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{{Family tree/start}}
===Symptoms Related to Tumor Growth in the Thorax===
{{familytree | | | | | | | | | | | | | A01 | | |A01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Identify cardinal findings that increase the pretest probability of wide complex tachycardia''' <br>❑ [[Palpitations]] <br> ❑ [[QRS complex]] > 120 ms <br>❑ [[Heart rate]] > 150 beats/min </div> <br> }}
* [[Cough]] (most common symptom)<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid12527569">{{cite journal| author=Beckles MA, Spiro SG, Colice GL, Rudd RM| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. | journal=Chest | year= 2003 | volume= 123 | issue= 1 Suppl | pages= 97S-104S | pmid=12527569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12527569  }} </ref>
{{familytree | | | | | | | | | | | | | |!| | | }}
* [[Wheezing]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref>
{{familytree | | | | | | | | | | | | | B01 | | |B01=<div style="float: left; text-align: left; width: 13em; padding:1em;">'''Does the patient have any of the following findings that require urgent cardioversion?''' <br>
* [[Dyspnea]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
❑ Hemodynamic instability
* [[Hemoptysis]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
:❑ [[Hypotension]]
* [[Chest pain]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
:❑ [[Cold extremities]]
:❑ [[Cyanosis|Peripheral cyanosis]]
:❑ [[Mottling]]
:❑ [[Altered mental status]]
❑ [[Chest discomfort]] suggestive of [[ischemia]] <br>
❑ [[Heart failure|Decompensated heart failure]]</div>}}
{{familytree | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | | B02 | | | | | | | | | | |B01=<div style="float: left; text-align: central; background: #FA8072; width: 13em; padding:1em;"> {{fontcolor|#F8F8FF| ❑ '''Yes'''}} </div>|B02=❑ '''No'''}}
{{familytree | | | | | | | | | |!| | | | | | | |!| | | | | | | | |}}
{{familytree | | | | | | | | | |!| | | | | | | C02 | | | | |C02=<div style="float: left; text-align: left; width: 13em; padding:1em;"> ❑ '''[[Wide complex tachycardia resident survival guide#Complete Diagnostic Approach|Continue with the complete diagnostic approach below]]''' </div>}}
{{familytree | | | | | | | | | C03 | | | | | | | | | | | | | | | |C03=<div style="float: left; text-align: left; background: #FA8072; width: 13em; padding:1em;"> {{fontcolor|#F8F8FF| '''Prepare the patient for immediate cardioversion and simultaneously do the following:'''<br> ❑ Maintain patent airway; assist breathing as necessary<br> ❑ Adminster [[oxygen]] (if the patient is hypoxemic)<br> ❑ Cardiac monitor to identify rhythm; monitor [[blood pressure]] and oximetry <br> ❑ Give IV sedation if the patient is conscious (don't delay cardioversion to sedate the patient) <br> ❑ Consider expert consultation }} </div>}}
{{familytree | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | | | |}}
{{familytree | | | | A01 | | | A02 | | | A03 | | | | | | | | | | |A01=<div style=" width: 13em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''[[VT]]/[[VF]] in the form of [[cardiac arrest]]'''<br> '''[[Cardiac arrest resident survival guide|<span style="color:white;">Click here for Cardiac arrest resident survival guide</span>]]''' }} </div> </div> |A02=<div style=" width: 13em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''Unsynchronized cardioversion'''<br> ❑ If a patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks <br>
:❑ Provide an initial shock of 200 Joules<br>
:❑ Increase the dose if no response to the first shock (eg, 300 J, 360 J, 360 J) }} </div> </div>|A03=<div style=" width: 13em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''Synchronized cardioversion''' }} </div> </div>}}
{{familytree | | | | | | | | | | | |,|-|-|+|-|-|.| | | | | | | | }}
{{familytree | | | | | | | | | | D01 | | D02 | | D03 | | | | | | |D01=<div style="float: left; text-align: left; background: #FA8072; width: 13em; padding:1em;"> {{fontcolor|#F8F8FF| '''Atrial fibrillation with aberrancy'''
:❑ Provide an initial dose of biphasic cardioversion of 120-200 Joules ([[ACC AHA guidelines classification scheme|<span style="color:white;">Class IIa, level of evidence A</span>]])
:❑ If the initial shock fails, increase the dose in a stepwise fashion }} </div>|D02=<div style="float: left; text-align: left; background: #FA8072; width: 13em; padding:1em;"> {{fontcolor|#F8F8FF| '''Arial flutter and other SVTs with aberrancy'''
:❑ Provide an initial dose of biphasic cardioversion of 50-100 Joules ([[ACC AHA guidelines classification scheme|<span style="color:white;">Class IIa, level of evidence B</span>]])
:❑ If the initial shock fails, increase the dose in a stepwise fashion
:❑ If monophasic wave form is used, begin at 200 Joules and increase in stepwise fashion if not successful }} </div>|D03=<div style="float: left; text-align: left; background: #FA8072; width: 13em; padding:1em;"> {{fontcolor|#F8F8FF| '''Monomorphic VT (regular form and rate)'''
:❑ Provide an initial dose of biphasic cardioversion of 100 Joules ([[ACC AHA guidelines classification scheme|<span style="color:white;">Class IIb, level of evidence C</span>]])
:❑ If the initial shock fails, increase the dose in a stepwise fashion }} </div> }}
{{familytree | | | | | | | | | | |`|-|-|-|+|-|-|-|'| | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | D01 | | |D01= <div style="float: left; text-align: left; width: 13em; padding:1em;">❑ '''[[Wide complex tachycardia resident survival guide#Complete Diagnostic Approach|After the stabilization of the patient, continue with the complete diagnostic approach below]]''' </div>}}
{{Family tree/end}}


