Broken femur and appendiceal mass

[K06100]

A 62-year-old woman is transferred to the medical service with an appendiceal mass serendipitously picked up at the edge of an x-ray taken of a broken femur in the emergency department.
Otherwise, the patient has no significant past medical history and no current symptoms.
Which of the following studies is most likely to be useful?

(A) Arterial blood gas
(B) CT of the chest and abdomen
(C) Immediate ECG
(D) MRI of the chest and abdomen
(E) Room air oxygen saturation

[heartbeat]

Have no any idea
Just close my eyes and pick answer (B)

[XpaezX]

WTF?
B? E? the heck i dont know jackshit

[cingulate.gyrus]

No idea

Possibly

(B) CT of the chest and abdomen

[K06100]

The correct answer is B. The most common
tumors of the appendix are carcinoid tumors.
Remembering the “rule of thirds,” 1/3 metastasize,
1/3 are accompanied by a second malignancy,
and 1/3 present with multiple carcinoid
tumors. Since treatment will be based on tumor
location, tumor size, and metastases, a CT
of both the chest and abdomen will give you
most of the information you need. This imaging
modality will also possibly reveal a second
malignancy.
Answer A is incorrect. With an asymptomatic
tumor, there should be no pulmonary compromise
secondary to late carcinoid heart syndrome,
so an arterial blood gas study would not
be helpful. Patients with carcinoid heart syndrome
may develop shortness of breath from
right heart failure, secondary to tricuspid valve
stenosis.
Answer C is incorrect. Carcinoid tumors may
cause carcinoid syndrome, which presents with
fl ushing, diarrhea, bronchospasm, and hy-
potension. This syndrome progresses to carcinoid
heart syndrome in up to 50% of patients,
characterized by endocardial plaques in the
right heart that can lead to right heart failure.
Late carcinoid heart syndrome can produce
diffuse low-voltage ECG changes. Since this
patient’s tumor was asymptomatic, there is no
need to suspect that it has damaged the right
side of her heart enough to produce ECG
changes. While there is no need for an immediate
ECG, she should get a standard admission
ECG when the nursing staff is able to get
her one.
Answer D is incorrect. An MRI is not the
imaging modality appropriate for this type of
screening for solid tumors.
Answer E is incorrect. Since the tumor is asymptomatic,
there should be no pulmonary complications,
so room air oxygen saturation would not
be helpful.

[Novobiocin]

Originally Posted by XpaezX

WTF?
B? E? the heck i dont know jackshit

You just have to connect the Jack (femur) to the **** (Appendix).
The most common tumor of the appendix >>>>Mets (femur)