Fatigue, cough, and dyspnea
Author and Disclosure Information [Show]

Karl J. D'Silva, MD, Clinical Assistant Professor, Department of Medicine, Tufts University School of Medicine, Boston; Medical Director, Department of Oncology and Hematology, Lahey Hospital and Medical Center, Peabody, Massachusetts

Karl J. D'Silva, MD, has disclosed no relevant financial relationships

Question 1 of 3

A 67-year-old woman presents with fatigue, cough, and dyspnea. She reports intermittent low-grade fever and an unexplained 15-lb weight loss in the past 2 months. She has a 30-year history of smoking but quit 10 years ago. Physical exam reveals diminished breath sounds and slight hepatomegaly. The patient appears pale and cachectic. Chest radiography shows an ill-defined mass in the right upper lobe. CT reveals a 4-cm spiculated mass. Histologic findings show prominent nucleoli and focal necrosis, with no evidence of keratinization or gland formation.

What is the likely diagnosis?


Large cell carcinoma

Small cell carcinoma

Squamous cell carcinoma

This quiz is not accredited for CME.

More from Case in Point: Lung Cancer


Fatigue and persistent cough
Fatigue and shoulder weakness
Recurrent fever and wheezing
40–pack-year smoking history
Man with dyspnea and chest pain
Chronic cough and lack of sleep
Woman with previously diagnosed SCLC
Man with coughing and bloody sputum