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A 65 year old man with a past history of

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A 65-year-old man with a past history of bronchiectasis presents to the ER withhemoptysis. He reports increased cough and sputum production over the last week.There is often blood streaking his sputum, but on the last day he has noted that he iscoughing up tablespoons of clotted blood. PE shows normal vital signs, O2 sat of 98%on room air. The patient is mildly dyspneic and has diffuse expiratory wheezing.Radiography reveals findings consistent with bronchiectasis. What is the most likelycause of the hemoptysis?*
5/5
A 50-year-old male presents to the clinic for a routine health examination. Acomprehensive metabolic panel shows a serum Calcium level of 11.2 mg/dl. Serumphosphate is 3.0 mg/dl. Serum creatinine is normal. He denies bone pain, lethargy,weakness, or weight loss. What is the most common cause of hypercalcemia inout-patients?*5/5
Vitamin D intoxicationMilk-alkali syndromeMedicationsGranulomatous diseaseFeedbackCorrect! Primary hyperparathyroidism and malignancy account for over 90% of cases ofhypercalcemia. Calcium is regulated in bone, the gastrointestinal tract, and the kidney. Other causes ofincreased bone turnover include Paget's disease, immobilization, hyperthyroidism, hypervitaminosis A,and adrenal insufficiency. Causes of increased GI absorption include vitamin D intoxication andmilk-alkali syndrome.A 35 year old female undergoes a physical exam while obtaining new insurancecoverage. She reports 1 year of slowly progressive dyspnea on exertion and a change inskin color. Her PE is notable for the the presence of cyanosis, an elevated JVP, a fixedsplit loud loud S2, and peripheral edema. Arterial O2 saturation is 84% at room air. CXRshows cardiomegaly and normal lung parenchyma. Ten years ago, at her last insurancePE, her PE, O2 saturation and CXR were normal. Echocardiography most likely willreveal:*5/5Ebstein's anomalyVentricular septal defectTetralogy of FallotTruncus arteriosus
Atrial septal defectFeedbackCorrect! The patient is presenting with Eisenmenger's syndrome (shunt anomaly with predominantright to left shunting) These shunts are initially left to right and therefore do not present with cyanosis.Pulmonary hypertension develops over the years as the result of increased pulmonary blood flow,increased vascular tone, and erythrocytosis. Atrial Septal defects are the most common in adultspresenting with Eisenmenger's syndrome. This patient had no evidence of pulmonary hypertension orcyanosis 10 years ago.

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Term
Spring
Professor
N/A
Tags
Atrial septal defect, vitamin B12 deficiency, fevers

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