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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.


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



g.Polycythemia vera

Explain your answer pz

Edited by Ivonne on Dec 29, 2007 - 6:17 PM


Hto? what that?


hero wrote:
Hto? what that?



the answrr is G


Thanks Gogeta, but not right answer yet



hemorrhagic telangiectasia, also known as Osler-Rendu-Webber,
chronic hypoxia and incr Ht due to arteriovenous shunt.



sticking out tongue




Is it C, Ivonne?


nodThis patient has most likely hereditary telangiectasia, characterized by diffuse telangiectasias, recurrent epistaxis, and widespread AV malformations(AVMs) that in the lungs can shunt blood from the R to the L side of the heart causing chronic hypoxemia and a reactive polycythemia.


There's a classic correlation of polycitemia vera with a (liver?) disease that this q triggered to me, can't remember which....does anybody remember which is it? thank you

if it werent for the lips, I would also have chosen polycytemia


Maybe Budd-Quiari Syndrome


It is fffffffff.,coz osler weber rendu cant justify inc liver girth...chronic smoker lead to copd lead to hypercarbia and polycythemia and right sided heart failure(cor pulmonale)leading to heptomegly wid no splenomegly...

Edited by new_n_lost on Feb 27, 2008 - 5:22 AM. : All Caps r not Allowed


so,ivone whts the correct answer? is it c?


Yes, Sandra as i explained in post #10

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