enlarging nose, thickening of her tongue, - okt3

[ArchivalUser]

So, wait - what's the answer to the questions??? lol

[ArchivalUser]

2 ... may be ... B

[ArchivalUser]

1)-The correct answer is D . This patient has acromegaly secondary to a paraneoplastic syndrome. Paraneoplastic syndromes refer to a large group of medical problems in patients suffering from cancer. They are defined as clinical syndromes that result from systemic effects of substances produced by the tumor. The symptoms are mostly endocrine, but may be neuromuscular, cutaneous, hematologic, renal, gastrointestinal or miscellaneous, depending on the chemical nature of the substance produced. Tumors can produce antibodies, hormones, hormone-like substances or hormone precursors, fetal proteins, or cytokines. Endocrine symptoms usually resemble the more common endocrine disorders (e.g., Cushing syndrome, acromegaly). Lung tumors can cause several types of endocrine paraneoplastic syndrome. Cushing syndrome and SIADH are related to the ectopic production of hormone-like substances by small cell cancer of the lung. Hypercalcemia, caused by the secretion of parathyroid hormone related peptide (PTHrP), and acromegaly, caused by an ectopic secretion of growth hormone, are endocrine paraneoplastic syndromes associated with squamous cell carcinoma of the lung. Acromegaly caused by an ectopic secretion of growth hormone (GH) is difficult to differentiate from that of pituitary origin. Provocation tests (oral glucose, TRH test, GHRH test) may be normal or may yield paradoxical results. The usual episodic pattern of secretion is missing in cases of ectopic GH secretion. Long-acting somatostatin analogues and dopamine agonists are used in the treatment of this condition. Surgical or other treatment of the lung tumor represents definitive therapy for the patient.

Hypersecretion of GH in childhood will result in gigantism (excessive linear growth; choice A ); onset in late adolescence will produce tall stature and acromegaly.

McCune-Albright syndrome (choice B) is manifested clinically with fibrous dysplasia of bones, hyperpigmented skin changes, goiter, acromegaly, hyperparathyroidism, and hypophosphatemic hyperphosphaturic rickets.

NAME syndrome (nevi, atrial myxoma, myxoid neurofibromas, and ephelides) (choice C) is associated with acromegaly due to pituitary GH-secreting tumors.
GH hypersecretion that occurs after epiphyseal fusion is termed acromegaly.

More than 90% of acromegaly cases are caused by pituitary adenomas (choice E) secreting excess GH.


2)-The correct answer is E . Paraneoplastic syndromes are clinical syndromes resulting from tumor-produced hormones and occur in 10-15% of cancer patients. Lung cancers can cause several paraneoplastic syndromes based on the humoral factor being produced. Squamous cell carcinomas are one of the most common primary malignancies of the lung and are often seen in smokers. They usually arise from central bronchi, producing a hilar mass. Hypercalcemia, caused by the secretion of parathyroid hormone-related peptide (PTHrP), and acromegaly, caused by an ectopic secretion of growth hormone, are endocrine paraneoplastic syndromes associated with squamous cell carcinoma of the lung.

Adenocarcinoma (choice A) often forms on scars, or in lungs with interstitial disease. It is the most prevalent form in the U.S. (35% of cases). It often induces fibrotic changes, usually accompanied by hilar and mediastinal node involvement. Adenocarcinoma is less strongly associated with smoking than squamous cell carcinoma.

Large cell lung carcinoma (choice B) may be of a giant cell or a clear cell variant. Giant cell carcinoma is a large cell type with a component of highly pleomorphic, multinucleated cells. It is particularly aggressive and carries a very poor prognosis.

Apical localization, with tumor invading the brachial plexus and sympathetic chain, pain in the shoulder, and Horner syndrome (ipsilateral miosis, ptosis and anhidrosis) are pathognomonic for Pancoast tumor (choice C) . These tumors most commonly represent a local extension of a squamous cell carcinoma to the upper part of the lung.

Small-cell (oat-cell) carcinoma (choice D) occurs almost exclusively in smokers. It is a very aggressive type and often metastasizes before the tumor reaches a large size. Microscopically, small cells with minimal cytoplasm are seen. SIADH (syndrome of inappropriate secretion of antidiuretic hormone) is most common in cases with small cell lung cancer.