11-21-2007, 12:25 PM
A 45-year-old woman was diagnosed with Stage 3 breast cancer last year and
is status post her third cycle of chemotherapy after a lumpectomy,
radiation therapy, and axillary lymph node dissection performed 4 months
prior. She has tolerated the chemotherapy well. Her only side effects have
included alopecia, mild nausea and vomiting, which is being treated with a
granisetron. She sees you prior to receiving her fourth cycle of
chemotherapy and complains of some dyspnea on exertion for the past week.
She reports that her normal fatigue during chemotherapy is now much worse
and she can barely walk more than 1 block at a time. On further
questioning, she also states that she has 3 pillow orthopnea and worsening
lower extremity edema. Her temperature is 37.0 C (98.6 F) and blood
pressure is 120/80 mm Hg. She is saturating 96% on room air. Physical
examination shows mild bibasilar crackles in the lungs and distant and
muffled heart sounds. She has jugular venous distension at 8 cm. The most
appropriate next step is to
A. obtain an arterial blood gas
B. obtain an electrocardiogram
C. order a chest x-ray
D. order an echocardiogram
E. schedule a bronchoscopy
is status post her third cycle of chemotherapy after a lumpectomy,
radiation therapy, and axillary lymph node dissection performed 4 months
prior. She has tolerated the chemotherapy well. Her only side effects have
included alopecia, mild nausea and vomiting, which is being treated with a
granisetron. She sees you prior to receiving her fourth cycle of
chemotherapy and complains of some dyspnea on exertion for the past week.
She reports that her normal fatigue during chemotherapy is now much worse
and she can barely walk more than 1 block at a time. On further
questioning, she also states that she has 3 pillow orthopnea and worsening
lower extremity edema. Her temperature is 37.0 C (98.6 F) and blood
pressure is 120/80 mm Hg. She is saturating 96% on room air. Physical
examination shows mild bibasilar crackles in the lungs and distant and
muffled heart sounds. She has jugular venous distension at 8 cm. The most
appropriate next step is to
A. obtain an arterial blood gas
B. obtain an electrocardiogram
C. order a chest x-ray
D. order an echocardiogram
E. schedule a bronchoscopy