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INTERACTIVE CASE DISCUSSION 2 CHEST B

INTERACTIVE CASE DISCUSSION 2 CHEST B. ALCARAZ, ALLEGRE, ALMORA, ALONZO, AMARO, AMOLENDA, ANACTA, ANDAL, ANG, J. General Data. A.T., 78 y.o ., female Pertinent data that should have been asked: Occupation. Chief Complaint. Chronic cough. History Of Present Illness. ADMISSION.

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INTERACTIVE CASE DISCUSSION 2 CHEST B

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  1. INTERACTIVE CASE DISCUSSION 2CHEST B ALCARAZ, ALLEGRE, ALMORA, ALONZO, AMARO, AMOLENDA, ANACTA, ANDAL, ANG, J.

  2. General Data • A.T., 78 y.o., female • Pertinent data that should have been asked: • Occupation

  3. Chief Complaint • Chronic cough

  4. History Of Present Illness ADMISSION

  5. History Of Present Illness • Pertinent data that should have been asked: • Timing • Onset, duration, frequency • Character • Severity • Associated events or accompanying symptoms • Relieving and aggravating factors • Quantify weight loss

  6. Past Medical History • No previous surgeries • No allergies • Non-hypertensive • Non-diabetic • (+) COPD • Pertinent data that should have been asked: • Date of diagnosis of COPD

  7. Family History • (-) Diabetes • (-) Hypertension/Heart disease • (-) Asthma/Allergies • (+) COPD • Pertinent data that should have been asked: • Family history of cancer or malignancies • Exposure to TB

  8. Personal/Social History • 30 pack year smoking history • Occasional alcoholic beverage drinker • Pertinent data that should have been asked: • Diet and exercise • Environmental data (living condition)

  9. Review Of Systems • No weakness • No headache • No cyanosis • No edema • (+) Fatigue • (+) Dyspnea • (+) Occasional chest pain

  10. Physical Examination • Vital Signs: BP = 120/80 PR = 100bpm RR = 24cpm Temp= 37.5°C

  11. Physical Examination • Conscious, coherent, ambulatory • Pink palpebral conjunctiva, anicteric sclera • Moist buccal mucosa, non hyperemic PPW • Supple neck, no palpable cervical lymph nodes • Adynamicprecordium, apex beat 5th LICS MCL, no murmurs • Symmetrical chest expansion, no retractions, (+) occasional wheeze, RUL • Flat abdomen, NABS, soft, non tender • No cyanosis, pulses full and equal

  12. Salient Features Subjective Objective Tachypnea (RR=24cpm) Fever (37.5°C) Occasional wheeze, RUL • 78 y.o., female • Chronic cough (productive) • Occasional chest pain • Dyspnea • Low grade fever • Fatigue • Weight loss • COPD • 30 pack year smoking

  13. Treatment

  14. General Measures • Treatment is determined by the extent of the spread • Surgery to remove all of the lung (pneumonectomy) or part of the lung (lobectomy) may be recommended if cancer is at an early stage • Treatment options depend upon TNM staging • Radiation may be recommended

  15. Medications • Chemotherapy with multiple drugs, cisplatin and topoisomerase inhibitors(with or without radiation therapy), has yielded higher survival rates than surgery particularly in patients with small cell carcinoma • Some improved results with drugs have been reported, but studies to determine the most effective chemotherapeutic combination are ongoing • Pain killers (narcotic analgesics) for palliation

  16. Palliative Treatments • May involve radiation therapy and is geared toward alleviating symptoms • Research about alternative therapies, such as vaccines and immunotherapy, are currently in progress

  17. Non-Small Cell Lung Cancer • Surgery offers the best chance for curing and is recommended if the patient is a viable candidate • Only 25% of lung cancer patients are considered to be surgical candidates at the time of diagnosis • Radiation controls local disease and is most commonly used to palliate symptoms • 10-20% of localized disease can be cured

  18. Non-Small Cell Lung Cancer • Chemotherapy and/or radiation therapy may be considered after surgery for cancer that has progressed to advanced stages • Radiation plus Cisplatin-based chemotherapy are recommended if the patient is not a surgical candidate

  19. Small Cell Carcinoma • Chemoterapy is the cornerstone of treatement • Regimens containing etoposide and either carboplatin or cisplatin is belived to offer the best combination of efficacy and lack of toxicity • Surgery is not considered helpful because small cell carcinoma has usually spread at the time of diagnosis

  20. Prognosis

  21. Prognosis • Without surgery, this condition is currently considered incurable, early diagnosis is critical • If lung cancer is caught in its early stages, the survival rate is approximately 50% • Recurrence is common • The five-year survival rate for all diagnosed lung cancers is 10-15%

  22. References • http://www.ecureme.com/emyhealth/data/Bronchogenic_Carcinoma.asp • http://www.rxmed.com/b.main/b1.illness/b1.1.illnesses/Bronchogenic%20Carcinoma.html • http://www.medstudents.com.br/pneumo/pneumo7/pneumo7.htm

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