I n t e r n a L medicine questions Bank

Q18 - X-ray showed a mass in the lung, you suspect this patient to have non-small cell lung cancer. What finding would be against this diagnosis:

4. 
   High ADH
   
   
   

Small cell carcinoma is associated with Eaton-Lambert syndrome (spares ocular muscles), SIADH, and other paraneoplastic syndromes. Lambert-Eaton syndrome (LES) lamcb_rt Tct[n a generalized disorder of neuromuscular transmission caused by a defect in the release of acetylcholine quanta from the presynaptic nerve terminals; often associated with small cell carcinoma of the lung, particularly in elderly men with a long history of cigarette smoking. In contrast to myasthenia gravis, weakness tends to affect solely axial muscles, girdle muscles, and less often the limb muscles; autonomic disturbances, e.g., dry mouth and impotence, are common; the deep tendon reflexes are unelicitable; on motor conduction studies, responses on initial stimulation are quite low in amplitude, but they show marked post-tetanic facilitation after a few seconds of exercise. Lambert-Eaton syndrome is

due to loss of voltage-sensitive calcium channels located on the presynaptic motor nerve terminal. See: myasthenic syndrome. Syn: carcinomatous myopathy, Eaton-Lambert syndrome, Lambert syndrome, myasthenic syndrome.

18. 
    Wrong about polycystic ovarian syndrome:
    
    1. 
       High LH/FSH ratio
       
    2. 
       Acanthosis nigricans
       
    3. 
       Acne
       
    4. 
       Hypertension
       

Answer: according to Wikipedia, Women with PCOS are at risk for the following: … acanthosis nigricans

Ehrmann et al1 reported recently that 33.4% of US women with PCOS exhibit symptoms of the metabolic syndrome, such as increased hyperglycemia, insulin resistance, and dyslipidemia, although this percentage varies depending on the cohort studied. Frequently these young women exhibit hypertension as well. Despite the list of characteristics that typically accompany PCOS, the exact mechanism(s) responsible for hypertension in women with PCOS is controversial. Many of the symptoms associated with PCOS have been shown to also be associated with increases in blood pressure, such as increases in body mass index and the presence of metabolic syndrome, with its accompanying insulin resistance and type 2 diabetes. http://hyper.ahajournals.org/content/49/6/1220.full

19.