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Since there is no evidence that androgens can forestall bone marrow failure definition cholesterol hdl ldl best purchase for atorlip-20, treatment is initiated when cytopenias drop to cholesterol medications that start with a p buy 20mg atorlip-20 overnight delivery clinically significant levels but before the marrow becomes completely devoid of hematopoietic stem cells for androgens to list of best cholesterol lowering foods atorlip-20 20mg sale stimulate cholesterol high medication atorlip-20 20mg free shipping. The standard recommended androgen is oxymetholone, with a starting dose of 2-5 mg/kg/day rounded to the nearest 1/4 tablet (50 mg tablets are available in the United States, while 10 mg tablets are available in many countries in Europe). If the patient responds to the initial dose with a stabilization of or increase in the hemoglobin level, the daily dose may be tapered in 1/2 tablet decrements after 3 months. Thereafter, a reasonable taper schedule might involve gradually decreasing the androgen dose at 2-4 month intervals. The family should be counseled about the possible side effects of androgen therapy and the child, especially teenagers, should be forewarned about them. Every effort should be made to minimize the side effects by tapering the dose whenever possible. Aggressive acne treatment with topical benzoyl peroxide and topical antibiotics (clindamycin or erythromycin) may make the treatment more tolerable. Since the masculinizing side effects of oxymetholone are particularly troublesome in girls and women, some female patients have been treated with a different androgen, danazol, which is hypothesized to produce fewer of these side effects. It has not been established whether, dose for dose, danazol is as effective and, at the same time, less masculinizing than oxymetholone. Clinical trials comparing efficacy and side effects of different androgens are currently being developed. The use of low dose (5-10 mg every other day) prednisone in an attempt to attenuate the premature epiphyseal closure by androgens has been advocated by some physicians. There are no data to support any sparing of androgen toxicity with the use of low dose prednisone. Furthermore, prednisone therapy carries a risk of 60 Fanconi Anemia: Guidelines for Diagnosis and Management additional bone toxicities, such as avascular necrosis or osteoporosis. Unfortunately, transaminases do not always correlate with the degree of liver inflammation on liver biopsy. If liver transaminases increase to 3-5 times above normal, the androgen dose can be tapered until the blood tests improve. Androgen-associated liver adenomas can resolve after androgens are discontinued, but some may persist even years after androgens are stopped. If screening tests raise a concern for adenocarcinoma, a liver biopsy (generally performed as an open procedure to minimize bleeding risk) should be considered. These formulations offer the advantage of decreased injection frequency (a particularly appealing prospect for thrombocytopenic patients). A bone marrow aspirate/biopsy with cytogenetics is recommended prior to the initiation of cytokine treatment, given the theoretical risk of stimulating growth of a leukemic clone. It is reasonable to monitor the bone marrow morphology and cytogenetics every six months while patients are treated with cytokines. There are currently no studies demonstrating a causal relationship between cytokine therapy and leukemogenesis. In the setting of a compelling clinical indication for cytokine therapy, there is no literature to mandate withholding cytokines from patients with clonal abnormalities. Investigational protocols For those patients who fail to respond to androgens or cytokines and have no acceptable transplant donor or pose an unacceptably high transplant risk, investigational protocols for new therapies may be considered (see Chapter 12). Early discussion with a transplant expert is recommended to allow families the option of initiating the procedure at an optimal time for the patient. If the patient has no hematologic abnormalities at the time of diagnosis, it is reasonable to defer referral to a transplant center. This suggestion for "preemptive transplantation" is highly controversial since some patients who might never progress to significant marrow failure would be unnecessarily subjected to both early and late mortality risk and potential morbidity associated with transplant. A careful discussion with a hematologist and transplant physician is warranted for families interested in this investigational approach. Selection of a donor requires additional confirmatory testing as well as determination of donor availability. This