07-22-2009, 04:12 PM
47 y/o male with 3 week history of increasing facial swelling and 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 temp is 37.2 deg C (98.9 deg F), BP of 142/80, and 8mm Hg parodoxical pulse. RR is 18/min. Examination shows significant diffuse facial and periorbital edema. The optic discs are sharp, and ocular movements are intact. The lungs are hyper-resonant bilaterally with 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 of these findings?
A) Chemotherapy-induced bone marrow toxicity
B) Chemotherapy-related cardiac toxicity
C) Vascular obstruction
D) Hypercoaguable state secondary to malignancy
E) Lymphatic obstruction
F) Interstitial metastatic pulmonary disease
G) Paraneoplastic syndrome
H) Pleural metastases
I) Soft tissue metastases
I think its B or C. How do you distinguish the right answer?
A) Chemotherapy-induced bone marrow toxicity
B) Chemotherapy-related cardiac toxicity
C) Vascular obstruction
D) Hypercoaguable state secondary to malignancy
E) Lymphatic obstruction
F) Interstitial metastatic pulmonary disease
G) Paraneoplastic syndrome
H) Pleural metastases
I) Soft tissue metastases
I think its B or C. How do you distinguish the right answer?
