Exam 2

Question 1

What is Pancoast Tumor Syndrome?

SSX?

Answer 1

Tumor in the apex of the lung infiltrates the brachial plexus
• Sx: pain, numbness and weakness of the affected arm (thoracic outlet syndrome)
• may be involvement of adjacent vertebra and ribs

Question 2

What is Horner’s syndrome? SSX?

Answer 2

Involvement of cervical and thoracic sympathetic nerves

• Sx: ipsilateral miosis, ptosis, facial anhidrosis

Question 3

What is Superior vena cava syndrome? SSX?

Answer 3

Obstruction of venous drainage

• Sx: dilation of neck veins, neck and facial edema, redness

Question 4

Which of the following is incorrect regarding lung cancer?

a. Non-Small Cell Lung CA (NSCLC) behave similarly and are treated similarly
b. It can be divided into two major groups which make up more than 90% or lung cancer cases: SCLC and NSCLC
c. Small cell carcinomas are worse, but they respond to chemotherapy better
d. SCLC are more common and make up about 80% of cases
e. All of these are correct

Answer 4

INCORRECT: SCLC are more common and make up about 80% of cases

TRUE: NSCLC: More common (~ 80% of LCA)

Question 5

Which of the following is incorrect regarding lung cancers?

a. SCLC tends to grow faster than NSCLC
b. All of these are correct
c. There are 3 major types of NSCLC: Adenocarcinoma, Squamous cell carcinoma, and Large cell undifferentiated carcinoma
d. SCLC carries a greater risk of metastasis than NSCLC
e. SCLC is often called “oat cell” carcinoma

Answer 5

All of these are correct

Question 6

Which is not true about smoking?

a. The younger a person is when they start smoking, the greater risk they have of getting lung cancer
b. Bronchogenic carcinoma is any malignant neoplasm that arises in the lung tissue
c. As a general rule, the 5-year survival rate for lung cancer is 35%
d. Quitting for 10 years reduces the risk, but not to the level of a non-smoker

Answer 6

FALSE: As a general rule, the 5-year survival rate for lung cancer is 35%

TRUE: * 5-year survival rate is only 15%

Question 7

Which of the following is incorrect regarding small cell carcinoma

a. Paraneoplastic syndromes are common with SCLC
b. The first sign of SCLC may be a paraneoplastic syndrome
c. SCLC has a better prognosis than most lung cancers
d. All of the above are correct
e. Histologically, SCLC shows small dark staining epithelial cells with scant cytoplasm

Answer 7

INCORRECT: SCLC has a better prognosis than most lung cancers

TRUE: *SCLCs are generally worse, but respond better to chemotherapy!

Question 8

Which of the following is incorrect regarding lung cancer symptoms?

a. Chest pain occurs in about 10% of patients
b. Weight loss occurs in about 40% of patients
c. Dyspnea occurs in about 20% of patients
d. Cough is the most common symptom occuring in about 75% of patients
e. The usual clinical presentation of a patient with lung cancer is someone in their 50’s whose symptoms are of several months’ duration

Answer 8

INCORRECT: Chest pain occurs in about 10% of patients

TRUE:*Chest pain is a common Sx of Lung CA

Question 9

Which is incorrect about the location of certain types of cancers?

a. Adenocarcinomas usually occur in the periphery
b. SCLC may occur anywhere, but most commonly are found central near the hilum
c. Large cell undifferentiated carcinomas can occur anywhere in the lung
d. All these locations are correct
e. Squamous cell carcinomas usually present centrally

Answer 9

All these locations are correct

Question 10

Which is not correct regarding adenocarcinoma of the lung?

a. Adenocarcinoma can be described with the three P’s: Peripheral, Pigmented, Puckered
b. Adenocarcinoma is really a glandular epithelial tumor that produces mucin
c. Adenocarcinoma may first come to the physicians attention on a routine CXR, but often not before cancer has spread
d. Adenocarcinoma is is the most frequently diagnosed type of lung cancer accounting for about 1/3rd of cases
e. Adenocarcinoma tends to be poorly circumscribed and grows outward radially with finger-like projections

Answer 10

INCORRECT: Adenocarcinoma tends to be poorly circumscribed and grows outward radially with finger-like projections

TRUE: Adenocarcinoma described by the “three P’s” - peripheral, pigmented and puckered; Well circumscribed and may contain central necrotic cores

Question 11

Which of the following is incorrect regarding squamous cell carcinoma of the lung?

a. Squamous cell carcinoma is characterized by the presence of keritinization in the form of pearls or individual cells with eosinophilic dense cytoplasm
b. Squamous cell carcinoma arise from either the main, lobar or segmental bronchi
c. When central, squamous cell carcinomas of the lung presents later with symptoms than when it occurs at the periphery
d. It’s thought to be related to chronic inflammation and injury of bronchial ciliated columnar epithelium
e. All of the above are correct

Answer 11

INCORRECT: When central, squamous cell carcinomas of the lung presents later with symptoms than when it occurs at the periphery

TRUE: Central location of a tumor tends to have earlier symptoms than tumors at periphery

Question 12

Which of the following is incorrect regarding large cell carcinomas?

a. LCC is found in sheets as SCLC often is
b. All of the above are correct
c. LCC is a epithelial tumor with large nuclei and moderate amounts of cytoplasm
d. Is also called large cell undifferentiated carcinoma

Answer 12

INCORRECT: LCC is found in sheets as SCLC often is

TRUTH: LCC is NOT found in sheets

Question 13

Which of the following is incorrect regarding bronchial carcinoid tumors?

a. Bronchial carcinoid tumors are the most common primary lung neoplasm in children
b. All of the above are correct
c. Bronchial carcinoid tumors are considered a seperate type of lung neoplasm
d. Bronchial carcinoid syndrome may present with diarrhea, facial fluching and wheezing, but usually only if the patient has liver metastasis
e. Bronchial carcinoid tumors are strongly associated with smoking

Answer 13

INCORRECT: Bronchial carcinoid tumors are strongly associated with smoking

*Not associated with smoking!

