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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.
“I have been coughing up blood.”
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.
Anemia of unknown etiology × 1 year
Father died of colorectal cancer at age 68
Aunt died of breast cancer at age 70
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
Ferrous sulfate 325 mg PO TID
Simvastatin 20 mg PO daily
Pantoprazole 40 mg PO daily
(+) For pulmonary symptoms as noted in HPI; no headaches, dizziness, or blurred vision
Mildly overweight Caucasian woman in slight distress. ECOG performance status of 1.
BP 169/100 mm Hg, P 90 bpm, RR 30, T 37.2°C; Wt 82 kg, Ht 5′6″
Patches of dry skin; no lesions
PERRLA; EOMI; fundi benign; TMs intact
No lymphadenopathy; neck supple
Wheezing in RUL; remainder of lung fields clear
RRR; normal S1, S2, slight systolic murmur on left lateral side
Soft, nontender; no splenomegaly or hepatomegaly
Normal female genitalia; guaiac (–) stool