stage accrues a substantial charge and is not undertaken until active plans for transplant are underway. Information regarding the number of potential donors available is helpful in estimating the time likely required to complete a full donor search if the marrow failure progresses. It remains unclear whether pre-transplant chemotherapy improves or worsens outcomes. Close monitoring of the hemoglobin is necessary, as outlined above, so that treatment may be instituted before transfusion with packed red blood cells is required. The hemoglobin level at which treatment is started should be modified upward for patients who live at high altitude, where the normal range for hemoglobin levels is higher. When treatment is anticipated, it should be initiated under the care of a hematologist. As discussed above, treatment options for anemia consist of bone marrow transplant or androgens. High transfusion burden may adversely affect transplant outcomes, so timely consideration of transplant is recommended. Some physicians advocate a more aggressive and regularly scheduled transfusion program to maintain as normal a quality of life as possible for patients with bone marrow failure. These physicians reason that the patient should maximize the benefit of transfusion therapy. Using the latter approach, a patient would be transfused to maintain a minimal trough hemoglobin of 7-8 g/dl. A post-transfusion hemoglobin level of 10-12 g/dl is generally sufficient to allow for normal activity, growth, and development in children. Irradiated blood products should be used to avoid transfusionassociated graft-versus-host disease. Extended antigen matching may be important for patients in certain racial groups, where minor antigen mismatch is more commonly encountered. The use of family members as directed donors may cause alloimmunization to an antigen that would increase the risk of graft rejection after sibling donor hematopoietic stem cell transplant. Secondary iron overload Each mL of transfused packed red cells contains approximately 0. Since the human body lacks mechanisms to actively eliminate excess iron, patients who receive multiple red blood cell transfusions are at risk for accumulating toxic levels of iron overload. The liver is a primary site of iron accumulation, and hepatic fibrosis and cirrhosis may result. Cardiac decompensation may be sudden and acute despite regular monitoring with electrocardiograms and measurements of cardiac function. Iron also targets endocrine organs such as the pituitary, pancreas, thyroid, and parathyroid (Table 5). Table 5: Clinical Complications of Iron Overload Liver disease with fibrosis and cirrhosis Cardiac failure, arrhythmias Hypopituitarism: central hypogonadism growth hormone deficiency central hypothyroidism Poor growth Diabetes mellitus Primary hypothyroidism Primary hypogonadism Hypoparathyroidism While ferritin levels are often followed as a convenient marker for total body iron load, their interpretation is complicated by additional factors such as acute or chronic inflammation and infection or hepatitis. The gold standard for the measurement of total body iron has been a liver biopsy; however, hepatic iron distribution may be uneven, particularly with cirrhosis and, thus, liver biopsies may be limited by sampling error. Elevated liver iron >15mg/g dry weight is associated with a high risk of cardiac toxicity. Bleeding or infection as possible complications of the surgical biopsy procedure are of heightened concern in patients who are thrombocytopenic or neutropenic. Guidelines for the institution of iron chelation therapy in bone marrow failure patients are based on those established for thalassemia patients, with the caveat that thalassemia patients who undergo accelerated, albeit ineffective, erythropoiesis, often have concomitant increases in iron absorption and are transfused to the point of suppressing endogenous hematopoiesis. Total red cell volumes transfused, particularly for infants and small children, as well as total body iron status as reflected in liver iron, cardiac iron, and ferritin levels must be carefully monitored. As a general guide, chelation is considered when the total red cell volume transfused reaches 200mL/kg (roughly corresponds to a total of 12-18 red cell transfusions) or the liver iron reaches 7mg/g dry weight. Chronically transfused patients heading to a hematopoietic stem cell transplant may also benefit from total body iron measurements and chelation therapy to reduce iron levels. In situations where liver iron measurements are not clinically available, a serum ferritin persistently greater than 1,500 without other apparent etiologies has been used as a surrogate, albeit imperfect (see prior discussion), marker.

