Answer
1)Abnormal findings
-Opacity at the left upper zone (elaborate)
-prominent hilar marking
2)Diagnosis
Lung carcinoma
3)2 Clinical signs
a)Finger clubbing
b)Horner syndromes
*Others; pan coast tumor, paraneoplastic syndrome, pleural effusion, tar staining, enlarge cervical lymph node, radiation mark, cachexia
4) One investigation to confirm the diagnosis
-Fibreoptic bronchoscopy to take the sample for histology examination.
•Other investigation; Early morning sputum cytology, pleural fluid cytology, U/S guided FNAC, staging (CT Thorax, abdomen and brain, bone scan), PET Scan, (in Malaysia available in two places only), Lymph node biopsy.
Notes: Important history
-Smoking & smoke per year
-Symptoms
a)Primary tumor
b)Mediastinal spread
c)Distant metastasize
d)Paraneoplastic syndromes
e)Systemic/constitutional sx.