Items 746 through 747

A 24-year-old primigravid woman, who is intent on breast feeding, decides upon a home delivery. Immediately after the birth of a 4.1-kg (9-lb) infant, the patient bleeds massively from extensive vaginal and cervical lacerations. She is brought to the nearest hospital in shock. Over 2 h, 9 units of blood are transfused, and the patient's blood pressure returns to a reasonable level. A hemoglobin value the next day is 7.5 g/dL, and 3 units of packed red blood cells are given.

7-46. The most likely late sequela to consider in this patient is a. Hemochromatosis b. Stein-Leventhal syndrome c. Sheehan syndrome d. Simmonds syndrome e. Cushing syndrome

7-47. Development of the sequela could be evident as early as a. 6 h postpartum b. 1 wk postpartum c. 1 mo postpartum d. 6 mo postpartum e. 1 year postpartum

7-48. A 24-year-old HIV-positive patient who has had AIDS for 3 years presents with painful swallowing and dysphagia to solids and liquids. He has no previous history of heartburn or reflux disease. His CD4 count is 41/^L and he recently required 3 wk of antibiotics for Pneumocystis carinii pneumonia. Examination of the pharynx reveals no oral thrush. Barium swallow demonstrates multiple nodular filling defects of various sizes that resemble a "cluster of grapes." Which of the following is the most likely diagnosis?

a. Candida esophagitis b. Reflux disease c. Barrett's esophagus d. Pneumocystis esophagitis e. Achalasia f. Plummer-Vinson syndrome g. Schatzki ring

7-49. On a hot summer day in a large urban center located in the southwestern United States, an emergency room department reports an increase in admissions for asthma in children and young adults, but not among patients suffering from chronic bronchitis or ischemic heart disease. The most likely air pollutant responsible for the exacerbation of asthma is a. Carbon monoxide b. Ozone c. Nitrogen dioxide d. Particulate matter e. Lead

7-50. A 30-year-old female patient who presents with bleeding per rectum is found at colonoscopy to have colitis confined to the transverse and descending colon. A biopsy is performed. Which of the following statements is true about this patient?

a. The inflammatory process is likely to be confined to the mucosa and submucosa b. The inflammatory reaction is likely to be continuous c. Superficial as opposed to linear ulcerations can be expected d. Noncaseating granuloma can be expected in up to 50% of patients with similar disease e. Microabscesses within crypts are common

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