Internal-Medicine

Questions: 53–62 251
58. A 66-year-old man with a 40-pack-per-year history
of smoking is investigated for hemoptysis.
CXR reveals a central 3-cm mass near the left
bronchus. His serum biochemistry is abnormal
for elevated calcium, but there is no boney
metastasis on the bone scan. Biopsy of the mass
is positive for a type of lung cancer associated
with paraneoplastic hypercalcemia. (SELECT
ONE)
59. A 55-year-old woman presents with symptoms
of fever, chills, and colored sputum production.
She is a former 40-pack-per-year smoker.
Her CXR is abnormal for a 2-cm right hilar
mass and right lower lobe infiltrate. She is
started on antibiotics and a biopsy of the hilar
mass is positive for a type of lung cancer responsive
to cytotoxic chemotherapy. (SELECT ONE)
60. A 71-year-old man is having an elective left
total knee replacement, when a routine preoperative
CXR finds a solitary lung mass. He has
no other symptoms related to the lung mass.
His surgery is cancelled and a biopsy of the
lung mass is positive for a type of cancer that
can potentially be cured by surgery. (SELECT
FOUR)
seizures, and her only new symptoms are
weight loss and anorexia. She looks unwell and
cachectic, and the remaining examination is
normal. Her serum sodium is 112 mEq/L,
osmolality 260 mOsm/kg, and urine osmolality
420 mOsm/kg. Her CXR is abnormal for a
large left hilar mass. She has a 30-pack-peryear
history of smoking. Biopsy of the mass is
positive for a lung cancer most commonly
associated with ectopic endocrine syndromes.
(SELECT ONE)
62. A 58-year-old man comes to the emergency
department because of left shoulder pain radiating
down his left arm. His only risk factor for
cardiac disease is hypertension and a 30-packper-year
smoking history. On examination, his
blood pressure is 150/90 mm Hg in both arms,
pulse 100/min, and heart sounds are normal.
He also has ptosis of his left eyelid and a left
pupil that is smaller than the right. ECG is
normal, and a CXR shows a large left apical
mass with 1st and 2nd rib destruction. A biopsy
of the mass is consistent with lung cancer most
commonly associated with Pancoast’s syndrome.
(SELECT ONE)
61. A 58-year-old woman has a witnessed generalized
seizure. She has no prior history of