(MCQS 371-373):A 30 year-old female has recent difficulties in swallowing. She is found to have a microcytic hypochromic anemia

Correct Answer: D
An aneurysmally dilated great vein of Galen causes high output congestive heart failure in neonates whilst in older children it obstructs the Aqueduct of Sylvius, producing non communicating hydrocephalus. This malformation is a congenital arteriovenous malformation with blood shunting from cerebral arteries into an aneurysmally dilated great vein of Galen and the straight sinus. The major feeding vessels are the posterior cerebral artery and its branches the posterior choroidal and posterior perforating artery Chest film shows cardiomegaly with right sided predominance. The superior mediastinum is widened due to dilation of the brachiocephalic arteries and veins. Pulmonary vascularity is frequently normal because of the pulmonary arterial hypertension of the newborn. On angiography rapid arteriovenous shunting into a dilated saclike vein of Galen and straight sinus is seen. The majority of patients diagnosed in the neonatal period present with life-threatening, intractable cardiac decompensation and high-flow arteriovenous fistulae, CHF due to AV shunting (L -> R) and predominantly RIGHT-sided cardiomegaly, a wide superior mediastinum and retrosternal fullness. In neonates it causes high output congestive heart failure. In older children it obstructs the Aqueduct of Sylvius, producing non communicating hydrocephalus.

Correct Answer: F
Pneumococcal pneumonia most commonly presents as a segmental or lobar alveolar consolidation. Pleural effusion can be found in 20-60% of cases. Cavitation is very uncommon with pneumococcal infection.

Correct Answer: H
The lab values reveal a woman with low serum iron and ferritin and an elevated TIBC. These lab values combined with the peripheral blood smear lead to the diagnosis of iron deficiency anemia. Based upon the clinical finding of anemia and her difficulty eating solid foods, this woman is probably suffering from Plummer-Vinson syndrome. Plummer-Vinson syndrome is a characterized by iron deficiency anemia and upper esophageal webs. Important Facts: Mean Corpuscular Volume: Less then 80 (microcytic) · iron deficiency anemia · sideroblastic anemia · thalassemia Between 80 and 94 (normocytic) · myeloplastic disease · decreased erythropoietin · chronic inflammation · hemorrhage Greater then 94 (macrocytic) · vitamin B-12 deficiency · folate deficiency .


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