MKSAP: 54-year-old woman with shortness of breath

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history. On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is 92% with the patient breathing ambient air. No palpable lymphadenopathy is noted. The patient has clubbing of the fingertips. The lung fields are clear on the left, with diminished breath sounds and dullness to percussion over the lower half of the right lung. The remainder of the examination is normal. A chest radiograph reveals a large right pleural effusion. A thoracentesis demonstrates an exudate, with cytologic analysis indicating adenocarcinoma. A chest tube is placed, and talc pleurodesis is performed. A CT scan reveals a 4-cm right peripheral lung mass with no obvious lymphadenopathy. A bone scan and a brain MRI are normal. Which of the following is the most appropriate treatment? A: Combination chemotherapy and radiation B: Radiation C: Surgical resection of the lung mass D: Systemic chemotherapy Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs