USMLE Step 1 Question of the Week #2

A 65-year-old male patient is brought to the emergency department by his relatives for sudden onset of shortness of breath. He was recently diagnosed with bronchogenic carcinoma of the small cell variety. He had come in with a history of coughing up blood on several occasions with a persistent cough. He had been smoking two packs of cigarettes a day for the last 20 years. Today he also complains of occasional headaches and a difficulty in seeing. He complains that these symptoms are more prominent in the morning when he wakes up from sleep. It subsides as the day progresses. Which of the following are the further physical findings the physician is expected to find in this patient?

A. Lower extremity edema along with distention of the superficial veins of the abdomen.

B. Edema and a purplish hue in the upper extremities, extending to the head.

C. Low blood pressure and a weak pulse, with extended jugular veins.

D. Breathing produces paradoxical movements in the chest.

E. Swelling of the feet with an increased shortness of breath as the patient lies down.

3 Responses

  1. B

  2. D. Paraneoplastic. Most likely diagnosis is LEMS .LEMS usually associated with small cell lung cancer but can be observed in bronchogenic as well. Later in the course of the disease they get respiratory muscle weakness

  3. C is the Answer

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