CCS - Lung Cancer (cough)

Question 1

PRESENTATION

Common Features of Lung Cancer

Answer 1

Typical Symptoms:

• Cough
• SOB
• Weight Loss
• Fatigue

Atypical Symptoms:

• Shoulder Pain

Other Symptoms:

• Yellow Sputum and Fever (from an associated Pneumonia)
• Hoarseness, Dysphagia, or Stridor (from Intrathoracic spread of Tumor)

If SIADH is Present, look for Signs of Hyponatremia:

• Anorexia, nausea, malaise, muscle cramps, weakness, headache, irritability

Question 2

PHYSICAL EXAMS

Physical Exams for Lung Cancer

Answer 2

• General Appearance - Thin, Older patient (50s - 70s), Hx of Smoking & COPD
• Skin - normal
• HEENT - normal
• Lymph Nodes - normal
• Lungs - Dullness to percussion, Decreased breath sounds over Lung Base
• Heart - normal
• Abdomen - normal
• Extremities/Spine - normal
• Neuro - normal

Question 3

DIAGNOSIS

Orders for Lung Cancer

Answer 3

1. Physical Exam :
   
   • Lungs: Features of Pneumonia (rales, rhonchi, wheeze, dullness to percussion)
2. CXR (PA/Lat):
   
   • Lung infiltrate, COPD signs
   • Provide the first clues to abnormality
3. Sputum Gram Stain, Culture** and **Cytology:
   
   • ​​May provide additional information
4. Chest CT:
   
   • ​​Should be performed for Diagnosing and Staging
5. Bronchoscopy or Mediastinoscopy with cytologic evaluation:
   
   • ​​May be needed for Diagnosis

Question 4

TREATMENT

Therapy for Lung Cancer

Answer 4

• Advise patient, Cancer Diagnosis
• Consult Heme/Onc
• Antibiotics (if pneumonia)
• Advise patient, fluid restriction (if SIADH)
• Demeclocycline (if SIADH)

Question 5

MONITORING

Monitoring for Lung Cancer

Answer 5

Not important for lung cancer case

Question 6

SEQUENCING

CCS Order Sequence for Lung Cancer

Answer 6

1. Physical Exams - General Appearance, Skin, HEENT, LNs, Lungs, Heart, Abdomen, Extremities/Spine, Neuro
2. Orders - Pulse Oximetry & CXR (PA/Lat)
3. Clock - advance to CXR results (Lung infiltrate, COPD signs)
4. Location - Inpatient unit
5. Orders - Sputum tests, Chest CT w/ contrast, Bronchoscopy, Antibiotics, Acetaminophen, Advise no smoking, Advise medication side effects, Counsel patient
6. Clock - advance to results of Bronchoscopy or Sputum Cytology
7. Orders - Advise cancer diagnosis, Abdominal CT w// contrast, CBC, BMP, LFT, Consult Heme/Onc, Consult Radiation therapy, Consult Thoracic surgery, Reassure patient
8. Clock - advance to additional results and case end. Treat SIADH and Hyponatremia if present
9. End Orders - Advise Advance Directives