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Old 08-18-2012
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Arrow interesting question on Respiratory system

A 24yr old male presents with difficulty in breathing, cough, tachypnea and exercise intolerance. Physical examination shows central cyanosis, wheezing while breathing. From history it is gathered that he is a frequent mountain climber. Blood gases reveal P02 90% PCo2 39%. Which of the following is not beneficial in the management of this patient
a)Nitrates
b)acetazolamide
c)nifedipine
d)sildenafil
e)oxygen therapy
f)loop diuretics
g)dexamethazone

futher blood work up with CBC reveals RBC: 6 x 10^6 /ml WBC: 9000/ml
what will be the most likely finding on another patient with the same cbc values
a)Actinic keratosis
b)Schistosoma hematobium infection
c)Elevated AFP
d)Loss of body Fluids
e)Myelodysplasia

pls follow up any suggestive answers with explanations.....
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Bbb... I think it will worsen acidosis in this pxt

2nd Question;
Bbb.. Reactive polycythemia from erythropoietin production by RCC?


Blood gases reveal P02 90% PCo2 39%. Which of the following is not beneficial in the management of this patient
a)Nitrates
b)acetazolamide
c)nifedipine
d)sildenafil
e)oxygen therapy
f)loop diuretics
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Carbonic anhydrase inhibitors(addsto the high altitude adaptation by producing met acidosis, thereby worsening the patients condition) and elevated AFP(hepatocellular carcinoma).
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[QUOTE=chux;140299]Bbb... I think it will worsen acidosis in this pxt

2nd Question;
Bbb.. Reactive polycythemia from erythropoietin production by RCC?

i don't think the patient has acidosis.., + schistosoma hematobium does not cause RCC...
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Quote:
Originally Posted by smanthrav View Post
Carbonic anhydrase inhibitors(addsto the high altitude adaptation by producing met acidosis, thereby worsening the patients condition) and elevated AFP(hepatocellular carcinoma).
CAI's should helpthe patiet bcoz he is suffering as a result of a complication from Altitude sickness....

Think guyz...
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E>>> 1st q
D>>> 2nd q
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Quote:
Originally Posted by obinocle View Post
A 24yr old male presents with difficulty in breathing, cough, tachypnea and exercise intolerance. Physical examination shows central cyanosis, wheezing while breathing. From history it is gathered that he is a frequent mountain climber. Blood gases reveal P02 90% PCo2 39%. Which of the following is not beneficial in the management of this patient
a)Nitrates
b)acetazolamide
c)nifedipine
d)sildenafil
e)oxygen therapy
f)loop diuretics
g)dexamethazone

futher blood work up with CBC reveals RBC: 6 x 10^6 /ml WBC: 9000/ml
what will be the most likely finding on another patient with the same cbc values
a)Actinic keratosis
b)Schistosoma hematobium infection
c)Elevated AFP
d)Loss of body Fluids
e)Myelodysplasia

pls follow up any suggestive answers with explanations.....

1) e
2) d
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Guyz i agree with the second option but oxygen therapy will most be helpful with the patient because he is suffering from some form of altitude disease...
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Quote:
Originally Posted by obinocle View Post
A 24yr old male presents with difficulty in breathing, cough, tachypnea and exercise intolerance. Physical examination shows central cyanosis, wheezing while breathing. From history it is gathered that he is a frequent mountain climber. Blood gases reveal P02 90% PCo2 39%. Which of the following is not beneficial in the management of this patient
a)Nitrates
b)acetazolamide
c)nifedipine
d)sildenafil
e)oxygen therapy
f)loop diuretics
g)dexamethazone

futher blood work up with CBC reveals RBC: 6 x 10^6 /ml WBC: 9000/ml
what will be the most likely finding on another patient with the same cbc values
a)Actinic keratosis
b)Schistosoma hematobium infection
c)Elevated AFP
d)Loss of body Fluids
e)Myelodysplasia

pls follow up any suggestive answers with explanations.....

