Question of the Week # 326

326)  A 55 year old african-american man presents to your office with complaints of shortness of breath that has slowly progressed over the past several months. He also reports chest pain which in non-pleuritic in nature. He has lost about 10lbs weight in the past three months. He has changed several jobs but he currently works as a sales representative for a drug company. On examination, his temperature is 100F, Pulse 98/min, RR 20/min and Blood Pressure 100/60 mm HG.  He is in mild distress due to shortness of breath. On chest examination, there is dullness to percussion over the right side of the chest. No masses are palpable. Laboratory investigations reveal WBC 8k/μl with normal differential, Hgb 10.5gm%, Platelets 550k/μl, Calcium 11.2gm% ( (Normal 8.9 to 10.5 mg%)

A chest-x-ray is shown below:

Which of the following element in the history would be most helpful in making a presumptive diagnosis of his presentation?

A) Smoking

B) Family history of Cancer

C) Bone pain

D) Flank pain and Hematuria

E) Previous Occupation

11 Responses

  1. Assuming that the patient has lung cancer history of smoking wound be the most helpful in making presumptive diagnosis.

  2. I think it’s a. Smoking

  3. any reason why smoking?

  4. patient has squamous cell carcinoma : High calcium

    Could it be occupational factors ? exposure to mineral , radon , metal dust ? Vinette says he switches jobs .

    Or it also can be caused by presence of smoking history .

    What is the right answer ?

  5. pls gve the right answer?

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