TCVS

PRACTICAL LECTURE
DR. ALETA DEC. 13, 2011

IV-1a

Case Management Case 1 50 y/o male with 2 cm round mass over the right upper lobe How do you manage this case? History & PE Diagnostics Possible Differential Diagnosis: Bronchogenic carcinoma Pulmonary tuberculosis Hamartoma Aspergilloma Metastatic cancer Case 2 A 50 y/o male, smoker, with 6 months history of coyhg and weight loss, was noted to have a 4 cm mass over the right lower lobe. Approach? Diagnosis? Lingular division= right middle lobe No medial basal segment- left

The most probable diagnosis for this case is Bronchogenic carcinoma Pulmonary tuberculosis Hamartoma Aspergilloma Metastatic ca The best treatment option for lung cancer Stage I to IIIa is a. SURGERY b. Radiotherapy c. Chemotherapy d. Neoadjuvant chemotherapy followed by surgery Case 3 A 43 y/o male will undergo right lower lobectomy for lung cancer. What examination will you will request to determine if the remaining lung post resection can support the patient? a. Ventilation perfusion scan b. ABG c. PULMONARY FUNCTION TEST d. Minute ventilation e. None of the above Right Lung Upperlobe-3 segments Middle lobe-2 segments Lower lobe-5 segments Left Lung Upper lobe-4 segments Lower lobe-4 segments

Solitary Pulmonary Nodule Peripheral, fairly smooth, well circumscribed lesion (coin lesion), asymptomatic patient Malignant in 10% of cases Malignant in 60-80% of patients of age >50 y/o Differential diagnosis includes o Lung cancer- very important to rule out o Lung metastasis o TB-common in the Philippines o Benign lung tumor (hamartoma) o AV fistulae Features of Malignancy o Large size (>4cm) o Indistinct/lobulated margins o Tumor doubling 35 to 280 days o Absence of calcification Features suggesting Benign Etiology o Small size (<1cm) o Distinct margins

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o o Calcification Doubling time <35 days or >465 days

Diagnostic Modalities o If peripherally, do percutaneous needle lung biopsy (80% yield) scan guided o If hilar, do bronchoscopy and biopsy (75% yield) o Wedge resection with frozen section is acceptable in patients who are good for surgery

Case 4 45 y/o M brought to ER for pain and sudden discoloration of Left foot Approach 1. 2. 3. 4. History PE Diagnostics Treatment

Case 5 A 54 y/o male with disabling claudication is recommended to have revascularization. The examination you will need before performing surgery is at least: a. Arterial duplex scan b. CT scan c. MRI d. Arteriogram Case 6 60 y/o M brought to ER hypotensive, pale, abdominal and back pain o History & PE o Differentials o Diagnostics o Treatment

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