14. Pulm. Path-7

Question 1

A 49 year old smoker has been complaining of chronic cough and weight loss. An CXR is performed showing central tumor growth. Histological samples are taken showing keratin pearls What else would likely be found on the histological examination?

A. Ciliated Columnar epithelium 
B. Increased mucin production 
C. Pleural thickening 
D. Intercellular bridges 
E. Crush Artifacts 

RFA

Answer 1

Ans. D. The patient has squamous cell carcinoma as classically present by keratin pearls and central tumor growth also is notable for intercellular bridges

A. Ciliated columnar epithelium- this is what squamous cell metaplasia from

B Describes Adenocarcinoma

C. Describes Mesothelioma

E. Describes Small Cell Carcinoma

Question 2

A 49 year old smoker has been complaining of chronic cough and weight loss. An CXR is performed showing central tumor growth. Histological samples are taken showing keratin pearls . What drug is contraindicated in this patient?

A. Getifinib 
B. Pemetrexed 
C. Crizotinib 
D. Erlotinib 
E.Bevacizumab

RFA

Answer 2

ANS. E. Bevacizumab- The vinnet is just like the guy in my other question he has squamous cell carcinoma and Bevacizumab is contraindicated in patients with squamous cell carcinoma because it can lead to life threatening hemorrhage.

A. & D Getifinib & Erlotinib - used for advance lung adenocarcinoma or unspecified NSCLC with EGFR mutation. Both work as tyrosine kinase inhibitors

B. Pemetrexed- patients with NSCLC or adenocarcino

C. Crizotinib- is a protein kinase inhibitor or EML4/ALK fusion, found in 45% of NSCLC patients

Question 3

A 45 y/o female presents to the ED with flushing, diarrhea, vomiting, and cyanosis. She c/o having frequent asthma attacks over the last month. She is diagnosed with a lung tumor and histology shows cell nests, neuroendocrine nuclear chromatin (salt and pepper like). Which of the following would also be present on labs?

A. Hypercalcemia
B. 5HiAA in urine
C. Elevated PTH
D. ADH
E. Hyponatremia

SZ

Answer 3

Ans. B 5HIAA in urine

Patient has a carcinoid tumor of the lung. It produces serotonin, histamine, bradykinin, and prostaglandins

Hypercalcemia and PTH = squamous cell

ADH and hyponatremia = small cell carcinoma

Question 4

Which of the following is best treated with gefitnib and erlotinib?

A. EGFR mutation 
B. KRAS mutation
C. EML4/ALK fusion 
D. Non-small Cell 
E. Squamous Cell 

SZ

Answer 4

Ans. A and D

EGFR mutations in non small cell carcinomas

Question 5

A 30 year old female never-smoker presents with dyspnea and increased mucus production. Histological inspection of her lungs shows lepidic growth of a neoplasm along alveolar septae. Diagnosis? (MG)

A. Oat cell carcinoma
B. Adenocarcinoma in situ
C. Large cell carcinoma
D. Squamous cell carcinoma of the lung
E Bronchial carcinoid tumor

Answer 5

B. Adenocarcinoma in situ

lepidic = butterflies on the wall
highly differentiated so it’s making mucus

Question 6

You are given a CT and told the patient is a male smoker. The scan shows bilateral hilar lymphadenopathy and a centrally located mass. If the patient also has central necrosis and cavitation of the lungs, which neoplasm is most likely? (MG)

A. Oat cell carcinoma
B. Adenocarcinoma in situ
C. Large cell carcinoma
D. Squamous cell carcinoma of the lung
E Bronchial carcinoid tumor

Answer 6

D. Squamous cell carcinoma of the lung

could also see obstruction, atelectasis, or infection