Transcript case_pr01seyfn

성균관대학교 의과대학
2007313075 손의영
Chief Complain
 이O연, F/71
 Abnormality of Chest X-ray
Present Illness
 Previously healthy
건강검진상 발견된 RUL의
solitary pulmonary nodule
평소 이상 증상 없었음
 2011. 02
 2011.04.03
Lung cancer w/u 위해 입원
Other History
 PMHx.
 HTN/DM/Tb/hepatitis/Allergy
(-/-/-/-/-)
 약물력 : Local에서 Both knee에 OA 진단 받고 Medication 중
 수술력
오른쪽 백내장 수술 (왼쪽도 받을 예정)
2010. 치질 수술
 FHx.
 넷째 오빠 심장병으로 수술 받으신 것 외에 특이사항 없음
 SHx.
 occupation: 농업, 임업
 smoking: no
 alcohol: no
 생강과 마가 섞인 한약재를 가끔 드심
Review of system
GW / EF ( - / - )
Weight change : 6mo 동안 6kg 증가 (d/t increased appetite )
fever/chill ( - / - )
Headache/dizziness ( - / - )
Rhinorrhea/ cough /sputum ( - / + / - ) : 3YA, 일상생활 지장 X
Dyspnea (+) : ATS grade II
chest pain / palpitation ( - / - )
anorexia/nausea/vomiting
(-/-/-)
abdominal pain/discomfort
( + / - ) : 폭식 후 심해짐
constipation/diarrhea
(+/-)
hematemesis/melena/hematochezia ( - / - / + ) : 수술 하였으나
지속
 Urinary Sx (-)
 Arthralgia (+) : both knee
 Myalgia (-)
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Physical Exam
V/S
172/88 mmHg - 63 - 18 - 36℃
G/A
Generally well-looking appearance
Mentality Alert & well orientation
HEENT pinkish conjunctivae, anicteric sclerae
Dehydrated tongue (-)
PNS tenderness(-)
PTH/PI (-/-) JVP (-) Neck VE (-)
Cervical LNE (-/-) Thyroid enlagement (-)
 Chest
Symmetric chest expansion
Regular heart beat w/o murmur
Clean breathing sound w/o wheezing
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Physical Exam
 Abdomen
Soft & flat
Bowel sound – normoactive
No tenderness/rebound tenderness
No shifting dullness
 Back
 Extremities
No CVAT
Skin rash(-)
Clubbing (-)
Joint ROM limitation (-)
Joint swelling & stiffness (-)
Joint deformity (-)
Imaging
Spirometry / EKG
Problem List / Assessment
 Problem List
 #1. solitary pulmonary nodule at RUL
 #2. Hypertension
 #3. Hematochezia
 Assessment
 #1 : R/O Lung cancer
 #3 : Recurrent hemorrhoid
Diagnostic w/u
 RUL mass gun Bx
 Bronchoscopy
 PET
Lung cancer – Dx
 Screening
 Sputum cytology, CXR, Low dose CT
 최근 연구에서 Benefit 이 있는 걸로 알려짐
 Tissue Diagnosis
 Fiberoptic bronchoscopy, Transthoracic FNA(PCNA)
 Mediastinoscopy, VATS (thoracoscopy)
 Operative specimen
 Staging Procedures
Lung cancer – Staging
Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls
<RadioGraphics>
Lung cancer – Px
 Non-small lung cancer의 Stage에 따른 예후
 Stage IA :
 Stage IB :
 Stage IIA:
 Stage IIB:
 Stage IIIA:
 Stage IIIB:
 Stage IV :
MSD
MSD
MSD
MSD
MSD
MSD
MSD
60개월
43개월
34개월
18개월
14개월
10개월
6개월
/ 5YSR 50%
/ 5YSR 43%
/ 5YSR 36%
/ 5YSR 25%
/ 5YSR 19%
/ 5YSR 7%
/ 5YSR 2%