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*  Pulmonary Nodule
 #835134  
  nivia1997 - 12/21/16 00:36
 
  A 59-year-old Caucasian man comes to see you in the office with complaints of cough, runny nose, and slight difficulty in breathing. His symptoms have been present for the past two weeks. He has a history of hypertension, coronary artery disease, and chronic obstructive pulmonary disease. He also has a 40-pack-year history of smoking and continues to smoke one pack of cigarettes daily. On physical examination, he has a temperature of 37.6C (99.8F), blood pressure of 110/72 mmHg, and respiratory rate of 18/min. His lung exam reveals bilateral scattered rhonchi. You send the patient to the radiology department for a chest x-ray. That same day, in the afternoon, the radiologist calls to inform you that the patient has a 1.5 cm peripherally located nodule in the left lower lobe of the lung
Which of the following is the most appropriate initial step in the management of the patient?
I
A) Reassure the patient that the lesion is probably benign.
B) Review all the old chest radiographs.
C) Obtain a chest CT scan.
D) Schedule him for a fiberoptic bronchoscopy.
E) Schedule the patient for video-assisted thoracoscopic surgery

II
The patient returns to the office a few days later. He is extremely anxious and concerned regarding the newly discovered lung nodule. The initial attempt to obtain any further diagnostic information is inconclusive. Which of the following is the most appropriate next step in the diagnostic workup of this patient?
A) Repeat the chest x-ray in six months.
B) Obtain any old chest radiograph.
C) Obtain a chest CT scan.
D) Schedule the patient for a video-assisted thoracoscopic surgery (VATS).
E) Perform an open thoracotomy for tissue diagnosis

III
The diagnostic workup performed in the above patient is highly suspicious for a malignant lesion. The patient becomes more anxious and wants everything done for the lung nodule. Which of the following is the most appropriate next step in the management of this patient?
A) Obtain a chest CT scan.
B) Perform a percutaneous needle aspiration of the suspicious nodule.
C) Order a PET scan.
D) Schedule the patient for video-assisted thoracoscopic surgery.
E) Schedule the patient for open thoracotomy
 
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* Re: Pulmonary Nodule
#3321651
  gelitino - 12/21/16 14:09
 
  B,C,D
-First look for any old radiograph if there is any change in size.
-Smoking for 40 years makes him high risk for malignancy ,lets do CT
-VATS is both diagnostic and therapeutic why not do that.


I answer as the clinical practice idk its right or wrong ....:D
 
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* Re: Pulmonary Nodule
#3322003
  lifesaverdr - 12/24/16 11:10
 
  Agree with all answers. this is how it is done in clinical practise  
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* Re: Pulmonary Nodule
#3322720
  feno12 - 01/02/17 15:27
 
  thank you for the questions. what is the source?  
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* Re: Pulmonary Nodule
#3323714
  cynap - 01/11/17 04:40
 
  Review all the old chest radiographs then order CT  
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