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NBME 24 Answers

nbme24/Block 3/Question#9

A 43-year-old woman comes to the physician because ...

Metastatic carcinoma

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 +8  upvote downvote
submitted by neonem(372),

I think metastasis was the best option here because there are multiple malignant neoplasms... primary cancers tend to start as a single mass in the tissue of origin. In the lung, metastases are more common than primary neoplasms.

dbg  I seriously could not figure out whether those white opacities were actual lesions or reflections from the actual picture (flash light) ... mind went all the way maybe this is the shiny pleura so they're going after mesothelioma. smh +2  
dbg  shiny pleura with tiiiiny granulations if you look closely. but obviously was far off +  
et-tu-bromocriptine  "Multiple cannonball lesions" is indicative of a metastatic cancer. I think if they were leaning towards a mesothelioma, they'd show the border/edge of the lung ensheathed by a malignant neoplasm (see image): https://library.med.utah.edu/WebPath/jpeg1/LUNG081.jpg +1  
bullshitusmle  guys something I learned from NBMEs is that if there is a clinical vignette dont even look at the images they give you ,they are all useless and time-consuming +1  
goaiable  The way i narrowed it down was that the patient had signs of weight loss since three months whereas her cough developed recently (3 weeks). If the cancer arose in the lung then I think the cough or other pulmonary symptoms should emerge earlier. +  
almondbreeze  FA2019 pg 669 in the lung, metastasis (usually multiple lesions) are more common the primary neoplasms. most often from breast, colon, prostate, and bladder ca. +  

Most common metastasis producer for lung is BREAST

+1/- usmlecrasherss(2),

 +0  upvote downvote
submitted by madojo(51),


Lung metastasis is the more common than a primary lung cancer and its most common source is breast or colon carcinoma. You will see canon ball nodules on imaging. Seperated by space nodules. Search canon ball nodules gross looks similar to this image.

Carcinoid tumor is the most common primary lung tumor in CHILDREN. Could be a central or peripheral tumor but i think they would show a polyp like mass in the bronchus for carcinoid. https://www.webpathology.com/slides-13/slides/Lung_Neoplastic_Carcinoid_Gross1.jpg

Malignant mesothelioma some sort of asbestos exposure with the tumor encasing the lung like the other photo posted on the comments.

Pulmonary hamartoma umm well there's two of them in this photo, a hamartoma is usually just a single nodule.

Small cell carcinoma would be more centrally located not peripheral.