===Constitutional Symptoms===
* [[Fatigue]]
* [[Anorexia]]
* [[Weight loss]]


{{familytree/start}}
===Symptoms Related to Paraneoplastic Syndrome===
{{familytree | | | | | | | | A01 | | A01=
 
<div style="float: left; text-align: left; width: 27em; padding:1em;"> '''Characterize the symptoms:'''<br>
===Symptoms Related to the Distant Spread of the Tumor===
❑ [[Palpitations]]<br> ❑ [[Lightheadedness]] <br> ❑ [[Dyspnea]] <br> ❑ [[Diaphoresis]] <br> ❑ [[Chest pain|Chest discomfort]] <br> ❑ [[Shock]]<br> ❑ [[Syncope]] <br> ❑ [[Seizures]] <br> ❑ [[Cardiac arrest]]<br>
* [[Hoarseness]] (involvement of the [[recurrent laryngeal nerve]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
'''Characterize the timing of the symptoms:'''<br>
* [[Dyspnea]] (one of the causes is the involvement of the [[phrenic nerve]] and subsequent elevation of the hemi-[[diaphragm]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
❑ Onset <br>
* [[Pain]], [[muscle wasting]], or change in the skin temperature in areas corresponding to C8, T2 to T4 (involvement of the [[brachial plexus]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ First episode
* [[Chest pain]] (one of the causes is the involvement of the chest wall)<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Recurrent
* [[Pleuritic chest pain]]<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
❑ Duration <br>
* [[Horner syndrome]] manifested by unilateral [[miosis]], [[ptosis]] and anhydrosis (involvement of the sympathetic trunk)<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
❑ Frequency<br>
* [[Arrhythmia]] (involvement of the [[pericardium]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166 }} </ref>
❑ Termination of the episode
* [[Cardiac tamponade]] manifested by chest pain, [[altered mental status]], [[cold extremities]], peripheral [[cyanosis]] (involvement of the [[pericardium]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Spontaneous
* [[Dysphagia]] (compression of the [[esophagus]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166 }} </ref>
:❑ Medication use
* [[Superior vena cava syndrome]] manifested by [[dyspnea]], [[headache]], and [[swelling]] of the face, neck, trunk, and arms<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Not terminated</div>}}
 
