RESPIRATORY CASE 3

Squamous Cell Small Cell Lung Large Cell

Carcinoma of the Lung Carcinoma Adenocarcinoma Carcinoma
General Data
58 years old √ √ √ √
Male √ √ X (female) √
Chief Complaint
Difficulty of breathing √ √ √ √
History of Present Illness
2 weeks prior to admission
Productive cough with √ (can be either wet or √ (can be either wet √ (can be either wet √ (can be either wet
yellowish sputum dry; yellowish sputum or dry; yellowish or dry; yellowish or dry; yellowish
may indicate bacterial sputum may indicate sputum may indicate sputum may
infection) bacterial infection) bacterial infection) indicate bacterial
infection)
Body malaise and √ √ √ √
dyspnea on exertion
(relieved by rest)
No relief of symptoms w/ √ √ √ √
medication
During the interim
Gradual progressive √ √ √ √
dyspnea
Left-sided chest pain, √ √ √ √
sharp/knife-like,
non-radiating
Cough √ √ √ √
1 day prior to admission
Increasing severity of √ √ √ √
dyspnea (even at rest)
Cough √ √ √ √
Chest pain √ √ √ √
No relief of symptoms √ √ √ √
with medication
(paracetamol &
dextromethorpan)
Smoking (2-21/2 packs per √ √ √ √
day for the last 35 years)
Past Medical, Personal/Social History
Diabetic for 10 years x x x x
(poor compliance)
Decreasing appetite √ √ √ √
Weight loss √ √ √ √
Lives in slums (congested √ √ √ √
area)
Work as a carpenter √ √ √ √
Family History
Father died at age 60 d/t √ √ √ √
complications of Lung CA
Physical Examination
Respiratory distress √ √ √ √
HR: 118 bpm (increased) √ √ √ √
RR: 34 cpm (increased) √ √ √ √
T: 38 C (increased)
o √ √ √ √
Pertinent Physical Findings
Chest and Lungs
Left lung field: √ √ √ √
Decreased fremitus
Dullness to percussion
Decreased breath sounds
Extremities
Clubbing of fingers √ √ √ √
Diagnostic Evaluation
CBC
WBC - 22,000 H √ √ √ √
Neu 70%
Lym 25%
Mono 3%
Chest X-Ray
Moderate amount of √ √ √ √
pleural effusion (left)
Well circumscribed mass √ √ √ √
at the left
paramediastinal border
Blood Serum
Serum Lactate ↑- tissue damage ↑- tissue damage ↑- tissue damage ↑- tissue damage
Dehydrogenase:
160ug/dl
(N: 140-280ug/dl)
Serum Protein: ↓- malnutrition ↓- malnutrition ↓- malnutrition ↓- malnutrition
3.5 g/dl L
(N: 6-8g/dl)
Pleural Fluid Studies
Lactate Dehydrogenase: ↑- malignant effusion ↑- malignant effusion ↑- malignant effusion ↑- malignant effusion
250ug/dl
(N: 140-280ug/dl)
Protein: 2.5 g/dl L √ √ √ √
WBC: >1000/uL H √ exudative; increased √ exudative; √ exudative; √ exudative;
Lym 50% H lymphocytes may increased increased increased
indicate malignancy lymphocytes may lymphocytes may lymphocytes may
indicate malignancy indicate malignancy indicate malignancy
Atypical cells as seen in √ √ √ √
malignancy