WBR1048

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Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Musculoskeletal/Rheumatology
Prompt A 65 year old man comes to the clinic with a weakness and not feeling well. He has been in bad mood since he lost his best friend, that died of cancer. Since then, he has been worried alot about his health. He noticed that he has difficulty raising his right eyelid for the last 6 weeks. His medical history is significant for an ischemic brain stroke 5 years ago, with no residual motor or sensory deficits. He drinks a two glass of red wine every night with dinner with his wife. He has been smoking 1 PPD for the last 30 years. He is treated for COPD by Formeterol and Tiotropium. The physical examination shows a ptosis of right eye lid, however the extraocular muscles movement are intact. The full neurological examination does not reveal any abnormality.The Chest X-ray shows a solitary lung mass on the apex of right lung, confirmed by CT. What would be the best next step in management?
Answer A US guided biopsy
Answer A Explanation [[AnswerAExp::Incorrect-[[]]]]
Answer B Pleural aspiration for cytological analysis
Answer B Explanation [[AnswerBExp::Incorrect-[[]].]]
Answer C Open lung biopsy
Answer C Explanation [[AnswerCExp::Correct-[[]]]]
Answer D Endobronchial biopsy
Answer D Explanation [[AnswerDExp::Incorrect-[[]].]]
Answer E Follow up the mass by CT after 6 months
Answer E Explanation [[AnswerEExp::Incorrect-[[]]]]
Right Answer C
Explanation Educational Objective: Solitary lung mass with high index of suspicion of lung cancer

Educational Objective:
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