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A 56 year old gentleman has just been diagnosed with a Pancoast's tumour. He is complaining of weakness and
numbness in his right arm. His shoulder is painful and this is radiating down his arm and on examination there is
muscle wasting in his hand and loss of sensation in an ulnar distribution. A recent CT had showed evidence of
lymphadenopathy near to the location of the tumour but no mediastinal lymphadenopathy and there was no
evidence of peripheral metastases. His bloods revealed hypercalcaemia. There was no evidence of any bony lytic
lesions.His FEV1 was 65% of his predicted.
Your answer was Hypercalcaemia which is incorrect
Signs and symptoms in the arm correct answer
Lymph node involvement
Hypercalcaemia
FEV1
Metastases
Explanation:
The signs and symptoms within the arm suggest brachial plexus involvement which precludes surgery. The
nodes involved is not a contraindication and there is no evidence of metastases. The hypercalcaemia in this
case is most likely due to a paraneoplastic syndrome and again this does not preclude surgery. His FEV1 is
reasonable.
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Question category: Respiratory
A 28 year old man and his partner present as they are having trouble
conceiving. Further investigations reveal immobile sperm. The gentleman also
gives a history of having chronic rhinorrhoea. He has also has a chronic
cough and has had several episodes of sinusitis and pneumonia. A Chest X-
ray reveals dextrocardia. A sweat test is normal. Which of the following is the
most likely diagnosis?
Yellow nail syndrome
Kartagener's Syndrome
Cystic Fibrosis
Primary Ciliary Dykinesia
Allergic Rhinitis
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