IM
HIV - 12-31-07 12:30
A 27 yo M presents to the ER with unremitting nose bleeding. He reports having a similar episode one year ago that was stopped in the ER. He drinks alcohol every weekend and smoke 1 pack of cigarette/week for 5 years. On physical exam, there are several ruby-colored papules on his lips that blanch parcially with pressure. Digital clubbing is also present. His abdomen is soft and non tender. The liver spam is 8cm and the spleen is not palpable.
Labs:
Hematocrit: 60%
WBC: 8000/mm3
Platelets: 180 000/mm3
Which of the following will explain most likely the Hematocrit
a.Steroid abuse
b.Pulmonary hypertension
c.Arteriovenous shunting
d.Plasma volume loss
e.Carboxyhemoglobinemia
f.Hypercarbia
g.Polycythemia vera
Explain your answer pz
HIV - 12-31-07 12:30
A 27 yo M presents to the ER with unremitting nose bleeding. He reports having a similar episode one year ago that was stopped in the ER. He drinks alcohol every weekend and smoke 1 pack of cigarette/week for 5 years. On physical exam, there are several ruby-colored papules on his lips that blanch parcially with pressure. Digital clubbing is also present. His abdomen is soft and non tender. The liver spam is 8cm and the spleen is not palpable.
Labs:
Hematocrit: 60%
WBC: 8000/mm3
Platelets: 180 000/mm3
Which of the following will explain most likely the Hematocrit
a.Steroid abuse
b.Pulmonary hypertension
c.Arteriovenous shunting
d.Plasma volume loss
e.Carboxyhemoglobinemia
f.Hypercarbia
g.Polycythemia vera
Explain your answer pz
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#2
Re: IM InSitu - 12-31-07 18:21 looking at hematocrit of 60% and bleeding I would think polycythemia vera.
#4
Re: IM Alexandre - 01-02-08 15:53 c Hereditary Hemorhagic telangiectasia, localized malformation of venules and capillaries of skin + mucous membranes --> heamorrhage (explaining the unremmiting epistaxis); Osler Weber Rendu syndrome. It fits pretty snuggly.. autosomal dominant? recessive? im thinking dominant, dont remember :) . anyways, my answer's C.
#7
Re: IM 8401glacieres - 01-16-08 12:07 G--PCV
Well starting by rule out other options---mailny important ones
1) AV Fistulas---He does not have any finding on examination which would suggest hyperdynamic circulation.
2) Heriditary haempraghic telangectasisa---would not wait for so long to present.
Having said that--he is avidly drinking beer daily and is a smoker which will predispose him to chronic hypoxia------->increase in RBC MASS to meet out the O2 demand. All other manifestation sare due to his PCV.
#9
Re: IM InSitu - 01-18-08 19:30 
posted by 8401glacieres on 01-16-08 12:07
G--PCV
Well starting by rule out other options---mailny important ones
1) AV Fistulas---He does not have any finding on examination which would suggest hyperdynamic circulation.
2) Heriditary haempraghic telangectasisa---would not wait for so long to present.
Having said that--he is avidly drinking beer daily and is a smoker which will predispose him to chronic hypoxia------->increase in RBC MASS to meet out the O2 demand. All other manifestation sare due to his PCV.
G--PCV
Well starting by rule out other options---mailny important ones
1) AV Fistulas---He does not have any finding on examination which would suggest hyperdynamic circulation.
2) Heriditary haempraghic telangectasisa---would not wait for so long to present.
Having said that--he is avidly drinking beer daily and is a smoker which will predispose him to chronic hypoxia------->increase in RBC MASS to meet out the O2 demand. All other manifestation sare due to his PCV.
Glaciers...i love each of your expalantions...you should post some questions and provide us with great expalantions ;)
#14
Re: IM babbu5508 - 07-07-10 21:44 g.Polycythemia vera ...recurrent nasal bleeds,digital clubbing,several ruby-colored papules on his lips that blanch parcially with pressure.
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