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On a routine check-up, a 65-year-old woman with recently diagnosed adenocarcinoma of the lung is found to have drooping of the right eyelid. Pupillary examination reveals anisocoria with the right pupil smaller than the left. Upon further questioning she reveals that after exerting herself she has to mop the sweat off of her left brow, but does not notice any sweat on her right side. Which of the following is the most likely etiology of the patient’s symptoms?
(A) Apical lung tumor
(B) Graves’ disease
(C) Myasthenia gravis
(D) Paraneoplastic endocrine hormone production
(E) Superior vena cava obstruction
 

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A- apical tumor. That s Pancoast tumor affecting cervical sympathetic plexus,( Horner syndrome with lesion above T1)
 
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