Pulmonary Nodule

HISTORY:

Presents for a ‍recently diagnosed ‍pulmonary nodule

Chest ‍X-rayCT scan: ‍mm nodule on the ‍, characteristics: ‍

Current symptoms: ‍none

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍hemoptysis

‍shortness of breath

‍chest pain, ‍retrosternal, ‍on exertionat restwith deep breath

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍night sweats



Smoking: ‍neversmokerformer smoker ‍ pack-years



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍



ASSESSMENT:

‍Pulmonary nodule ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Chest X-ray

- CT scan of the chest

- PET scan

- Bronchoscopy

- Percutaneous needle biopsy

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍LFTs, ‍CEA, ‍CA 19-9, ‍CA 125, ‍AFP,

- ‍Chemotherapy

- ‍Radiation therapy

- ‍Targeted therapy

- ‍Immunotherapy

- Smoking cessation counseling

- Repeat CT scan in ‍ ‍months (based on Fleischner guidelines)

- Referral to pulmonologist

- Referral to thoracic surgeon

- Referral to oncologist

- Referral to radiation oncologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if symptoms worsen or if new symptoms develop such as shortness of breath, chest pain, or weight loss