dimps
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A 74-year-old man is admitted to the hospital because of bone pain in the pelvis and spine. The patient has never seen a doctor before. He has an 80 pack-year history of smoking. Physical examination is significant for dullness of the right lung apex and focal bone pain of the pelvis and spine. X-rays of the pelvis and spine reveal multiple lucent bony lesions suspicious for metastatic disease. Given his history, a chest x-ray is obtained. The results are shown.
The most important next step is to
A. biopsy the finding in the lung
B. discuss "do not resuscitate" status
C. discuss the goals of therapy with the patient
D. do a bone scan to evaluate for additional lesions
E. get a preoperative anesthesia evaluation
F. order an MRI of the thorax
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| meg
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My answer would be
1)biopsy the lung
2)bone scan
3)discuss goals of therapy
4) discuss DNR
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| dimps
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meg answer given is C
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| meg
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does 'therapy' include diagnostic steps as well? If yes, then C is right, otherwise without establishing diagnosis, how can we discuss treatment? or am i missing the diagnosis with the findings mentioned?
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| dimps
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The correct answer is C. On the chest x-ray, the right apex is markedly thickened as compared to the left, which is consistent with a right superior sulcus tumor. The probability that this is lung cancer is high. A biopsy must be performed to confirm that this is lung cancer, but now is the time to begin a discussion with the patient about the goals of therapy. Metastatic lung cancer has a mean survival time of less than one year even with aggressive treatment, so quality as well as quantity of life should be discussed prior to proceeding with any treatment.
A biopsy of the lung mass (choice A) and further imaging studies are surely necessary to determine the appropriate treatment. Before any more invasive steps are taken, however, the physician needs to determine the patient's wishes.
Discussion of "do not resuscitate" status (choice B) is important, but is not the immediate concern for this patient with newly diagnosed metastatic lung cancer.
Further imaging studies (choice D) are surely necessary to determine the appropriate treatment. Before any more invasive steps are taken, however, the physician needs to determine the patient's wishes.
A preoperative evaluation (choice E) is premature at this time. A discussion regarding the goals of therapy in the setting of metastatic lung cancer is the most appropriate next step.
An MRI of the thorax (choice F) is necessary to evaluate the chest wall for staging. Before additional scans and biopsies are obtained, however, a discussion with the patient and his family is necessary
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hi how r u
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| meg
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thanks
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