#july2020mccqe1
A 60-year-old Caucasian female farm worker presented with a supraclavicular left-sided neck lump, gradually increasing in size over a three-month period. Over the past month she had noted weakness and clumsiness of the left hand, and some numbness over the inner aspect of the left upper arm near the armpit. She has been a smoker for many years and drinks two cans of beer each night. Physical examination shows a firm fixed 2cm lump in the posterior triangle of the neck above the clavicle as illustrated. Lymph node fields are otherwise clear. Neurological examination of the left arm shows that she can make a firm fist with power grip, but separation of her fingers is weak, as is pincer grip and thumb opposition, and she has diminished sensation over the inner arm near the armpit. She is also noted to have some drooping of the eyelid and a constricted pupil on the left, but ocular movement and reflexes are normal. Metastasis from which one of the following cancers is the most likely explanation for the patient's symptoms and signs?
(A) Skin
(B) Lower oesophagus
(C) Larynx (piriform fossa)
(D) Thyroid
(E) Lung
A 60-year-old Caucasian female farm worker presented with a supraclavicular left-sided neck lump, gradually increasing in size over a three-month period. Over the past month she had noted weakness and clumsiness of the left hand, and some numbness over the inner aspect of the left upper arm near the armpit. She has been a smoker for many years and drinks two cans of beer each night. Physical examination shows a firm fixed 2cm lump in the posterior triangle of the neck above the clavicle as illustrated. Lymph node fields are otherwise clear. Neurological examination of the left arm shows that she can make a firm fist with power grip, but separation of her fingers is weak, as is pincer grip and thumb opposition, and she has diminished sensation over the inner arm near the armpit. She is also noted to have some drooping of the eyelid and a constricted pupil on the left, but ocular movement and reflexes are normal. Metastasis from which one of the following cancers is the most likely explanation for the patient's symptoms and signs?
(A) Skin
(B) Lower oesophagus
(C) Larynx (piriform fossa)
(D) Thyroid
(E) Lung
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