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NBME 20 Answers

nbme20/Block 4/Question#13

A 62-year-old woman comes to the physician because ...

Bronchogenic carcinoma

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 +2  upvote downvote
submitted by xxabi(81),

Bronchogenic carcinoma = lung cancer

That being said, lung adenocarcinoma specifically is associated with hypertrophic osteoarthropathy, which is a paraneoplastic syndrome characterized by ´╗┐digital clubbing, arthralgia, joint effusions, and periostosis of tubular bones

luke.10  why not systemic scleroderma since i did this question wrong and i chose systemic sclerosis scleroderma , can someone explain that ? +1  
kernicterusthefrog  My best guess answer to that @luke.10 is that: a) there's no mention of any skin involvement (which there would be in order to be scleroderma) b) Scleroderma shows pitting in the nails, not clubbing c) There would be collagen deposition with fibrosis, not hypertrophy of the bone at joints Saying that, I also got this wrong! (but put RA...) so I'm not claiming to "get this" Hope my thought process helps, though! +1  
yotsubato  This is in FA 2019 page 229 +1  
larascon  I agree with @kernicterusthefrog on this one, Bronchogenic carcinoma = lung cancer. Squamous cell carcinoma gives you hypercalcemia (new bone formation; maybe?), commonly found in SMOKERS ... +  

 +0  upvote downvote
submitted by hpsauce(0),

I believe this is Caplan Syndrome (bronchogenic carcinoma + rheumatoid arthritis). Only flaw to that is that the pulmonary findings don't perfectly represent pneumoconioses.

dbg  it's just bronchogenic ca, type of adenoca, which is classically associated with 'hypertrophic osteoarthropathy' +  
woodenspooninmymouth  To get it for the test, remember that lung adenocarcinoma is associated with clubbing. Mechanistically, this woman probably had RA. Then she was exposed to asbestos. The asbestos in the context of RA lead to caplan syndrome. The asbestos also triggered her bronchogenic carcinoma. +