frank100
Forum Guru
Topics: 48
Posts: 586
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A 47 y/o man comes to the pysician because of a 3 day history of increasing facial swelling and a 1 week history of morning headaches and mild shorness of breath. He had previously felt well. he completed a course of chemotherapy four months ago for a small cell carcinoma of the lung. His temperature is 37.2. blood pressure is 142/80, and 8mmhg paradoxical pulse, pulse: 84, repirations: 18. examinantion 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 ronchi are heard on inspiration and expiration. An x-ray of the chest shows a 10cm mass in the right upper lobe and apex. which of the following is the most likely explanation of these findings?
a) chemotherapy-induced bone marow toxcity
b) chemotherapy-related cardiac toxocity
c) Hypercoagulable state secondary to malignancy
d) Interstitial metastatic pulmonary diseace
e) Intracraneal metastasis
f) lymphatic obstruction
g) malignant pericarditis
h) Paraneoplastic syndrome
i) pleural metastases
j) soft tissue metastases
k) vascular obstruction
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| mazinger
Forum Guru
Topics: 46
Posts: 920
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k
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original mazinger z
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| veens
Forum Junior
Topics: 4
Posts: 64
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facial &periorbital edema r due to svc obstruction,resp symptoms due to mass per se ...
i wld go with k tooo
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| frank100
Forum Guru
Topics: 48
Posts: 586
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sound like Superior vena cava syndrome, it is also a paraneoplastic syndrome. so I have two answers...Ħhow can I exclude option H?, so I can happily pick (k)...
By the way, chose K too, but H is bothering my mind...
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| drhyd
Forum Senior
Topics: 7
Posts: 82
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he asked what is responsible for this findings, not the diagnosis.
drhyd
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| frank100
Forum Guru
Topics: 48
Posts: 586
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yes, the most likely explanation is SVCS, which is a paraneoplastic syndrome, and a vascular osbtruction also...
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