the clinic with dyspnea, fatigue, night sweats, weight loss, and non-productive cough. Long-term smoking causes what characteristic progression of respiratory epithelium development?
answer
A. Hyperplasia-> Metaplasia-> Dysplasia
question
1. Tom Johnson III is a 65 year old male presenting to your clinic with a chief complaint of cough, chest pain and a recent loss of ten pounds weight. He is a 50 pack year smoker who recently quit six months ago. When he enters your office room and sits down he complains of a large number of sharp pains in his back upon sitting, as well as having had an upset stomach for the past week. On physical exam, he appears cachectic and lethargic with wheezing heard on auscultation. A chest x-ray is ordered revealing a hilar mass arising bilaterally, and laboratory studies reveal: Na+: 105, Cl-: 98, K+: 3.8, Ca++: 14.5. You subsequently order a sputum for cytology with results pending. What laboratory blood test would most likely confirm the patient's hypercalcemia?
answer
B. PTHrP
question
2. Tom Johnson III is a 65 year old male presenting to your clinic with a chief complaint of cough, chest pain and a recent loss of ten pounds weight. He is a 50 pack year smoker who recently quit six months ago. When he enters your office room and sits down he complains of a large number of sharp pains in his back upon sitting, as well as having had an upset stomach for the past week. On physical exam, he appears cachectic and lethargic with wheezing heard on auscultation. A chest x-ray is ordered revealing a hilar mass arising bilaterally, and laboratory studies reveal: Na+: 105, Cl-: 98, K+: 3.8, Ca++: 14.5. You subsequently order a sputum for cytology with results pending. . Histology of the tumor most likely reveals:
answer
A. Keratin pearls and intracellular bridges
question
1) 63 year old Indian female patient presents with flushing, diarrhea, wheezing, salivation and lower extremity edema. Her labs show elevated serotonin, and chest CT shows fibrous deposits on the right heart valve which is contributing to her tricuspid insufficiency. She has a 80 pack year history of smoking. What type of cancer is most likely.
answer
B. Carcinoid tumor
question
2) A 70 year old Caucasian female with a 60 pack year smoker visits her PCP due to weight gain and hempotysis. On physical exam, patient has thin extremities, truncal obesity, buffalo hump, and abdominal purple striae. CXR shows a hilar lesion. What is the most likely diagnosis?
answer
A. Small cell (oat) carcinoma
question
1) Which carcinogen found in cigarette smoke is known to mutate p53?
answer
E. BPDE
question
2) What is the first line screening approach to lung tumor detection?
answer
D) Low-dose, non-contrast, spiral CT scan of the chest
