Question

See the table below. In the right column are words and phrases that link in some way with each of the items numbered I-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

Answer 1

11.G.fluid sfiftfrom from blood to tissue due to the malfunctioning of hepatocytes cause odema.

12.M.body is lost its ability to institute gluconeogenesis leads to hypoglycemia.

13.O.liver is unable to convert ammonia to urea this cause abnormal metabolism of anemia lead to asterixis.

14.H.fluid collection occurs in the abdominal cavity due to hypoosmolaity causes ascitis

15.j

16.F.incresed amount of cortisol is produced by adrenal gland in cushing syndrome,

17.A

18.D.presence of fluid in alveoli leads crackls sound in lungs when auscultating.

19.E.fatigue may due to less amount of red blood cells.

20.C.