1)a
2)d



Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE), which are potentially fatal.
Acetazolamide efective at early in course of mountain sickness, Dexamethasone be reserved for treatment of AMS and HACE during descents,notes that Nifedipine may prevent HAPE.
oxygen therapy is efective in some cases,loop diuretics can be given in some situations to improve the oxyenation,
Sildenafil Inhibits Altitude-induced Hypoxemia and Pulmonary Hypertension

at high altitude eventually, the body has lower lactate production (because reduced glucose breakdown decreases the amount of lactate formed), decreased plasma volume, increased hematocrit (polycythemia), increased RBC mass, a higher concentration of capillaries in skeletal muscle tissue, increased myoglobin, increased mitochondria, increased aerobic enzyme concentration, increase in 2,3-BPG, hypoxic pulmonary vasoconstriction, and right ventricular hypertrophy.Pulmonary artery pressure increases in an effort to oxygenate more blood.

Last edited by riya rai; 08-18-2012 at 01:44 PM.
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Quote:
Originally Posted by riya rai View Post
1)a
2)d



Acute mountain sickness can progress to high altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE), which are potentially fatal.
Acetazolamide efective at early in course of mountain sickness, Dexamethasone be reserved for treatment of AMS and HACE during descents,notes that Nifedipine may prevent HAPE.




at high altitude eventually, the body has lower lactate production (because reduced glucose breakdown decreases the amount of lactate formed), decreased plasma volume, increased hematocrit (polycythemia), increased RBC mass, a higher concentration of capillaries in skeletal muscle tissue, increased myoglobin, increased mitochondria, increased aerobic enzyme concentration, increase in 2,3-BPG, hypoxic pulmonary vasoconstriction, and right ventricular hypertrophy.Pulmonary artery pressure increases in an effort to oxygenate more blood.
Thanks!!! so if Nitrates are preventing HAPE wouldn't it then be effective in the management of this patient? the question says medication whic is "NOT" Effective in the management.
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Quote:
Originally Posted by obinocle View Post
Thanks!!! so if Nitrates are preventing HAPE wouldn't it then be effective in the management of this patient? the question says medication whic is "NOT" Effective in the management.
1)
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Default my answer :)

I'll go with:

1) a

I remember a story Goljan said about a guy who went rock climbing and was cyanotic bc he was drinking mountain water that contains nitrited nitrates - oxidazing agents that oxidize Fe2+ fo Fe3+ (MetHb)and that's why O2 therapy didn't help him out.


2) d

Last edited by Casandra; 08-18-2012 at 10:08 PM.
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Default errata

sorry it should say:
"...the water contained nitrates..."
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d) sildenafil

and

d) loss of body fluids


nice question man!
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Default "The Answers are F and C"

This patient is suffering form HAPE (High Altitude pulmonary edema) that occurs in otherwise healthy mountaineers at altitudes typically above 2,500 meters. . HAPE remains the major cause of death related to high-altitude exposure. The pathophysiology high-altitude pulmonary edema (HAPE) is not well understood however it is believed to be as a result of pulmonary arterial vasoconstriction resulting in circulatory shear forces and a consequent permeability leak and antidiuresis possibly mediated by increased antidiuretic hormones, which contribute to fluid retention.

The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen, and descent to a lower altitude Bed rest, nifedipine/nitrates and acetazolamide. Research has proven dexamethasone. and Phosphodiesterase inhibitors such as tadalafil to be effective in prevention of HAPE.

Administration of Loop diuretics though effective in lessening symptoms of pulmonary Edema will not be effective in therapeutic correction of Alkalosis seen with altitude disease. (Loops causes metabolic alkalosis)

"Absolute Polycythemia" as seen in the patient is a result of excessive Erythropoietin production due to hypoxia.
This is a common finding in Clear Cell Renal cell Carcinoma and Hepatocellular Carcinoma (Elevated AFP).
Loss of body fluids will lead to "Relative Polycythemia" in which there is an apparent rise of the erythrocyte level in the blood; however, the underlying cause is reduced blood plasma.
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Quote:
Originally Posted by obinocle View Post
This patient is suffering form HAPE (High Altitude pulmonary edema) that occurs in otherwise healthy mountaineers at altitudes typically above 2,500 meters. . HAPE remains the major cause of death related to high-altitude exposure. The pathophysiology high-altitude pulmonary edema (HAPE) is not well understood however it is believed to be as a result of pulmonary arterial vasoconstriction resulting in circulatory shear forces and a consequent permeability leak and antidiuresis possibly mediated by increased antidiuretic hormones, which contribute to fluid retention.

