Tuesday, January 11, 2005

You Be the Doctor

Here's a one question quiz, just to get your lateral thinking skills percolating:

A 57 year old man with stage IV non-small cell lung cancer metastatic to the upper thoracic spine and contralateral lung has recently finished a course of palliative chemotherapy. His follow-up scans show stable disease, which means the tumors are not 50% smaller, but also not 25% bigger.

Two months after his last chemotherapy treatment, during a routine follow-up visit he complains of five days of severe pain in the right sacroiliac region, radiating somewhat laterally to the right flank.

As his medical oncologist, what would you do next in order to find the cause of his pain?

A. CT scan of the lumbosacral spine
B. MRI of the lumbosacral spine
C. CT scan of the abdomen/pelvis
D. Bone scan
E. Fusion PET/CT scan
F. Rent several old episodes of Marcus Welby, M.D. for guidance
G. None of the above

The answer can be found in the comment section.

Thank you for playing You Be the Doctor. Today's episode was brought to you by The Cheerful Oncologist, who reminds you to take care of yourself before you end up in my waiting room...


At 10:10 PM, Blogger Dr. Craig Hildreth said...

The correct answer is G. If you geniuses would remember your fine medical education you would recall that the physical examination is ALWAYS done before ordering any tests.

When the patient lifted his shirt, a quick inspection revealed the cause of his pain - he had developed herpes zoster in the corresponding dermatome!

Of course, I know you all got this one right. Please take one pat-on-the-back from the prize basket and apply it vigorously to thyself.

At 1:41 AM, Blogger NerdyGradStudent said...

Just wondering what would be done if on physical examination nothing was found to be the cause of the pain. How frequently do lung tumors metastasize to bone? Do the bone scans have the resolution necessary to detect small numbers of cancer cells? Just curious...I am a graduate student in carcinogenesis :)

At 10:45 AM, Blogger Dr. Craig Hildreth said...

To N.G.S.:

If my exam had not revealed the cause of his pain, yes he would have been asked to undergo a bone scan or similar imaging study, since lung cancer frequently spreads to the skeleton.

At 8:22 PM, Blogger Nick the TCM student said...

Heh, so obvious in hindsight! For me, the issue was significantly confused by the fact that I didn't know the meaningful differences between MRI and CT and soforth.

I did get onto some fun speculation about changes in muscle tone and pinched nerves, and wanted to palpate the painful area. I'm ashamed to admit that the idea of LOOKING at it didn't cross my mind - a useful reminder that not everything happens below the surface!

At 2:21 PM, Anonymous Louise Kessie said...

i'm only thirteen years old but i know that when i'm older i want to be a doctor
i don't really know much about the brain so i do get fascinated when i watch things based in the hospital like casualty, ER and holby city i really want to be a doctor because lots of people are dying from uncureable diseases which i think is really sad.
thats mostly why i want to be a doctor. either an Obstertrician or an oncologist!!

At 11:55 PM, Blogger amacdrummer said...

I liked your cancer tropic blog.... You might find this cancer tropic site interestin :cancer tropic

At 8:39 PM, Anonymous Anonymous said...

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At 7:26 AM, Blogger Editor said...

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I have a cancer cure site. It pretty much covers Cancer related stuff.

Come and check it out if you get time :-)

At 8:27 PM, Blogger hsv667 said...

Hello Dr. Craig Hildreth, I am often astonished at how many people simply brush aside all the sexuually transmitted diseases about Sexually transmitted diseases. If one remembers about how long the warnings regarding general STD's have been about, and how quickly they are disseminating, particularly in the third world, and that is not even not even citing herpes vaccine, then the value of sites like You Be the Doctor become obvious. The proliferation of Sexually transmitted diseases such as herpes vaccine must be stopped. Just my two cents worth. Keep up the excellent work I enjoyed your site and will check it again soon.

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