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Shortness of breath and abdominal swelling
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A 56-year old female presents with recent onset of shortness of breath and abdominal swelling. She describes bloating and urinary frequency that began two months ago. The patient is nulliparous and her last menstrual period was 10 days ago. She has a family history of breast cancer in both sisters, diagnosed at 32 and 35 years of age.
Exam:
Vitals: Heart Rate: 85 BP: 116/72 Temperature: 36.7 RR: 22/min
The patient is uncomfortable but does not appear to be in acute distress, she is dyspneic.
Cardiac Exam: unremarkable
Pulmonary exam: absent breath sounds, dullness to percussion and decreased tactile fremitus over the left lower lobe.
Abdominal exam: bulging flanks, positive fluid wave.
no abdominal tenderness or guarding, no obvious masses.
The most likely diagnosis is:
Responses:
choose the best one answer
Explanation:
Answer: C
Due to the few and unspecific symptoms associated with ovarian cancer, many women do not present until the disease has spread from the ovary. This patient presents with GI symptoms including bloating and abdominal distension. The respiratory symptoms may present due to a pleural effusion, abdominal distension or metastases. On physical exam, the symptoms are most consistent with a pleural effusion. There may also be constitutional symptoms such as weight loss and loss of appetite.
Risk factors for ovarian cancer include nulliparity, early menarche, and late menopause as well as genetic factors. Metastatic colon cancer can also present with abdominal distension and respiratory symptoms, therefore it would be important to rule out.
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