The toxic effects of doxorubicin include cardiotoxicity cholesterol profile definition buy generic atorlip-20 20 mg online, myelosuppression cholesterol and bp chart buy atorlip-20 with a mastercard, and alopecia cholesterol score explained purchase 20 mg atorlip-20 otc. Congestive heart failure could present with a nonproductive cough and exertional dyspnea cholesterol lowering foods spanish cheap 20mg atorlip-20 free shipping, but this patient is also suffering from hyperpigmentation and minimal myelosuppression, making bleomycin the best answer. The toxic effects of vinblastine include neurotoxicity (areflexia, peripheral neuropathy, paralytic ileus) and bone marrow suppression. Other physical findings include angular stomatitis (fissuring at the corners of the mouth) and painful glossitis (a shiny, "beefy" tongue). Patients with cobalamin deficiency also experience symmetric neuropathy, especially of the lower extremities. The peripheral blood smear demonstrates macrocytosis and hypersegmented neutrophils. The most common cause of cobalamin deficiency is pernicious anemia, a disorder in which dietary cobalamin is not absorbed as a result of gastric parietal cell atrophy and the subsequent absence of intrinsic factor. Bacterial overgrowth in an intestinal blind loop can lead to competition for dietary cobalamin. Provided cobalamin intake is adequate, floral overgrowth is a less common cause of cobalamin deficiency. Gastrectomy can result in insufficient intrinsic factor secretion and subsequent cobalamin deficiency. Infection with the fish tapeworm Diphyllobothrium latum can also result in competition for dietary cobalamin. Nutritional deficiency is a rare cause of cobalamin deficiency and is seen in patients who have adhered to strict vegan diets over several years. Bodily stores of cobalamin are large (on the order of years) and must be depleted before a deficiency can develop. Pancreatic insufficiency results in decreased or absent levels of pancreatic proteases, which free cobalamin from carrier proteins and allow it to bind intrinsic factor. Weight gain and redistribution of body fat (in contrast to the cachexia typical of cancers alone) and moon facies are classic signs of Cushing syndrome. Poor wound healing (due to inhibition of collagen synthesis by glucocorticoids) and facial plethora are also part of Cushing syndrome. This patient is likely suffering from decreased bone density secondary to increased glucocorticoid activity. Although Cushing syndrome can also cause proximal limb weakness from selective atrophy of fast-twitch (type 2) myofibers, it does not have the cardiac effects of hyperthyroidism. This is an X-linked mutation and therefore typically occurs only in male patients. It is specific for the S-phase of the cell cycle, so rapidly dividing cancer cells are targeted. Myelosuppression may occur, because the production of blood cell progenitors in the bone marrow is also inhibited. Myelosuppression can be reversed with leucovorin, an analog of folate, which counters the effects of methotrexate. Epoetin can be used to ameliorate bone marrow toxicity through stimulation of erythroid proliferation. Administration of a granulocyte colony stimulating factor drug such as filgrastim is useful in correcting neutropenia post-chemotherapy, but it does not correct pancytopenia as seen in this patient. This patient has pancytopenia due to methotrexate therapy, which is reversed with leucovorin. Plasma cells can be seen throughout this image, recognized by their off-center nuclei and clock-face chromatin distribution. Aplastic anemia is a pancytopenia that manifests as anemia, thrombocytopenia, and neutropenia. There are many different types of lymphoma, two of the most distinctive histologic types being Burkitt