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Old 01-16-2013
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Default can anyone help me with this question pls?

. A 67-year-old man comes to the physician for a follow-up examination. Three years ago, he underwent radical resection of a T3 N0 M0 epidermoid carcinoma of the floor of his mouth and supraomohyoid dissection of his neck. He currently takes no medications. He smoked three packs of cigarettes daily for 40 years but stopped 3 years ago. Vital signs are within normal limits. Examination shows well-healed surgical scars. There are no signs of local recurrence. An x-ray of the chest shows a 3-cm mass in the medial upper lobe of the right lung. Which of the following is the most likely cause of these findings?

A
) Bronchioalveolar carcinoma of the lung

B
) Metastatic carcinoma

C
) Obstructive pneumonia

D
) Primary squamous cell carcinoma of the lung

E
) Sarcoidosis
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  #2  
Old 01-16-2013
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Default D?

DD...hx of 120 pack years of smoking
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Old 01-16-2013
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I'd go with D as well. the guy has a strong history of smoking. it takes 7 years to have stopped smoking to get your risk of lung cancer to CLOSE to that of a non-smoker. this guy is only 3 yrs out

A. bronchioalveola ca of lung- a/w with non-smokers. eventhough this is the MC cancer overall, the stem didnt give you enough info to tell you that this is bronchioalveolar ca instead of squamous cell. and since this guy is a smoker, squamous cell is more likely
B. mets: would see more than 1 lesion. also his primary oral cancer had no mets to begin with and was excised
C. obstructive pneumonia: would be caused by cancer or atelectasis or something of that sort. this guy has no evidence of atelectasis. pneumonia wouldnt be "3cm mass". it was be more of a " lobar consolidation"
E. sarcoidosis: not the answer bc sarcoidosis is common in women (this is a dude.) the question stem doesnt describe any sx of sarcoidosis or the classic "B/L hilar lymphadenopathy"
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Old 01-16-2013
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Quote:
Originally Posted by USMLE234 View Post
I'd go with D as well. the guy has a strong history of smoking. it takes 7 years to have stopped smoking to get your risk of lung cancer to CLOSE to that of a non-smoker. this guy is only 3 yrs out

A. bronchioalveola ca of lung- a/w with non-smokers. eventhough this is the MC cancer overall, the stem didnt give you enough info to tell you that this is bronchioalveolar ca instead of squamous cell. and since this guy is a smoker, squamous cell is more likely
B. mets: would see more than 1 lesion. also his primary oral cancer had no mets to begin with and was excised
C. obstructive pneumonia: would be caused by cancer or atelectasis or something of that sort. this guy has no evidence of atelectasis. pneumonia wouldnt be "3cm mass". it was be more of a " lobar consolidation"
E. sarcoidosis: not the answer bc sarcoidosis is common in women (this is a dude.) the question stem doesnt describe any sx of sarcoidosis or the classic "B/L hilar lymphadenopathy"
That is a good analysis..thank you..
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Old 01-16-2013
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Quote:
Originally Posted by USMLE234 View Post
I'd go with D as well. the guy has a strong history of smoking. it takes 7 years to have stopped smoking to get your risk of lung cancer to CLOSE to that of a non-smoker. this guy is only 3 yrs out

A. bronchioalveola ca of lung- a/w with non-smokers. eventhough this is the MC cancer overall, the stem didnt give you enough info to tell you that this is bronchioalveolar ca instead of squamous cell. and since this guy is a smoker, squamous cell is more likely
B. mets: would see more than 1 lesion. also his primary oral cancer had no mets to begin with and was excised
C. obstructive pneumonia: would be caused by cancer or atelectasis or something of that sort. this guy has no evidence of atelectasis. pneumonia wouldnt be "3cm mass". it was be more of a " lobar consolidation"
E. sarcoidosis: not the answer bc sarcoidosis is common in women (this is a dude.) the question stem doesnt describe any sx of sarcoidosis or the classic "B/L hilar lymphadenopathy"
Very intellectual and well put. Appreciate you taking time out of your studying to write. Thanks and good luck.
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