Question

See the table below. In the right column are words and phrases that link in some way with each of the items numbered 1-XV on the left. In other words, this is a typical "matching exercise. Read the scenario and fill out the table FIRST, then use it to answer questions 11-20 below. THERE IS ONE ANSWER TO EACH LEFT-HAND TERM. DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE. CHOOSE THE BEST FIT Scenario: A 47 y/o female patient presents to the ER with the following complaints: "I'm short of breath and swollen all over." She reports a history of heavy ETOH (alcohol) use & has had worsening cirrhosis for many years. On examination she is noted to be confused and to have icteric sclera, various areas of bruising, infected skin sores, crackles in her lungs, & a distended abdomen. Labs are done. The following matching exercise describes various aspects of the patient's presentation and pathophysiology, and also some problems that might occur because of her cirrhosis. I. etiology of "swollen all over A. Increased destruction of WBCs due to hypersplenism II. direct bilirubin level B. AST 1000 (normal 10-40); ALT 1100 (normal 10-55) III. has caused fatigue, and also caused some of SOB IV. hyperaldosteronemia C causes retrograde venous flowesophageal varices may be present D. serum osmolality of 260 (normal - 280-295) ► fluid shifts into alveoli E. hypersplenism increased destruction of blood cells RBC count = 2.5 mill (norm = 4 to 6 mill) F. decreased metabolism of cortisol hypercortisolism intra-cellular enzymes V. damaged hepatocytes leak into blood VI. icteric sclera VII, portal HTN G. malfunctioning hepatocytes→ hypoproteinemia fluid shift from blood to tissue VIII. unconjugated bilirubin not being conjugated by cirrhotic liver IX. etiology of infected sores I. malfunctioning hepatocytes decreased breakdown of aldosterone 1. high indirect bilirubin in the blood. X. hypersplenism thrombocytopenia high XI. decreased ability to break down ammonia serum ammonia levels. K. assessment finding related to presence of pathologically high bilirubin in tissue cells XII. blood glucose of 37 XIII crackles in lungs L low because liver unable to conjugate unconjugated bilirubin M. decreased ability to institute glycogenolysis or gluconeogenesis as needed N. bruising & other S&S of easy bleeding XIV. development of Cushing's syndrome XV. hypoosmolality fluid shift into abdominal cavity O. etiology of asterixis

Answer 1

11. Etiology for swollen all over is malfunctioning hepatocytes→ hypoproteinemia→ fluid shift from blood to tissue (G). Option c is the correct answer.

12. The possible sequelae of cirrhosis are decreased in the ability to institute glycogenolysis or gluconeogenesis as needed (M). Option d is the correct answer.

13. Decreased ability to break down ammonia→ high serum ammonia levels is etiology of asterixis (O). Option a is the correct answer.

14. Hypoosmolality→ fluid shift into the abdominal cavity causes ascites (H). Option b is the correct answer.

15. Unconjugated bilirubin not being conjugated by the cirrhotic liver is high indirect bilirubin in the blood (J). Option b is the correct answer.

16. Development of Cushing's syndrome is because of a decreased metabolism of cortisol →hypercortisolism (F). Option d is the correct answer.

17. Increased destruction of WBCs due to hypersplenism (A) caused infected sores. Option a is the correct answer.

18. Serum osmolality of 260 (normal = 280-295)→ fluid shifts into alveoli (D) caused crackles in the lungs. Option b is the correct answer.

19. Hypersplenism→increased destruction of blood cells→ RBC count = 2.5 mill (norm = 4 to 6 mill) (E). Option d is the correct answer.

20. Portal hypertension causes retrograde venous flow→esophageal varices may be present (C). Option a is the correct answer.