Lung Nodule

29 Questions | Total Attempts: 71

SettingsSettingsSettings
Please wait...
Lung Nodule

Questions from small group to help prepare for Course 3 exam


Questions and Answers
  • 1. 
    A 47 year old bus driver presents to a family practice office with cough for one month and right shoulder pain for 2 months.  He assumed that the shoulder pain was due to a pulled muscle but it did not respond to anti inflammatory medications and seems to be worsening.  Regarding the cough, it is new, dry, mostly during the day and is not associated with any hemoptysis.  the patient denies dyspnea.  He smokes 1 pack per day for the past 30 years.  No other past medical history, family history or allergies.  On exam, vitals are normal, chest exam reveals some reduced air entry over the right anterior chest.  all else is normal.All of the following are found on the radiograph EXCEPT
    • A. 

      RUL opacity at apex

    • B. 

      No adenopathy

    • C. 

      No lesions

    • D. 

      The affected area is well seen on the lateral

  • 2. 
    Why would it be important to ask the patient about ptosis/myosis/anhydrosis?
    • A. 

      Brachial plexus involvement

    • B. 

      Mediastinal adenopathy

    • C. 

      Metastatic spread

    • D. 

      Horner's syndrome

  • 3. 
    CT reveals RUL mass at apex, no mediastinal lymph node enlargement, and the above (right adrenal gland enlargement).  Bone scan reported right 2nd rib uptake consistent with direct rib invasion.  What test would you do next?
    • A. 

      Biopsy lung mass

    • B. 

      Biopsy adrenal gland mass

    • C. 

      Biopsy bone mass

    • D. 

      PET scan

  • 4. 
    Right adrenal gland biopsy (CT guided needle aspirate) confirms squamous cell carcinoma/non-small cell lung cancer.  What is the stage of the cancer, using the TNM staging system?
    • A. 

      Stage I

    • B. 

      Stage II

    • C. 

      Stage III

    • D. 

      Stage IV

  • 5. 
    What treatment options may be offered? (check all that apply)
    • A. 

      Surgery

    • B. 

      Radiation

    • C. 

      Chemotherapy

    • D. 

      Homeopathic remedies

    • E. 

      Supportive care

  • 6. 
    What is his prognosis (median survival)?
    • A. 

      3 years

    • B. 

      5 years

    • C. 

      5 months

    • D. 

      9 months

  • 7. 
    A 32 year old woman presents with fever, cough and sore throat for 5 days.  She also complains of right pleuritic chest pain.  While waiting in the ER she reports feeling improved and wants to go home, but CXR is found to be abnormal.The CXR shows a solitary pulmonary nodule, less than 3cm and no other lesions.  According to the scheme for lung nodule, which of the following is NOT on the DDx for a solitary nodule?
    • A. 

      Neoplasm

    • B. 

      Granuloma

    • C. 

      PE

    • D. 

      Hamartoma

  • 8. 
    She is a life-long non-smoker, no old x-rays, no constitutional symptoms, review of systems is negative, no recent travel, and no previous cancer.  Which TWO of the following are LEAST likely the cause of the nodule?
    • A. 

      Malignant tumour - small cell or non-small cell

    • B. 

      Malignant tumour - carcinoid

    • C. 

      Benign tumour - hamartoma

    • D. 

      Benign tumour - chondroma

    • E. 

      Infectious - healed granuloma

    • F. 

      Infectious - abscess

    • G. 

      Infectious - rounded pneumonia

    • H. 

      Inflammatory

    • I. 

      Vascular - arterio-venous malformation (AVM)

  • 9. 
    What investigaton would you order next?
    • A. 

      Biopsy

    • B. 

      Scope

    • C. 

      Chest CT

    • D. 

      Bone scan

  • 10. 
    Chest CT reveals:  CT chest reveals a lobular/tubular structure with a "feeding vessel", which enhances with contrast ejection.  Which of the following diagnoses is consistent with the results of the CT?
    • A. 

      Carcinoid tumour

    • B. 

      Hamartoma

    • C. 

      Chondroma

    • D. 

      Rounded pneumonia

    • E. 