Question 14

Which of the following is incorrect regarding epiglottitis?

a. The causal organisms in many cases is H. Influenzae
b. It’s signs and symptoms can be remembered as the 4 D’s
c. Some people have a high-riding epiglottis
d. It produces steeple sign on neck x-ray
e. Children 2-5 used to be most susceptible

Answer 14

INCORRECT: It produces steeple sign on neck x-ray

Tracheolaryngobronchitis (Croup) does that.

Question 15

Which of the following is incorrect regarding laryngitis and laryngeal polyps?

a. Singer’s nodules are unilateral, whereas polyps are bilateral
b. Laryngotracheobronchitis produces a steeple sign on neck x-ray
c. Can be causes by GERD
d. Laryngotracheobronchitis is often caused by parainfluenza virus
e. Laryngeal polyps essentially never transform to malignancies

Answer 15

INCORRECT: Singer’s nodules are unilateral, whereas polyps are bilateral

TRUE: *Singer’snodules–bilateral and Polyps–unilateral

Question 16

Which of the following is not true of pharyngitis?

a. Mononucleosis causes posterior cervical chain adenopathy
b. C. diptheriae often causes a gray exudate
c. GABHS typically causes anterior cervical lymphadenopathy
d. Viral pharyngitis produces no exudate, this is proven by mononucleosis
e. N. gonorrhoea pharyngitis often produces a greenish exudate

Answer 16

NOT TRUE: Viral pharyngitis produces no exudate, this is proven by mononucleosis

*Mono is often concomitant with tonsillitis, in which there is a whitish exudate.

Question 17

Which of the following is not true of bacterial pharyngitis or ARF?

a. Peritonsilar abscesses have greater potential for airway obstruction than do retropharyngeal or parapharyngeal abscesses
b. Peritonsillar abscesses can produce a “hot potato voice”
c. ARF is thought to be caused when antigen cross reactivity occurs between the M proteins on GABHS and epitopes of cardiac myosin and laminin
d. AFR is the leading cause of cardiovascular related death in the first five decades of life
e. ARF results from GAS Pharyngitis only

Answer 17

NOT TRUE: Peritonsilar abscesses have greater potential for airway obstruction than do retropharyngeal or parapharyngeal abscesses

TRUE: *Retro/para-pharyngeal abscesses have a greater potential for airway obstruction than peritonsilar abscesses.

Question 18

Which of the following statements about vertigo is incorrect?

a. Ramsay Hunt Syndrom can also cause vertigo
b. BPPV is the most common cause of recurrent vertigo arising from the middle ear
c. Displaced otoliths stimulate CN VIII hair cells and create the sensation of movement
d. BPPV can be confused with Meniere’s because both can cause hearing loss
e. One difference distinguishing between labyrinthitis and BPPV is often made based upon whether the person has had a viral infection preceding the illness

Answer 18

INCORRECT: BPPV can be confused with Meniere’s because both can cause hearing loss

BPPV and Meneire’s are often confused because they both involve a lack of balance

Question 19

Which of the following is incorrect regarding oral pathologies?

a. Irritation fibromas can be differentated from pyogenic granulomas by the absence and presence of blanching, respectively
b. PAS staining detects polysaccharides present in the hyphae and budding yeast of candida
c. Leukoplakia is a clinical description not aspecific clinical entity
d. All of the above are correct
e. Tzanck smears may show large squamous cells with inclusions when an infection of herpes virus is present

Answer 19

All of the above are correct

Question 20

Which of the following is incorrect?

a. In poorly differentiated SCC you sometimes can’t even tell the cells are of squamous origin
b. All are correct
c. SCC is differentiated into 3 categories, well, moderate, and poor
d. In moderately differentiated SCC you see intercellular bridges but not pearls
e. In well differentiated SCC you can see keratin pearls

Answer 20

All are correct

Question 21

Which of the following is incorrect regarding salivary gland pathology?

a. Mikulicz syndrom is a combination of salivary and lacrimal galnd enlargement
b. Mucoceles produce fluctuant swellings of the lower lip, often with a blue translucent hue
c. The most common form of viral sialadenitis is secondary to measles infection
d. Mucoceles are often due to trauma causing blockage or rupture of a salivary gland duct
e. In Mikulicz syndrom gland enlargement is usually painless but produces xerostomia

Answer 21

INCORRECT: The most common form of viral sialadenitis is secondary to measles infection

TRUE: most common form secondary to mumps.

Question 22

Which of the following is not true of pleomorphic adenoma?

a. All of the above are correct
b. When removed by enucleation its recurrence rate is about 4%
c. Pleomorphic adenomas make up the majority of parotid gland tumors
d. Pleomorphic adenomas can progress to adenocarcinomas, a risk that increases with time
e. It presents as a painless, slow-growing mobile mass within the parotid or submandibular areas, or in the buccal cavity

Answer 22

NOT TRUE: When removed by enucleation its recurrence rate is about 4%

TRUE: *Recurrence rate with adequate parotidectomy is about 4% but, with attempted enucleation (removal of the entire mass or part without rupture), approaches 25%.

Question 23

Which one is just plain wrong?l

a. Odontogenic cysts that are malignant are rare and of ameloblastic origin
b. Infectious rhinitis is usually viral
c. Thyroglosal duct cysts present as midline masses
d. Branchial cleft cysts present as lateral neck masses
e. Posterior cervical lymphadenopathy is common

Answer 23

FALSE: Posterior cervical lymphadenopathy is common.

It is UNCOMMON!