QuestionSBA
QuestionChoice
This is correct. The following aspects of the history make this the most likely answer:
* Age of the patient- adenocarcinoma is the most common lung cancer subtype in patients aged under 45
* Sex of the patient- adenocarcinoma is more common in women
* Smoking status of the patient- adenocarcinoma is the most common lung cancer subtype in non-smokers
* Pleural effusion on chest x-ray: adenocarcinomas commonly cause pleural effusion
10025905
a
Adenocarcinoma
QuestionChoice
This is incorrect. Small cell carcinoma is commonly seen alongside paraneoplastic syndromes such as the syndrome of inappropriate antidiuretic hormone (SIADH), Cushing's syndrome or Lambert Eaton myasthenic syndrome. With no indication of paraneoplastic syndromes, adenocarcinoma is a more likely underlying diagnosis.
10025907
c
Small cell carcinoma
QuestionChoice
This is incorrect. Large cell carcinoma is a poorly differentiated subtype of lung cancer which is often a diagnosis of elimination. This is more common in men and has a strong relationship with smoking. It is associated with beta-hCG secretion and can cause gynaecomastia. It is less common than adenocarcinoma.
10025909
e
Large cell carcinoma
QuestionChoice
This is incorrect. Squamous cell carcinoma is strongly associated with cigarette smoking and cavitations on imaging. This subtype is also associated with paraneoplastic syndromes including ectopic parathyroid hormone secretion (hypercalcaemia) and hypertrophic pulmonary osteoarthropathy (which involves painful, swollen joints).
10025908
d
Squamous cell carcinoma
QuestionChoice
This is incorrect. Whilst mesothelioma is commonly associated with pleural effusions, it is strongly associated with occupational exposure to asbestos which this patient does not have. There is a median latency period of 40 years, meaning it would be extremely rare to see this condition in a 43 year old.
10025906
b
Mesothelioma
Concept
Chapter
2693
3702
Lung Cancer
Topic
132
Respiratory
17579
A 43 year old female patient presents to A&E with acute breathlessness and haemoptysis. She has had a cough for around 3 months and has required treatment for five chest infections over the last 6 months. She reports 2 stone of unintentional weight loss across this period.

Her past medical history includes osteoarthritis of the right hip, for which she takes occasional paracetamol. She has never smoked and drinks alcohol rarely. She denies any exposure to asbestos.

A chest x-ray shows a right-sided mass associated with mediastinal lymphadenopathy and pleural effusion in the right lower lung field.

Which of the following is the most likely underlying diagnosis?
a