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Old 09-24-2012
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Arrow Belindalimm Daily Questions: Pathology #14

A 65-year-old Caucasian male comes to your office because of loss strength when trying to carry stuffs. He also admits observing bloody-tinted sputum after cough. The patient's medical history is significant for cigarette smoking, 1 pack daily for more than 20 years. Thoracic X-ray shows a mass located in the upper lobe of right lung. Which of the following diseases you can expect in this patient's scenario?

A. Polymyalgia rheumatica
B. Polymyositis
C. Myasthenia gravis
D. Lambert-Eaton syndrome
E. Osteoarthritis
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Old 09-24-2012
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D. Lambert-Eaton syndrome..seems small cell lung ca
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Old 09-24-2012
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D paraneoplasic synd
eaton lambert
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Old 09-24-2012
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i'll go with D) lambert eaton-----proximal muscle weakness..defect in presynaptic neurotransmitter(ach) receptors....often associated with small cell ca. of lung
often pain improves by use
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Old 09-24-2012
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Default D. Lambert-Eaton syndrome

Quote:
Originally Posted by belindalimm View Post
A 65-year-old Caucasian male comes to your office because of loss strength when trying to carry stuffs. He also admits observing bloody-tinted sputum after cough. The patient's medical history is significant for cigarette smoking, 1 pack daily for more than 20 years. Thoracic X-ray shows a mass located in the upper lobe of right lung. Which of the following diseases you can expect in this patient's scenario?

A. Polymyalgia rheumatica
B. Polymyositis
C. Myasthenia gravis
D. Lambert-Eaton syndrome
E. Osteoarthritis
i would go with

D. Lambert-Eaton syndrome
but it involves small cell carcinoma association
So by upper lobe of right lung doesn't exactly specify is it central of on apex right?
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Old 09-25-2012
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Default my answer :)

D. Lambert-Eaton syndrome
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Old 09-25-2012
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Default

Quote:
Originally Posted by belindalimm View Post
A 65-year-old Caucasian male comes to your office because of loss strength when trying to carry stuffs. He also admits observing bloody-tinted sputum after cough. The patient's medical history is significant for cigarette smoking, 1 pack daily for more than 20 years. Thoracic X-ray shows a mass located in the upper lobe of right lung. Which of the following diseases you can expect in this patient's scenario?

A. Polymyalgia rheumatica
B. Polymyositis
C. Myasthenia gravis
D. Lambert-Eaton syndrome
E. Osteoarthritis
Ans: D
Polymyalgia associate with Giant cell arteritis. Polymyositis: muscle pain heliotrope grottons patches, no skin involvement unlike dermatomyositis.Myasthenia not related to blood tinted sputum. OA doesnt fit. small lung ca produce paraneoplastic synd --Lambert Eaton ( antibody against calcium channels) where muscle weakness is a feature. Unlike Myasthenia repeatitive use of muscle won't produce fatigue in Lambert Eaton.
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Old 09-25-2012
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Lambert Eaton!! paraneoplastic syndrome of lung carcinoma!!
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Old 09-25-2012
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Default Yes, the answer is D

The patients is a heavy smoker and has a lung mass shown on X-ray, both of these two evidence give us the clue of lung cancer. Besides, he also presents weakness of upper extremities strength. All of the above makes us think of paraneoplastic syndrome: in this case it is the lung cancer throw the effect. Autoantibodies to the Ca2++ channel leads to decrease in Ach release, further causing muscular weakness.
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Old 09-25-2012
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Default The answer is D

Lambert-Eaton syndrome may occur with cancers such as small cell lung cancer ....
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Old 09-26-2012
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I disagree Eaton Lambert Syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, posttetanic potentiation, and autonomic changes. The initial presentation can be similar to that of myasthenia gravis (MG), but the progressions of the 2 diseases have some important differences.
In 40% of patients with LEMS, cancer is present when the weakness begins or is found later. This is usually a small cell lung cancer (SCLC), although LEMS has also been associated with non-SCLC, lymphosarcoma, malignant thymoma, or carcinoma of the breast, stomach, colon, prostate, bladder, kidney, or gallbladder.
Clinical manifestations frequently precede cancer identification. In most cases, the cancer is discovered within the first 2 years after onset of LEMS and, in virtually all cases, within 4 years.
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