      Arterio-venous malformation

  • 11. 
    ABG: 7.39/40/62/24  Why is this patient hypoxemic?
    • A. 

      Hypoventilation

    • B. 

      Low FiO2

    • C. 

      Shunt

    • D. 

      Diffusion defect

    • E. 

      V/Q mismatch

  • 12. 
    All of the following are complications of pulmonary AVM EXCEPT
    • A. 

      Massive hemoptysis

    • B. 

      Hemothorax

    • C. 

      Hypoxemia

    • D. 

      Systemic abscess

    • E. 

      PE

    • F. 

      Stroke

  • 13. 
    The Natural History of AVM is that...
    • A. 

      Lesions tend to regress with time and rarely grow

    • B. 

      Lesions tend to grow with time and rarely regress

    • C. 

      Lesions multiply rapidly

  • 14. 
    To confirm diagnosis, you would:
    • A. 

      Scope

    • B. 

      Biopsy

    • C. 

      Angiogram

    • D. 

      PET scan

  • 15. 
    Which elements of patient's family history is significant with this type of finding?
    • A. 

      Hereditary Hemorrhagic Telangiectasia

    • B. 

      Osler-Weber Rendu Syndrome

    • C. 

      Both

    • D. 

      Neither

    • E. 

      One or both...they're the same thing

  • 16. 
    A 68-year-old male presents with increasing cough and sputum production, slight fever, no rigors, and mild dyspnea.  Interpret the chest x-ray
    • A. 

      Left hilar/mediastinal mass

    • B. 

      Right hilar/mediastinal mass

    • C. 

      Pneumothorax

    • D. 

      Pneumonia

  • 17. 
    Further history revealed 72-96 pack-years.  Occasional blood streaked sputum 2-3 months. 14 pound weight loss over 2 months, appetite poor 3 months.  Can climb 2-3 flights of stairs without problems, and has stable angina on exertion, nitro 2 times per week on average.  No MI, angioplasty/stent 2 years previous.  Physical exam normal other than reduced air entry into left upper lobe.  Which of the following is least likely to fit on the DDx?
    • A. 

      Lung cancer

    • B. 

      Metastatic cancer

    • C. 

      Lymphoma

    • D. 

      Rheumatoid

    • E. 

      TB

    • F. 

      Fungus

  • 18. 
    What test would you do next?
    • A. 

      CT chest

    • B. 

      Bronchoscopy

    • C. 

      CT guided biopsy

    • D. 

      All of the above

    • E. 

      A and B

  • 19. 
    CT CHEST revealed extensive mediastinal adenopathy with small left lower lobe nodule.  BRONCHOSCOPY shows endoluminal abnormalities which prove to be small cell lung cancer on pathology.  Head CT, Ct abdo/adrenals, bone scan are all normal.  Abnormalities on bone scan are felt to be inflammatory.  What is the stage of his carcinoma?
    • A. 

      Stage II

    • B. 

      Stage III

    • C. 

      Stage IV

    • D. 

      Limited

    • E. 

      Extensive

  • 20. 
    What is the significance of his hoarseness?
    • A. 

      Suggests Recurrent Laryngeal Nerve involvement

    • B. 

      Metastatic involvement of the Mediastinal Lymph nodes

    • C. 

      The patient is not a candidate for surgical resection

    • D. 

      All of the above

  • 21. 
    True or False: this patient requires medistinoscopy
    • A. 

      True

    • B. 

      False

  • 22. 
    True or False: small cell cancers can be treated with surgery
    • A. 

      True

    • B. 

      False

  • 23. 
    What type of treatment would you offer this patient?
    • A. 

      Chemotherapy

    • B. 

      Radiation

    • C. 

      Chemo AND Radiation

    • D. 

      Surgery

  • 24. 
    What is the median survival for treated, limited small cell lung cancer?
    • A. 

      16-20 months

    • B. 

      3 months

    • C. 

      6 weeks

    • D. 

      9 months

  • 25. 
    What types of paraneoplastic syndromes can be caused by this tumour?
    • A. 

      Neurologic

    • B. 

      Hormonal

    • C. 

      Cutaneous

    • D. 

      All of the above