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LEARNING OBJECTIVES

After completing this case study, the reader should be able to:

  • Recognize the most common symptoms of non–small cell lung cancer (NSCLC).

  • Design a treatment plan for patients with NSCLC.

  • Design a pharmacotherapeutic plan for the treatment of hypercalcemia.

  • Describe appropriate treatment strategies for brain metastases in NSCLC.

  • Educate patients on the anticipated side effects of carboplatin, paclitaxel, and nivolumab therapy.

PATIENT PRESENTATION

Chief Complaint

“I have been coughing up blood.”

HPI

This 66-year-old woman presents to her PCP with complaints of a dry, nonproductive cough for 2.5 months, dyspnea on exertion, and hemoptysis for 1 week.

PMH

Dyslipidemia

HTN

Anemia of unknown etiology × 1 year

Type 2 DM

PPD (–)

FH

Father died of colorectal cancer at age 68

Aunt died of breast cancer at age 70

SH

Married, lives with son and daughter; 30 pack-year cigarette smoking history (approximately 1 ppd × 30 years); occasional ETOH use; no known recent exposure to TB

Meds

Folic acid 1 mg PO daily

Ferrous sulfate 325 mg PO TID

Simvastatin 20 mg PO daily

Metformin 500 mg PO BID

Pantoprazole 40 mg PO daily

All

Penicillin (rash)

Sulfa (rash)

ROS

(+) For pulmonary symptoms as noted in HPI; no headaches, dizziness, or blurred vision

Physical Examination

Gen

Mildly overweight Caucasian woman in slight distress. ECOG performance status of 1.

VS

BP 169/100 mm Hg, P 90 bpm, RR 30, T 37.2°C; Wt 82 kg, Ht 5′6″

Skin

Patches of dry skin; no lesions

HEENT

PERRLA; EOMI; fundi benign; TMs intact

Neck/Lymph Nodes

No lymphadenopathy; neck supple

Lungs

Wheezing in RUL; remainder of lung fields clear

Heart

RRR; normal S1, S2, slight systolic murmur on left lateral side

Abd

Soft, nontender; no splenomegaly or hepatomegaly

Genit/Rect

Normal female genitalia; guaiac (–) stool

Neuro...

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