lymphoma and Hodgkin lymphoma. While a slight increase in prostate-specific antigen is normal with aging, severely elevated levels indicate prostate cancer. It commonly metastasizes to the axial skeleton and can cause back pain and spinal cord compression. It causes osteoblastic lesions in bone, although the rib would be an unusual location. Excess bleeding must be reversed with aminocaproic acid, which blocks the conversion of plasminogen to plasmin. It is a positively-charged molecule that binds to negatively charged heparin molecules, thereby neutralizing the molecule and rendering it ineffective. This patient presents with metastatic gastric adenocarcinoma and peritoneal carcinomatosis. The image shows a diffusely infiltrating signet ring cell carcinoma of the stomach, with large vacuoles of mucin displacing the nuclei of cells. These include the physical signs of Cushing syndrome (weight gain, moon facies, thin skin, muscle weakness, and brittle bones), along with cataracts, hypertension, increased appetite, elevated blood sugar level, indigestion, insomnia, nervousness, restlessness, and immunosuppression. Prednisone is known to produce profound mood changes known as glucocorticoid psychosis. The typical adverse effects of bleomycin are pulmonary fibrosis, skin changes, and myelosuppression. Wildly swinging mood is suggestive of cyclothymic disorders, which are common in patients with chronic medical illness. Cyclothymic disorders cannot be diag- nosed until the patient has experienced two years of mood symptoms. The progression of Hodgkin disease typically does not involve profound psychiatric symptoms. They usually present in the fourth and fifth months of pregnancy with vaginal bleeding. Moles can be either partial or complete and are caused by either fertilization of an egg that has lost its chromosomes or fertilization of a normal egg with two sperm. Partial moles may contain some fetal tissue but no viable fetus, and a complete mole contains no fetal tissue. Hydatidiform moles must be surgically removed, because the chorionic villi may embolize to distant sites and because hydatidiform moles may lead to choriocarcinoma, an aggressive neoplasm that metastasizes early but is very responsive to chemotherapy. Preeclampsia is the triad of hypertension, proteinuria, and edema seen in pregnancy. Because the patient may exsanguinate, ruptured ectopic pregnancy is a surgical emergency. Also, because of the small size of the fallopian tubes, tubal pregnancies present long before four months of gestation. Classically, megaloblastic anemia is caused by either vitamin B12 or folate deficiency. The mean corpuscular volume suggests a normocytic, normochromic anemia, which includes the hemolytic anemias. However, because the serum iron level is increased, sideroblastic anemia should be suspected if these lab values are found. This vignette suggests a hepatoma (hepatocellular carcinoma), which is associated with an elevated a-fetoprotein level. Other risk factors include Wilson disease, hemochromatosis, alcoholic cirrhosis, a1-antitrypsin deficiency, and exposure to toxins and carcinogens such as aflatoxin. Yolk sac tumors (also known as endodermal sinus tumors) arise from the germ cells that eventually become the adult gonads. Yolk sac tumors are the most common malignant testicular and ovarian tumors in children. Remember, tumor markers should not be used to make the primary diagnosis, but for confirmation and to monitor the response to therapy. This marker is also elevated with hydatidiform moles and gestational trophoblastic tumors. This marker is nonspecific and is also produced by pancreatic, gastric, and breast carcinomas. This marker also is elevated with neuroendocrine tumors such as astrocytomas and even carcinoid tumors.

