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Pulmonology Quiz

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75 yr old non smoker in otherwise good health presents with persistent cough. He has a remote history of asbestos exposure. Physical exam is unremarkable aside from dullness to percussion and decreased breath sounds in the R lung base.

CT of the chest reveals R pleural thickening and loculated R sided pleural effusion. There are 2 cm R hilar nodes and 2 cm ipsilateral mediastinal lymph nodes. 

Pleural biopsy reveals mesothelioma.


Of the following options, the next best step in the management of this patient is:

  1.  Pemetrexed cisplatin
  2.  Gefitinib
  3.  Gemcitabine
  4.  Palliative care