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Old 02-13-2012
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Question 56 y-old men with L-heart failure, apparent a thought one in Uworld

A 56-year-old man comes to the emergency department because of progressively worsening dyspnea. He cannot walk more than a few blocks without getting short of breath and finds it particularly difficult to sleep while lying flat. He regularly sleeps on three pillows at night and is unable to sleep comfortably without them. The patient does not use tobacco, alcohol, or illicit drugs. His other medical problems include a past diagnosis of hypertension, but he only takes medication when he experiences headaches. His blood pressure is 170/100 mm Hg and pulse is 80/min. Physical examination shows bilateral basilar lung crackles, jugular venous distention, and bilateral trace lower extremity edema. A chest x-ray reveals cardiomegaly. An EKG shows evidence of left ventricular hypertrophy. An echocardiogram shows significant pulmonary arterial hypertension. Which of the following is the most likely mechanism for this patient's pulmonary hypertension?

A. Mechanical obstruction of the pulmonary arterial tree
B. Respiratory hypoxia-induced pulmonary vasoconstriction
C. Obliteration of the pulmonary vascular bed
D. Inflammatory pulmonary vascular reaction
E. Reactive vasoconstriction due to venous congestion
F. Increased volume of flow and pressure in the pulmonary arteries
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Old 02-13-2012
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Ans .......... E.........
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ans is E....
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Old 02-14-2012
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Default Ans E

E, the reason is chronic backflow of blood plus the pulmonary edema and progressive increase in Pulmonary Hydrostatic pressure, also remember that when pressure goes beyond 30 mm Hg, the lungs fluid reabsoprtion capacity is overwhelmed and thats when PE starts to develop (chronically of course)
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