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There is also an association with contralateral ureteropelvic junction obstruction (1) cholesterol lowering foods diet plan purchase generic atorlip-20 on line. Other major anomalies can be seen in the cardiac cholesterol hdl ratio numbers atorlip-20 20mg lowest price, respiratory and gastrointestinal systems (1) cholesterol levels ati cost of atorlip-20. Bilateral cystic kidneys are usually not compatible with life due to cholesterol in eggs is dangerous discount 20mg atorlip-20 with visa oligohydramnios and result in either stillborn babies or newborns requiring dialysis at birth (2). Hydronephrosis usually retains a reniform shape and shows apparent renal parenchyma around a central cyst (1). Hydronephrosis also retains communication of the cysts with the collecting systems (2). Autosomal dominant polycystic kidneys are usually bilaterally enlarged while autosomal recessive polycystic kidneys are generally small with a hyperechoic pattern. It is recommended to obtain sonography and perform a voiding cystourethrogram within the first 48 hours of life. Radionuclide studies are also performed after 1 month of age to determine renal functioning. Since most cases are asymptomatic, nephrectomy is not always performed and instead close follow-up is maintained. Ultrasound is performed every 3 months up to 1 year of age and then every 6 months up to 5 years of age. Nephrectomy is usually performed only if the child is symptomatic or the parents choose surgery after understanding the benefits and risks. In 73% of cases, the cysts decrease in size, with a 40% complete resolution rate (1). Uncommonly, children may have pain, infection, or hypertension and even rarer is the possibility of malignant degeneration into a Wilms tumor (1). In the 5% to 17% of cases that are bilateral, newborns generally do not survive and if they do, they require dialysis immediately (1). The kidneys are enlarged, while retaining their normal shape and have a spongy appearance. Three factors have been shown to contribute to the formation of renal cysts and their subsequent enlargement. The first factor is that tubular hyperplasia is present in all cystic diseases and contributes to cystic expansion (5). Second, secretion of tubular fluid leads to the accumulation of intratubular fluid and progressive enlargement (5). Third, abnormalities in extracellular matrix interactions appear to have an effect on cell growth and can lead to abnormal epithelial hyperplasia and secretion (5). Many cases are seen prenatally on ultrasound with oligohydramnios and large renal masses (5). Other presentations include enlarging abdominal masses, respiratory problems due to limited diaphragm mobility (or pulmonary hypoplasia), failure to thrive due to enlarged kidneys, proteinuria, pyuria, hypertension due to fluid overload, and urinary tract infections due to vesicoureteral reflux (4). Children eventually develop chronic renal failure and end-stage renal disease with associated electrolyte imbalances of hyperkalemia and hyperphosphatemia (4). Liver abnormalities may present as signs of portal hypertension such as esophageal varies, hepatomegaly, and spider nevi. Ultrasound is the diagnostic test of choice, although an intravenous pyelogram will also show enlarged kidneys (4). On renal ultrasound, there is increased echogenicity with a possible hypoechoic rim (4). Hypertension should be treated with medications, although it may be difficult to control. Urinary tract infections should be properly diagnosed and treated with antibiotics. Chronic renal failure and end-stage renal disease are treated by managing electrolyte abnormalities, anemia, and renal osteodystrophy, with eventual dialysis and transplantation (4). Nephrectomy may be an option if there are respiratory problems and/or feeding problems due to compression (4). Studies show that about 46% are alive at 15 years of age and those that survive through the first year of life have an even higher survival rate (79% alive at 15 years) (5). It is characterized by renal cysts in various locations and extrarenal manifestations in the gastrointestinal and cardiovascular systems. The variability in cyst formation and disease severity depends on the locus affected and how much protein is being made. Symptomatic children typically present in late childhood or adolescence with any of the following: hematuria, hypertension, abdominal or flank pain, abdominal mass, urinary tract infection, or proteinuria (4). The third pediatric presentation is severe neonatal disease that is frequently fatal. These neonates usually die from respiratory failure but they may also die of renal failure during the first year of life (4). These extrarenal problems include mitral valve prolapse, hypertension, extrarenal cysts, aortic aneurysms, intracranial aneurysms, hernias, colonic diverticula, cholangiocarcinoma, and congenital hepatic fibrosis (4). Intracranial aneurysms are a significant cause of mortality when they rupture (4). As children age, the number and size of cysts increases and