elitoki
Forum Guru
Topics: 54
Posts: 508
|
http://www.prep4usmle.com/forum/comments.php?id=3...
http://www.prep4usmle.com/forum/comments.php?id=4...
http://www.prep4usmle.com/forum/comments.php?id=5...
http://www.prep4usmle.com/forum/comments.php?id=5...
42. 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 142/80 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?
A ) Chemotherapy-induced bone marrow toxicity
B ) Chemotherapy-related cardiac toxicity
C ) Hypercoagulable state secondary to malignancy
D ) Interstitial metastatic pulmonary disease
E ) Intracranial metastases
F ) Lymphatic obstruction
G ) Malignant pericarditis
H ) Paraneoplastic syndrome
I ) Pleural metastases
J ) Soft tissue metastases
K ) Vascular obstruction
Answer is K. SVCS - vascular obstruction.
reference: eMedicine.
signs or symptoms of superior vena cava syndrome (SVCS)
typically, accelerate as the underlying malignancy increases in size and/or invasiveness.
Dyspnea is the most common symptom, followed by trunk or extremity swelling.
Also present Facial swelling, Cough, Orthopnea, Headache,Nasal stuffiness, Light-headedness.
on Physical examination often reveals facial or upper extremity edema. The degree of facial edema has been described as facial engorgement. The degree of jugular venous distention is variable.
Other markers of lung malignancy, such as Horner syndrome, paralysis of the vocal cords, and paralysis of the phrenic nerve, are rarely present.
|
| cirus
Forum Guru
Topics: 108
Posts: 740
|
well in this q every one was between paraneopl & Vascular obst..
for the first minute i thought about para neoplastic but look on the q again:
paraneoplastic S: ptosis, miosis, Anhydrosis & pulm edema..So i guess i dosn't fit that much as SVC obst
|
|
| |
| | |
