03-26-2009, 02:57 PM
40. A 47-year-old man comes to the physician because of a 3-week history of increasing facial swelling and a 1-week history of morning headaches and mild shortness of breath. He had previously felt well. He completed a course of chemotherapy 4 months ago for small cell carcinoma of the lung. His temperature is 37.2°C (98.9°F), blood pressure is 142180 mm Hg with an 8-mm Hg paradoxical pulse, pulse is 84/min, and respirations are 18/min. Examination shows significant diffuse facial and periorbital edema. The optic discs are sharp, and ocular movements are intact. The lungs are hyperresonant bilaterally with a moderately prolonged expiratory phase. Mild rhonchi are heard on inspiration and expiration. An x-ray film of the chest shows a 10-cm mass in the right upper lobe and apex. Which
of the following is the most likely explanation for these findings?
O A) Chemotherapy-induced bone marrow toxicity
O B) Chemotherapy-related cardiac toxicity
O C) Hypercoagulable state secondary to malignancy
O D) Interstitial metastatic pulmonary disease
O E) Intracranial metastases
O F) Lymphatic obstruction
O G) Malignant pericarditis
O H) Paraneoplastic syndrome
O I) Pleural metastases
O J) Soft tissue metastases
0 K) Vascular obstruction
of the following is the most likely explanation for these findings?
O A) Chemotherapy-induced bone marrow toxicity
O B) Chemotherapy-related cardiac toxicity
O C) Hypercoagulable state secondary to malignancy
O D) Interstitial metastatic pulmonary disease
O E) Intracranial metastases
O F) Lymphatic obstruction
O G) Malignant pericarditis
O H) Paraneoplastic syndrome
O I) Pleural metastases
O J) Soft tissue metastases
0 K) Vascular obstruction