therefore, the sensitivity and specificity of diagnosis by ultrasound increases as children become older (4). Chronic renal insufficiency is monitored carefully, especially with respect to its effects on nutrition and growth (4). Hypertension is treated with antihypertensives and urinary tract infections are treated appropriately. Screening for intracranial aneurysms should be performed in teenagers with a family history of intracranial aneurysms due to the serious consequences of rupture (4,5). One study showed that 80% of children diagnosed maintained normal renal function throughout childhood (5). Potter syndrome is variably defined as including congenital renal failure or cystic kidneys associated with oligohydramnios, abnormal facies and hypoplastic lungs. If the fetal kidneys are non-functional or minimally functional, oligohydramnios results since the source of amniotic fluid is fetal urine. Oligohydramnios results in the abnormal facies due to the compression of the developing face against the inner uterine wall. Pulmonary hypoplasia results from large kidneys (due to one of the cystic kidney conditions) compressing the diaphragms, preventing fetal lung development. Potter syndrome is generally incompatible with life due to congenital renal failure and pulmonary hypoplasia. There can also be signs of respiratory distress or abnormal feeding due to the compressive effects of enlarged kidneys. A biopsy of her kidney at that time revealed a diffuse proliferative glomerulonephritis with prominent crescents and minimal fibrosis. Her abdomen is soft and nontender and her upper and lower extremities have 1-2+ edema. A renal ultrasound shows small echogenic kidneys with no hydronephrosis, masses or stones. A chest x-ray shows engorged pulmonary vessels (fluid overload) and an enlarged heart. An echocardiogram reveals a moderate pericardial effusion, but is otherwise normal. One is renal failure (creatinine clearance less than 10) as manifested by a urea nitrogen over 150 mg/dL or a serum creatinine elevated 10-fold over normal, or signs and symptoms of uremia. This may include nausea and vomiting, altered mental status, seizures, pericarditis or bleeding diathesis (platelets become progressively dysfunctional in the setting of uremia). In the acute or emergent setting, a doublelumen catheter (such as a Vas-Cath) can be placed in a large vein. The internal jugular or femoral vein is preferred, but sometimes the subclavian vein is used. As with any central venous line, there is a risk of pneumothorax if the internal jugular or subclavian sites are used; a risk of bleeding (especially in the uremic patient) and a risk of infection.

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Breast trauma can lead to cholesterol test no food effective atorlip-20 20 mg traumatic fat necrosis cholesterol new drug purchase generic atorlip-20 line, which can produce a painful indurated mass with possible skin retraction cholesterol levels life insurance buy generic atorlip-20 20 mg online, simulating cancer cholesterol levels in quail eggs discount 20mg atorlip-20. Given this patient has no history of breast trauma and this condition only occurs sporadically, it is most likely not traumatic fat necrosis. These excess androgens can be converted into testosterone by most peripheral tissues, leading to hirsutism, acne, or male pattern alopecia. On ultrasound imaging, the common appearance is that of multiple ovarian "cysts"; these are actually immature follicles with arrested development due to ovarian dysfunction. A hydatidiform mole is a noninvasive tumor caused by aberrant fertilization, leading to cystic swelling of chorionic villi and proliferation of the trophoblast. It results in a mass that can look like a "cluster of grapes," as seen in the image. A partial mole contains more than two sets of chromosomes that usually consist of two paternal and one maternal set of chromosomes, resulting in triploidy or tetraploidy. Partial moles may present with a similar grapelike mass but are also associated with fetal parts. A partial mole contains more than two sets of chromosomes that usually consist of both paternal and maternal sets, resulting in triploidy or tetraploidy. Partial moles may present with a similar grapelike mass and are associated with fetal parts. It stimulates the corpus luteum to produce estriol and progesterone to maintain the pregnancy until the placenta takes over this role in the second and third trimesters. Estrogen and progesterone are produced by the corpus luteum in the first trimester and by the placenta in the second and third trimesters. Infection with this organism also can cause thrush, usually in immunocompromised patients. Histoplasmosis typically does not present symptomatically, although some patients experience a flu-like illness with fever, cough, headaches, and myalgias. Lesions in lung cavities ("fungus balls") are typical of Aspergillus fumigatus infection. A fumigatus is a non-dimorphic mold with septate hyphae that branch at a Vshaped 45-degree angle. In immunocompromised hosts, several fungi cause