QuestionSBA
QuestionChoice
Non-small cell lung cancers are the most common overall forms of lung cancer. Squamous cell carcinoma is one type of non-small cell lung cancer, and has a strong association with smoking. The presence of a hilar mass makes a lung lesion most likely, and the associated symptoms of weight loss and fatigue support a diagnosis of cancer. Squamous cell cancers develop in the cells lining the airways and are typically found near the hilum/main bronchi. These lesions can sometimes obstruct the airways and may press on nearby structures causing dysphagia and hoarseness. Squamous cell lung cancer is associated with parathyroid-related peptide (PTHrP), which would explain the hypercalcaemia in this patient.
10006846
a
Squamous cell lung cancer
QuestionChoice
Patients with sarcoidosis typically present with a dry cough, shortness of breath and non-pulmonary features such as erythema nodosum and fever. A chest X-ray would demonstrate bilateral hilar lymphadenopathy and patients are typically significantly younger than this patient. Sarcoidosis is associated with weight loss and hypercalcaemia.
10006849
d
Sarcoidosis
QuestionChoice
Small cell lung cancers make up a relatively small portion of all lung cancers (10-20%), and are considered a highly aggressive form of lung cancer. Patients typically present in the advanced stage of the disease, with metastases seen in the majority of presenting patients. This patient has had non-specific symptoms for six months which would make small-cell lung cancer less likely. It is also associated with neuroendocrine cells resulting in paraneoplastic syndromes such as SIADH (ectopic ADH secretion).
10006847
b
Small cell lung cancer
QuestionChoice
Infection within the lung can cause the appearance of a mass in the lung. However, the prolonged history of shortness of breath and cough, the presence of red-flag symptoms such as unintentional weight loss, and the lack of fever make the diagnosis of pneumonia unlikely.
10006850
e
Pneumonia
QuestionChoice
Adenocarcinoma is the most common lung cancer in non-smokers and is often associated with asbestos exposure. It is less likely to present as a paraneoplastic syndrome.
10006848
c
Adenocarcinoma
Concept
Chapter
2693
3702
Lung Cancer
Topic
132
Respiratory
13916
A 73-year-old woman presents with a two-month history of shortness of breath, productive cough and chest pain. For the past six months, she has been feeling progressively more tired and has had 10kg of unintentional weight loss. She has a past medical history of hypertension, for which she takes amlodipine. She is retired, although previously worked as an accountant, and has a 45 pack-year history of smoking. A chest X-ray is ordered which shows a right hilar mass. Blood tests demonstrate hypercalcaemia.

What is the most likely diagnosis?
a