{{familytree | | | | | | | | |!| | | }}
===Uncommon Symptoms===
{{familytree | | | | | | | | B01 | | | B01= <div style="float: left; text-align: left; width: 27em; padding:1em;"> '''Identify possible triggers:'''<br>
* [[Abdominal discomfort]] due to bilateral adrenal mass<ref name="pmid23825789">{{cite journal| author=Singh N, Madan K, Aggarwal AN, Das A| title=Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature. | journal=J Thorac Dis | year= 2013 | volume= 5 | issue= 3 | pages= E83-6 | pmid=23825789 | doi=10.3978/j.issn.2072-1439.2011.09.05 | pmc=PMC3698258 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23825789  }} </ref>
<table>
* [[Facial nerve palsy]] due to [[metastasis]] to the [[facial nerve]]<ref name="pmid21526004">{{cite journal| author=Yildiz O, Buyuktas D, Ekiz E, Selcukbiricik F, Papila I, Papila C| title=Facial nerve palsy: an unusual presenting feature of small cell lung cancer. | journal=Case Rep Oncol | year= 2011 | volume= 4 | issue= 1 | pages= 35-8 | pmid=21526004 | doi=10.1159/000324182 | pmc=PMC3082487 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21526004  }} </ref>
<tr class="v-firstrow"><td>❑ [[Infection]]</td><td>❑ [[Caffeine]]</td><td>❑ [[Alcohol]]</td></tr>
<tr><td>❑ [[Nicotine]] </td><td> ❑ [[Recreational drugs]]</td><td>❑ [[Hypovolemia]]</td></tr>
<tr><td>❑ [[Hyperthyroidism]]</td><td> ❑ [[Hypoxia]]</td><td> ❑ [[Acidosis]] </td></tr>
<tr><td>❑ [[Hypokalemia]]</td><td> ❑ [[Hyperkalemia]]</td><td> ❑ [[Hypoglycemia]] </td></tr>
<tr><td>❑ [[Hypothermia]]</td><td> ❑ [[Toxins]]</td><td>❑ [[Pulmonary embolism]] </tr>
<tr><td>❑ [[Coronary thrombosis]]</td><td> ❑ [[Cardiac tamponade]]</td><td> ❑ [[Trauma]] </td></tr></table>
</div>}}
{{familytree | | | | | | | | |!| | | }}
{{familytree | | | | | | | | C01 | | C01= <div style="float: left; text-align: left; width: 27em; padding:1em;">
'''Examine the patient:'''<br>
'''Vitals'''<br>
❑ Pulse
:❑ Rate <br>  
::❑ [[Tachycardia]]   <br> 
:❑ Rhythm  <br>
::❑ Regular <br>
::❑ Irregular  <br>
:❑ Strength  <br>
::❑ Weak  <br>
::❑ Alternating in strength ([[atrial fibrillation with aberrancy]]) <br> 
❑ [[Respiration]]<br>
: ❑ [[Tachypnea]]<br>
❑ [[Blood pressure]]<br>
:❑ [[Normal]] (typical)<br>
:❑ [[Hypotension]] (in hemodynamically unstable patients)<br>
:❑ Marked fluctuation of [[blood pressure]] (suggestive of AV dissociation in [[VT]])   
'''Neck'''<br>
:❑ Canon [[A waves]] in examination of jugular venous distension of the neck (suggestive of AV dissociation in [[VT]])<br>
'''Cardiovascular examination'''<br>
❑ Auscultation <br>
:❑ [[Heart sounds]]
::❑ Rapid regular or irregular beats <br>
::❑ Murmurs (suggestive of valvular diseases)<br>
::❑ Variability in the occurrence and the intensity of heart sounds especially S1 (suggestive of AV dissociation in [[VT]])<br>
❑ Inspection <br>
:❑ Midsternal incision (sugestive of previous cardiothoracic surgery)<br>
❑ Palpation <br>
:❑ Pace maker or ICD are usually palpapable on the left pectoral area
</div>}}
{{familytree | | | | | | | | |!| | | }}
{{familytree | | | | | | | | A01 | | | | | A01= <div style="float: left; text-align: left; width: 27em; padding:1em;">
❑ Order and monitor the [[ECG]]<br>
<span style="color:red">Perform urgent cardioversion in unstable patients</span>
</div>}}
{{familytree | | | | | | | | |!| | | }}
{{Family tree/end}}

Latest revision as of 13:48, 19 June 2014

Symptoms Related to Tumor Growth in the Thorax

Constitutional Symptoms

Symptoms Related to Paraneoplastic Syndrome

Symptoms Related to the Distant Spread of the Tumor

Uncommon Symptoms

  1. ↑ 1.0 1.1 1.2 1.3 1.4 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
  2. ↑ Beckles MA, Spiro SG, Colice GL, Rudd RM (2003). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes". Chest. 123 (1 Suppl): 97S–104S. PMID 12527569.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
  4. ↑ Singh N, Madan K, Aggarwal AN, Das A (2013). "Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature". J Thorac Dis. 5 (3): E83–6. doi:10.3978/j.issn.2072-1439.2011.09.05. PMC 3698258. PMID 23825789.
  5. ↑ Yildiz O, Buyuktas D, Ekiz E, Selcukbiricik F, Papila I, Papila C (2011). "Facial nerve palsy: an unusual presenting feature of small cell lung cancer". Case Rep Oncol. 4 (1): 35–8. doi:10.1159/000324182. PMC 3082487. PMID 21526004.
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