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NBME 21 Answers

nbme21/Block 2/Question#24 (55.6 difficulty score)
A 65-year-old man dies in a motor vehicle ...
Squamous cell carcinoma🔍

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 +11  upvote downvote
submitted by tinydoc(190),
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cntfiasr uwold eb a eorm rhpapilere gdewe psaeh

bcsesa undtwlo eb vsiieavn to het iguodrunsrn raea i .khitn

asmoqsuu elcl si eorm tlrecyanl loedcta

ta'wns 100% rues but tatsh het steb rwesan hultgosh isudtp to igev 0 ostpymsm nda just a pu,cietr ntniohg ikle an tulcaa lnaiccli oeinasrc

tsl19  Squamous cell is centrally located and has cavitation, which you can see in the pic. Similar to this one: +4  
drdoom  ^ linkifying: +3  
zevvyt  I also didn't choose infarct cuz i think the lung would have a red infarct. +  

 +6  upvote downvote
submitted by hungrybox(791),
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,alrpaMysocloicc saqusomu ecll ncmicoara ntdes ot be ot-ehfwfi in lro,oc iasgnir rof,m dan dgxetinne onit a rbsconu.h

ur:eocS pRiadodeia

privatejoker  Lol am I the only one that picked Malignant Lymphoma? I thought I remembered Sattar mentioning that metastases are the most common form of cancer to be found in the lung? I tend to pick the "most common" presentation when given so little information to work with +2  
blueberrymuffinbabey  but metastases typically present with multiple lesions so I think at least in exams when it's showing you a solitary lesion, think a primary tumor. +1  

 +4  upvote downvote
submitted by lnsetick(84),
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I od’nt inthk ti swa ati;ycavr I htkni hatt wsa sjut eht rbc.nhsuo I ihtnk sesssceab detn to be mlearls, and o’wndtlu fecatf teh unridguonrs emhyrcnapa hm.uc I astnw’ uersp nofcietdn ni pickign omsasquu lecl raccao,mni tub I idd kwon ttha sosuuamq elcl acimrnoac destn ot eb a aeotletdac-lclnry nglu mour.t

fallabella4  Squamous cell carcinoma of the esophagus presents itself as an raised plaque with ulcerations +  

 +1  upvote downvote
submitted by bbr(15),

Abscess: You'd see a hole (remember the air/fluid level on x ray?)

Hamartomas: Benign neoplasm of normal tissue (you'd see more Lung tissue, whatever this white stuff ain't normal red lung tissue). Infarct: No wedge?

Malignant lymphoma: (idk how to rule out)

Mesothelioma: Pleural plaques (this is intra-parenchymal)

Squamous cell Carcinoma: bingo. Centrally located.

 +1  upvote downvote
submitted by joanmadd(4),

I know that small cell carcinoma wasn't an option in this question, but would there be any possible way to distinguish small cell from squamous cell on this specific gross pathology?

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My icoche for qsSuuaom lCle Ccromaina swa deiugd yb eth crnleta lnoocait of teh .ourtm To m,e ttha dnitd’ ookl leik hte tyciva ’youd etg twhi becasss tbu a heug trmou.

 +0  upvote downvote
submitted by mdsu(0),

Lung abscess pic

Squamous cell carcinoma; Central - Hilar mass- Cavitation

am i the only one who chose mesothelioma? didnt that look like a pleural plaque posteriorly to anyone?

brotherimodu  That's what I thought too. +  

FA 2020 p. 684

SCC: Hilar mass arising from bronchus; cavitation, cigarettes, hypercalcemia.

Esophageal squamous cell cancers are more common in smokers