p2
Forum Senior
Topics: 41
Posts: 52
|
19. A 62-year-old woman with ovarian cancer comes
to the emergency
department because of fever for 2 days. Ten days ago,
she received
chemotherapy with paclitaxel and carboplatin. She
feels tired but has not
had nausea or vomiting. Her temperature is 39.5 C
(103.1 F), blood
pressure is 100/60 mm Hg, and pulse is 115/min. The
lungs are clear to
auscultation. Examination shows a soft, nontender
abdomen. Her
hematocrit is 32%, leukocyte count is 800/mm3, and
platelet count is
105,000/mm3. Serum electrolyte levels are within
normal limits. Which of the
following is the most appropriate next step in
treatment?
A
) Plasmapheresis
B
) Additional chemotherapy
C
) Intravenous antibiotic therapy
D
) Intravenous corticosteroid therapy
E
) Transfusion of 2 units of leukocytes
F
) Transfusion of 2 units of packed red blood cells
21. A previously healthy 85-year-old man has had
abdominal
distention, decreased caliber of stools, and decreased
appetite over the past 2
weeks and a 9-kg (20-lb) weight loss over the past 3
months. On
sigmoidoscopy, he is found to have a constricting
adenocarcinoma of the
sigmoid colon; imaging studies show three 1-cm
metastases to the liver.
Which of the following is the most appropriate next
step in management?
A
) No treatment
B
) Radiation therapy
C
) Chemotherapy
D
) Combination radiation therapy and
chemotherapy
E
) Resection of the colon tumor
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| doc_clotaire
Forum Guru
Topics: 159
Posts: 1,245
|
1.- C ) Intravenous antibiotic therapy --pt has FEBRILE NEUTROPENIA
2.- C ) Chemotherapy ( not sure )
___________________
The elevator to succes is broke ,you must take the stairs
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| p2
Forum Senior
Topics: 41
Posts: 52
|
pl ease give explanations for options in 2q .
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| neuroblastoma
Forum Guru
Topics: 100
Posts: 1,018
|
metastatic ca already spread to other organs...so chemotherapy works only.
if it were localised--resection then radiotherapy
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
|
resection of tumor for the second one...you can resect upto five isolated liver mets with curative primary tumor resection
___________________
When going gets tough, the tough gets going
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| neurom
Forum Senior
Topics: 2
Posts: 127
|
C for the 2nd Q. The patient's age put him at high risk for developing surgery-related complications. In this case the patient would not benefit from the surgery.
___________________
"Nature magically suits a man to his fortunes, by making them the fruit of his character".
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| alzheimer
Forum Newbie
Topics: 4
Posts: 41
|
SECOND QUESTION IS E..The most likely complication if canacer is left there is obstruction..after surgery, u could go for chemotherapy..but there is already a slight sign of obstruction with abdominal distension and decreased stool caliber
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
|
I THINK CANCER COLON FOR SURGERY
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| dr.wad
Forum Senior
Topics: 3
Posts: 335
|
1- C
2_ E
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| drduck
Forum Guru
Topics: 82
Posts: 529
|
for Q number 1, it got to be I/V antibiotics, febrile neurtopenia........still there cud be something more important than giving the patient antibiotics......i mean to say...the patient is getting into a state of shock.....i wud like start off with I/V fluids...or if possible whole blood...thats not there in the options,
Q number 2......patient has metastatic colon cancer......it has to be palliative with multiple mets.
since patients age is 85....he is not going to be benifited by any surgery...as hes not fit......its always PALLIATIVE, give him SYMPTOMATIC RELIEF....
this is not an age of tolerating surgeries or toxic effects of chemotherapeutic agents.
i m waiting for the answer, P2
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| alzheimer
Forum Newbie
Topics: 4
Posts: 41
|
I still think E..EXCEPT 9 Ib WEIGHT LOSS..Nothing is indicative that this patient cannot stand surgery..This patient is having an obstruction already...It will be an emergency in few days..tO PREVENT that, u have to go for it,..I agree with u that it is a major procedure but if u don,t do it, than this patient will not be able to undergo surgery in a few weeks as, it will be an obstructive emergency..The chemotherapy is good but not at this point where this patient is already having pre sign of obstruction..
Do u prefer to start chemotherapy and wait few months to see if it will decrease or do you try to perform surgery immediately to avoid emergency situation...
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| drduck
Forum Guru
Topics: 82
Posts: 529
|
hey.....i know it is debatable......even i m not 100 percent sure,
harrison says....metastasis into liver if single can be resected.
devita says 1 to 3....liver mets not a contraindication towards resection of the mets.
problem here is with the primary....it got to be resected....no doubt...but age of 65 and more are never benifited by surgery...
now if at all surgery is to be done...it has to be full bowel removal with colestomy and closing the distal anus.......called as hartmans procedure...
think it is done in carcinoma rectum...specially in old and feeble individuals.
its high time.....p2 plz post the answer......
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