pathophysio q2 - jcbc - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 1 (https://www.usmleforum.com/forumdisplay.php?fid=2) +--- Thread: pathophysio q2 - jcbc (/showthread.php?tid=294951) |
pathophysio q2 - jcbc - ArchivalUser - 04-21-2008 A 65-year-old retired accountant with a 60-pack-year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He reports that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second heart sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected? A. A hemoglobin of 9 g/dL B. A hemoglobin of 17 g/dL C. A platelet count of 84,000 D. A platelet count of 102,000 E. A white blood cell count of 3400 0 - ArchivalUser - 04-21-2008 Is it bbb? A case of COPD. 0 - ArchivalUser - 04-21-2008 BBB?? 0 - ArchivalUser - 04-21-2008 bb 0 - ArchivalUser - 04-21-2008 why B???? explain 0 - ArchivalUser - 04-21-2008 COPD-hypoxia-compensation 0 - ArchivalUser - 04-21-2008 bbb 0 - ArchivalUser - 04-21-2008 The correct answer is B. A hemoglobin of 17 g/dL would be expected. The question describes a patient with chronic obstructive pulmonary disease (COPD) confirmed by his physical examination, which also suggests right-sided heart failure, loud P2, and hepatic congestion and peripheral edema due to right-sided heart failure. The pulmonary function tests are consistent with the diagnosis of obstructive airway disease. Given the long history of smoking, this patient most likely has COPD. Because of chronic hypoxia, these patients also develop erythrocytosis in an effort to increase the oxygen carrying capacity. 0 - ArchivalUser - 04-21-2008 COPD comes to mind, in response to decreased oxygen and increased carbondioxide concentration EPO production is triggered. To compensate by increasing hemoglobin to increase oxygen binding. 0 - ArchivalUser - 04-21-2008 COPD with right side heart failure hypoxic vasoconstriction |