A 45-Year-Old Woman Comes to the Physician with Exertional Shortness

question 244

Multiple Choice

A 45-year-old woman comes to the physician with exertional shortness of breath and lower-extremity swelling over the last 6 weeks.  She has no chest pain, dizziness, or orthopnea.  She also suffers from chronic diarrhea that has not responded to dietary modifications.  Colonoscopy with biopsies done 6 months ago was unremarkable.  The patient has been taking herbal supplements for hot flashes that she describes as severe.  She does not use tobacco or illicit drugs but does drink a few beers on weekends.
Her blood pressure is 142/80 mm Hg and pulse is 98/min.  Her body mass index is 26 kg/m².  Purplish, blanching telangiectasias are seen on her upper lip and nose.  Jugular venous distention is present.  A 3/6 holosystolic murmur is heard at the lower sternum that increases with inspiration.  Lungs are clear to auscultation.  The liver is enlarged and pulsatile.  There is 2+ edema of both lower extremities.  The remainder of the examination is within normal limits.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

• A)Carcinoid syndrome
• B)Pheochromocytoma
• C)Systemic mastocytosis
• D)Systemic sclerosis
• E)VIPoma

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Definitions:

Cash Sales

Transactions where payment is made in cash at the time of the sale, with immediate transfer of ownership and benefits.

Salaries Payable

An account representing the owed but not yet paid salaries to employees at the end of a period.

Salary Expense

Salary expense refers to the total amount paid by an employer to its employees for work performed during a specific period, which is reported on the income statement.

Cash Paid

Amounts of cash disbursed by a business for various purposes, including operating expenses, asset purchases, and debt repayments.