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  #1  
Old 11-04-2012
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Arrow Billy Step 1 Questions # 75

A 64-year-old man, who is a chain smoker, sees his physician because he had had a cough and a 5-kg weight loss over the past 3 months. Physical examination shows clubbing of the fingers. He 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. Bronchoscopy shows a lesion almost occluding the right main stem bronchus. A biopsy is performed. Based on the pathologist's report and further testing, including chest and abdomen CT and bone scans, the patient is told that a surgical procedure with curative intent would be attempted. Which of the following neoplasms is most likely to be present in this patient?


□ (A) Adenocarcinoma
□ (B) Bronchioloalveolar carcinoma
□ (C) Kaposi sarcoma
□ (D) Large-cell carcinoma
□ (E) Metastatic renal cell carcinoma
□ (F) Non-Hodgkin lymphoma
□ (G) Small-cell carcinoma
□ (H) Squamous cell carcinoma
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Old 11-04-2012
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H) sq.cell ca.---PTH rp

small cell ca.--chemo treatment

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Old 11-04-2012
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Quote:
Originally Posted by billy View Post
A 64-year-old man, who is a chain smoker, sees his physician because he had had a cough and a 5-kg weight loss over the past 3 months. Physical examination shows clubbing of the fingers. He 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. Bronchoscopy shows a lesion almost occluding the right main stem bronchus. A biopsy is performed. Based on the pathologist's report and further testing, including chest and abdomen CT and bone scans, the patient is told that a surgical procedure with curative intent would be attempted. Which of the following neoplasms is most likely to be present in this patient?


□ (A) Adenocarcinoma
□ (B) Bronchioloalveolar carcinoma
□ (C) Kaposi sarcoma
□ (D) Large-cell carcinoma
□ (E) Metastatic renal cell carcinoma
□ (F) Non-Hodgkin lymphoma
□ (G) Small-cell carcinoma
□ (H) Squamous cell carcinoma
H)scc-hypercalcemia-PTHrP
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  #4  
Old 11-04-2012
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Default my answer H

The answer is H , but atypical localization of the tumor (normally peripheral localization)

cavitation within a 3-cm lesion near the right hilum
Bronchoscopy shows a lesion almost occluding the right main stem bronchus
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My answer is HH too...........
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Old 11-05-2012
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Default my answer :)

(H) Squamous cell carcinoma- PTH-related peptide
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Old 11-05-2012
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squmaous-cell carcinoma
of lung
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Old 11-05-2012
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Correct Answer H is correct

Of all lung cancers, squamous cell carcinoma is the one most likely to produce paraneoplastic hypercalcemia, and there is a strong association with smoking. These tumors also can undergo central necrosis—hence a cavity may form. Localized squamous cell carcinomas, in contrast to small-cell carcinomas, may be cured by surgery. Adenocarcinomas,
bronchioloalveolar carcinomas, and large-cell carcinomas tend to produce peripheral masses and generally are not associated with paraneoplastic syndromes. Kaposi sarcoma involving visceral organs is most often seen in association with AIDS, and it is often multifocal. Renal cell carcinomas may be associated with hypercalcemia, but metastases usually appear as multiple masses (although of all metastatic tumors, renal cell carcinoma is most likely to produce solitary metastases). Non-Hodgkin lymphomas generally do not have paraneoplastic effects; they are uncommon in the lung and are not associated with smoking. Small-cell carcinomas are never localized enough for curative surgery (they are usually detected at an advanced stage), although they often produce various paraneoplastic syndromes, but not hypercalcemia.
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