The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen, and descent to a lower altitude Bed rest, nifedipine/nitrates and acetazolamide. Research has proven dexamethasone. and Phosphodiesterase inhibitors such as tadalafil to be effective in prevention of HAPE.

Administration of Loop diuretics though effective in lessening symptoms of pulmonary Edema will not be effective in therapeutic correction of Alkalosis seen with altitude disease. (Loops causes metabolic alkalosis)

"Absolute Polycythemia" as seen in the patient is a result of excessive Erythropoietin production due to hypoxia.
This is a common finding in Clear Cell Renal cell Carcinoma and Hepatocellular Carcinoma (Elevated AFP).
Loss of body fluids will lead to "Relative Polycythemia" in which there is an apparent rise of the erythrocyte level in the blood; however, the underlying cause is reduced blood plasma.

what you say about nitrates??
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here i would like to share qbank knowledge:there are 5 conditions which leads polycythemia are:
1)cerebelar hemangioblastoma, 2)RCC (renal CA), 3) HCC (hepatocelular CA), 4) uterine myomata and 5)pheochromocytoma
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Quote:
Originally Posted by riya_rai84 View Post
here i would like to share qbank knowledge:there are 5 conditions which leads polycythemia are:
1)cerebelar hemangioblastoma, 2)RCC (renal CA), 3) HCC (hepatocelular CA), 4) uterine myomata and 5)pheochromocytoma
nice job!! about nitrates together with nifedipine they help with pulmonary edema by improving preload ans afterload..
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Quote:
Originally Posted by obinocle View Post
This patient is suffering form HAPE (High Altitude pulmonary edema) that occurs in otherwise healthy mountaineers at altitudes typically above 2,500 meters. . HAPE remains the major cause of death related to high-altitude exposure. The pathophysiology high-altitude pulmonary edema (HAPE) is not well understood however it is believed to be as a result of pulmonary arterial vasoconstriction resulting in circulatory shear forces and a consequent permeability leak and antidiuresis possibly mediated by increased antidiuretic hormones, which contribute to fluid retention.

The treatment of high-altitude pulmonary edema (HAPE) includes rest, administration of oxygen, and descent to a lower altitude Bed rest, nifedipine/nitrates and acetazolamide. Research has proven dexamethasone. and Phosphodiesterase inhibitors such as tadalafil to be effective in prevention of HAPE.

Administration of Loop diuretics though effective in lessening symptoms of pulmonary Edema will not be effective in therapeutic correction of Alkalosis seen with altitude disease. (Loops causes metabolic alkalosis)

"Absolute Polycythemia" as seen in the patient is a result of excessive Erythropoietin production due to hypoxia.
This is a common finding in Clear Cell Renal cell Carcinoma and Hepatocellular Carcinoma (Elevated AFP).
Loss of body fluids will lead to "Relative Polycythemia" in which there is an apparent rise of the erythrocyte level in the blood; however, the underlying cause is reduced blood plasma.
Wow very nice question ,solved both of them first step diagnosing right no idea of second
it means ??
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Quote:
Originally Posted by riya_rai84 View Post
here i would like to share qbank knowledge:there are 5 conditions which leads polycythemia are:
1)cerebelar hemangioblastoma, 2)RCC (renal CA), 3) HCC (hepatocelular CA), 4) uterine myomata and 5)pheochromocytoma
can you please give the mechanism behind it
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Quote:
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can you please give the mechanism behind it
They are paraneoplastic syndromes in which the exact pathology behind them cannot be of have not been fully determined. These phenomena are thought to be mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor.
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can you please give the mechanism behind it
ya obinocle is saying right, its because of paraneoplastic syndromes.
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