meningoencephalitis, most notably Cryptococcus neoformans. Cryptococcus is a non-dimorphic, heavily encapsulated yeast found in soil and pigeon droppings. Migrating synovitis is a feature of disseminated gonococcal infection with Neisseria gonorrhoeae. N gonorrhoeae is a gram-negative diplococcus that causes urethritis in both sexes and pelvic inflammatory disease in women. Her blood pressure is 80/40 mmHg, respiratory rate is 30 breaths/minute, and her heart rate is 160/minute. What is the mechanism of action of the most appropriate drug to counteract her intoxication? A 28-year-old smoker presents to the emergency department because of sudden onset of chest pain and dyspnea while at rest. His heart rate is 115/min, respiratory rate is 24/min, and blood pressure is 140/80 mm Hg in both arms. Lung examination shows decreased breath sounds and decreased fremitus on the right with hyperresonance to percussion. Laboratory studies are remarkable only for an elevated lactate dehydrogenase level. Which of the following is the best choice for prophylaxis against this infection in a patient with a sulfa allergy? A previously healthy 41-year-old man misses several days of work as a result of a viral illness with symptoms including fever, headache, and fatigue. Which of the following describes the structure of the viral genome that most likely caused his initial illness? At autopsy a few days later, the lungs are wet and heavy with areas of atelectasis alternating with occasional dilated alveoli or alveolar ducts. Intra-alveolar hyaline membranes consisting of fibrin and cellular debris are also present. A patent ductus arteriosus and intraventricular brain hemorrhage are also seen at autopsy. Which of the following methods could help identify the organism responsible for this most likely causative pathogen? A 2-year-old boy presents to the emergency department because of sore throat, fever, hoarseness, and stridor. The patient, who recently immigrated to the United States from Vietnam, has had fever and night sweats on a daily basis for the past four years. The patient is diagnosed with active tuberculosis and sent home on an antimycobacterial regimen. One month later, the patient returns with new complaints of joint pain, photosensitivity, and a facial rash. Which of the following is the mechanism of action of the drug with the adverse effects described above? A 26-year-old man presents to the emergency department with respiratory difficulty. Serial pulmonary function tests revealed gradually increasing total capacity and residual volume. His renal function laboratory results were normal, but his aspartate aminotransferase and alanine aminotransferase levels were significantly elevated. He began requiring home oxygen earlier this year, but his condition continued to worsen. A 57-year-old man presents to his primary care physician for a routine wellness check. On physical examination, his vital signs are within normal limits except for his blood pressure, which is 170/95 mm Hg. Which of the following antihypertensive agents is relatively contraindicated in this patient? A physiologist divides the lung into three zones, with the apex being zone 1, the middle region being zone 2, and the base being zone 3. In an experiment the physiologist applies a small amount of positive pressure ventilation while studying blood flow in different lung zones. Which of the following will be noted in this experiment assuming the subject is standing? He was playing with marbles in the playground when his mother noticed him cough and become acutely short of breath. Her attempt to dislodge the object on site was unsuccessful, and he was brought to the hospital. The patient reports having three of these episodes over the past two years, with each episode lasting approximately four months. Histological examination of the lung reveals hypertrophy of mucus-secreting glands in the bronchioles, with a Reid index >50%. A 65-year-old man with an 80-pack-year history of smoking presents to his physician because of a cough and increasing dyspnea over the past six weeks. X-ray of the chest shows a 2-cm mass in the left lower lobe of the lung, which is biopsied, revealing squamous cell carcinoma. Which of the following types of epithelium not normally present in the lung lines the bronchus shown in this image? The oxygen-hemoglobin dissociation curve represents the percent saturation of hemoglobin with oxygen as a function of the partial pressure of oxygen in the blood. This curve is sigmoidal in shape due to the change in affinity of heme groups for additional oxygen molecules. Which of the following in an adult would cause a shift in the curve so that it resembles that of a neonate? A 50-year-old woman complains of darkcolored urine and says she has not been feeling well for the past two-three weeks; she has generalized malaise and a nagging cough that occasionally is productive of blood-tinged sputum. Physical examination reveals an ill-appearing middle-aged woman with a blood pressure of 180/110 mm Hg.

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