By Y. Moff. Benedict College. 2017.
Of the symptoms this patient has had buy super p-force oral jelly 160mg without a prescription, which one suggests the worst prognosis? Hoarseness Key Concept/Objective: To know the symptoms of pulmonary hypertension and their prognos- tic significance All of the symptoms listed are associated with pulmonary hypertension cheap 160 mg super p-force oral jelly. Chest pain can mimic angina pectoris, and hoarseness can occur because of compression of the recur- rent laryngeal nerve by enlarged pulmonary vessels (Ortner syndrome). Syncope and right heart failure generally occur later in the course of illness and are associated with a poorer prognosis. A 32-year-old man comes to your office for a job-related injury. His family history is remarkable for two relatives who had “internal bleeding” in their 40s. On examination, you notice multiple small telan- giectasias on his lips, skin, and oral mucosa. Chest x-ray reveals several small, perfectly round nodules in both lungs. He is likely to develop pulmonary hypertension and right heart failure B. He has an increased risk of stroke and brain abscess D. His pulmonary function tests will show significant restrictive disease E. There is no need to consider treatment if he remains asymptomatic Key Concept/Objective: To be able to recognize hereditary hemorrhagic telangiectasia and to know its consequences In this disorder, there are often numerous arteriovenous malformations (AVMs) in the lungs and elsewhere in the body. Such patients have an artificially low pulmonary resistance because a substantial fraction of blood may be shunting through the AVMs. Although the presence of AVMs generally does not lead directly to pulmonary hyper- tension, occasionally pulmonary hypertension is seen in association with AVM therapy; that is, if AVMs are resected, one can develop pulmonary hypertension because of vas- cular remodeling and an abrupt increase in resistance once the AVMs are no longer able to shunt blood. Orthopnea is actually unusual in this disorder; classically, patients have 36 BOARD REVIEW increased dyspnea when standing up, a symptom called platypnea. Pulmonary func- tion tests are generally normal except for a slightly diminished diffusing capacity of lung for carbon monoxide (DLco). The long-term risk associated with the disease is large- ly the possibility that a clot or organism could embolize through one of these malfor- mations directly to the brain.
Because uncontrolled hypertension can contribute to the pro- gression of renal disease purchase 160 mg super p-force oral jelly otc, target blood pressure values have been established buy super p-force oral jelly 160 mg cheap. These val- ues vary slightly, depending on the source of the recommendation, but in general, a blood pressure of 130/80 mm Hg or less should be sought. Microalbuminuria is a risk factor for progression to end-stage renal disease in diabetic and nondiabetic patients with renal disease. Smoking is an independent risk factor for microalbuminuria in both hypertensive and normotensive patients. Finally, a low-protein diet can easily lead to malnutrition and calorie deficiency and therefore must be closely monitored. A previously healthy 54-year-old woman presents with a 3-week history of arthralgias and edema. Her examination is remarkable for a blood pressure of 170/106 mm Hg, bibasilar pulmonary crackles, and lower extremity edema. A freshly voided urine reveals red blood cells and red cell casts. Her serology is positive for antineutrophil cytoplasmic antibody (ANCA). For this patient, a renal biopsy with immunofluorescent staining would be expected to show which of the following? Positive staining for immune deposits IgG and C3 C. Positive staining for linear deposition of IgG and C3 E. Negative staining for antibody or C3 12 BOARD REVIEW Key Concept/Objective: To understand that ANCA–associated glomerulonephritis is not asso- ciated with staining for immunoglobulin, complement, or immune deposits ANCA-associated glomerulonephritis involves a vasculitic process of the small- and medium-sized blood vessels that usually presents as a focal segmental necrotizing glomerulonephritis. Renal involvement is usually acute, severe, and progressive, and glomeruli contain crescents. ANCA-associated glomerulonephritis is one of the causes of rapidly progressive glomerulonephritis, which many authors consider a medical emergency. ANCA-associated glomerulonephritis can be limited to the kidney or coex- ist with systemic illness such as Wegener granulomatosis.
A complete blood count (CBC) reveals a neutrophilic leukocytosis cheap super p-force oral jelly 160mg overnight delivery, and you suspect chronic myelogenous leukemia (CML) purchase super p-force oral jelly 160mg otc. Which of the following statements regarding CML is false? CML is a myeloproliferative disorder (MPD) and represents a clonal disorder of the pluripotential hematopoietic stem cell B. The CBC often reveals thrombocytosis, neutrophilic leukocytosis, and basophilia C. The presence of the Philadelphia chromosome (Ph) is characteristic of CML and is a poor prognostic sign D. The three main phases of CML are the chronic phase, the accelerated phase, and the blast phase Key Concept/Objective: To understand the pathogenesis and clinical course of CML MPDs represent clonal disorders of the pluripotential hematopoietic stem cell and include CML, polycythemia vera, essential thrombocythemia, myeloid metaplasia, and idiopathic myelofibrosis. CML accounts for 15% of all cases of leukemia in adults. Males are affected more often than females, and the median age at presentation is 45 to 55 years. CML is caused by the transforming capability of the protein products resulting from the Ph translocation t(9;22). Up to 95% of patients with CML express Ph, which results from a reciprocal translocation between the long arms of chromosomes 9 and 22. Patients with CML who do not have Ph translocation have a significantly worse prognosis than do patients who test positive for the bcr-abl gene. CML is characterized by expansion of myeloid progenitor cells at various stages of their maturation, by the premature release of these cells into the circulation, and by their tendency to home to extramedullary sites. Symptoms at presentation reflect the increase in mass and turnover of the leukemic cells.