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Self-Assessment Questions


Lung Cancer: Review Questions

Nita Mahajan, MD, MPH

Dr. Mahajan is chief medical resident, Cedars-Sinai/VA Greater Los Angeles Internal Medicine Residency Training Program, and clinical instructor, UCLA David Geffen School of Medicine, Los Angeles, CA

Choose the single best answer for each question.

1. Which of the following statements regarding the epidemiology of lung cancer is correct?
  1. Chronic obstructive pulmonary disease (COPD) is not associated with an increased risk of lung cancer
  2. Cigar smoking is associated with an equal risk of lung cancer as compared with cigarette smoking
  3. Occupational exposure to radon is associated with an increased risk of lung cancer
  4. The risk of developing lung cancer for cigarette smokers exposed to asbestos is equal to that of those not exposed to asbestos
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2. A 53-year-old male smoker presents to the emergency department with exertional dyspnea that has progressed to dyspnea at rest and a cough for 1 month. Two weeks ago, he started having headaches and noticed swelling of his face. Physical examination reveals prominent neck veins and edema of the upper limbs. A chest radiograph demonstrates a suspicious nodule in the right hilar region. Which of the following types of lung cancer is most commonly associated with the signs and symptoms this patient is experiencing?

  1. Adenocarcinoma of the lung
  2. Carcinoid tumor of the lung
  3. Large cell lung cancer
  4. Small cell lung cancer (SCLC)
  5. Squamous cell lung cancer
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3. Paraneoplastic syndromes are clinical disorders associated with malignant diseases but not directly related to the physical effects of primary or metastatic tumors.1,2 Several paraneoplastic syndromes are more closely associated with a particular subtype of bronchogenic carcinoma.2 Which of the following paraneoplastic syndrome is appropriately matched with its most commonly associated histologic type of lung cancer?

  1. Ectopic Cushing’s syndrome/bronchial carcinoid tumor
  2. Hypercalcemia/adenocarcinoma
  3. Hypertrophic pulmonary osteoarthopathy and digital clubbing/SCLC
  4. Lambert-Eaton myasthenic syndrome (LEMS)/squamous cell carcinoma
  5. Syndrome of inappropriate antidiuretic hormone (SIADH)/SCLC
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4. A 60-year-old man with known squamous cell cancer of the lung presents to the clinic for a follow-up appointment with complaints of dyspnea on exertion. The patient has completed 3 cycles of cisplatin and gemcitabine. Surveillance computed tomography (CT) scan of the thorax performed 2 days prior indicates a stable 2-cm right lower lung lesion, a stable 1-cm right mediastinal lymph node, and a new moderate-sized right pleural effusion. The patient subsequently undergoes a right thoracentesis, which yields an exudative effusion with cytology positive for squamous cells. Which of the following is the patient’s current stage of disease?
  1. Stage IIA
  2. Stage IIB
  3. Stage IIIB
  4. Stage IV
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5. A 64-year-old nonsmoking woman presents to her primary care physician with a 2-month history of cough, progressive shortness of breath, and recent development of hemoptysis. She has been depressed recently with the death of her 69-year-old husband, who had a 60 pack-year smoking history and passed away due to end-stage COPD. A chest radiograph reveals a suspicious lesion in the left hilar region. CT of the thorax confirms a 3-cm left central hilar lesion and a 1-cm ipsilateral peribronchial lymph node. Bronchoscopy yields bronchial washings indicative of lymphocyte-like small round cells growing in sheets of scant cytoplasm. What is the best treatment for this patient’s condition?

  1. Combination chemotherapy alone with etoposide and cisplatin
  2. Combination chemotherapy with a platinum-based regimen and concurrent thoracic radiotherapy
  3. Single-agent chemotherapy and sequential thoracic radiotherapy with prophylactic cranial irradiation
  4. Surgical resection of the 3-cm left hilar lesion, combination chemotherapy with a platinum-based regimen, and sequential thoracic radiotherapy
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