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A 59-year-old woman with a 10-year history of type - 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: A 59-year-old woman with a 10-year history of type - jcbc (/showthread.php?tid=295008) |
A 59-year-old woman with a 10-year history of type - jcbc - ArchivalUser - 04-21-2008 A 59-year-old woman with a 10-year history of type 2 diabetes mellitus is noted by her physician to have bilateral pitting edema of the ankles and feet. No erythema is noted. On questioning, the patient also reports shortness of breath on exertion and states that she has been using 3 pillows at night in order to sleep comfortably. Question 1 of 6 This patient's symptoms are most suggestive of which of the following? / A. Cellulitis / B. Congestive heart failure / C. Gynecologic cancer / D. Lipedema / E. Thrombophlebitis Question 2 of 6 A chest x-ray film demonstrates pulmonary venous congestion and interstitial edema indicative of pulmonary edema. Which of the following physiologic mechanisms is most likely the immediate cause of the pulmonary edema? / A. Damage to endothelial cells / B. Damage to the epithelial lining of the alveoli / C. EIevated pulmonary capillary pressure / D. Low serum albumin / E. Poor lymphatic drainage of fluid Question 3 of 6 A chest x-ray film additionally demonstrates a markedly enlarged cardiac shadow with dilation of both the right and left ventricles. Echocardiography shows dilated, hypokinetic ventricles. The physician prescribes several medications, including captopriI. Which of the following best characterizes captopriI? / A. ACE inhibitor / B. AIpha blocker / C. Beta blocker / D. Diuretic / E. Positive inotrope Question 4 of 6 An increase in which of the following is the most likely explanation for the edema in her legs? / A. Interstitial colloid osmotic pressure / B. Lymph flow / C. PIasma colloid osmotic pressure / D. Right atrial pressure / E. Stroke volume Question 5 of 6 As this patient's condition progresses, she is started on digoxin. Her most recent digoxin blood level was 2.0 ng/mL. She will be at the highest risk for developing digoxin toxicity if she has which of the following conditions? / A. Hypokalemia / B. Hyponatremia / C. Hypophosphatemia / D. Vitamin B12 deficiency / E. Vitamin K deficiency Question 6 of 6 This patient's condition is associated with which of the following 5-year mortality rates? / A. 5% / B. 30% / C. 50% / D. 70% / E. 95% 0 - ArchivalUser - 04-21-2008 bbb ccc aaa ddd aaa ccc?? 0 - ArchivalUser - 04-21-2008 This patient's condition is associated with which of the following 5-year mortality rates? / A. 5% / B. 30% / C. 50% / D. 70% / E. 95% Explanation - Q: 1.6 The correct answer is D. In temperate zones, dilated congestive cardiomyopathy is most commonly the result of diffuse coronary artery disease with diffuse ischemic myopathy, which produces chronic myocardial fibrosis with diffuse loss of myocytes. Other causes are very diverse and can include a wide variety of infections, granulomatous disease, metabolic disorders, drugs and toxins, cancers, connective tissue disorders, familial neuromuscular disorders, and pregnancy. The dilated chambers usually function poorly, leading to a low ejection fraction. Tachycardia and increased end-diastolic volume initially maintain cardiac output, but often eventually fail with disease progression to adequately supply the tissues with oxygenated blood. Overall, dilated congestive cardiomyopathy is more often fatal than many cancers, with a 5-year mortality rate of 70%. 0 - ArchivalUser - 04-21-2008 70%! it is a dangerous disease, thanks jcbc 0 - ArchivalUser - 04-21-2008 B, C, A, D, A except for the last question regarding percentage, these questions seem easy, from what question bank is this? thanks |