A 32-Year Old Woman Comes to the Physician Because of Shortness

question 691

Multiple Choice

A 32-year old woman comes to the physician because of shortness of breath while walking uphill or climbing steps for the last 3 months.  She immigrated with her family to the United States from Thailand 15 years ago.  She is a nurse's aide and had a recent work physical performed prior to starting a new job.  The physician noted "irregular heart sounds" and performed an EKG, which showed atrial fibrillation with a ventricular rate of 85 beats per minute.
A transthoracic echocardiogram showed normal left ventricular size and function with an ejection fraction of 60%.  The left atrium was severely dilated and the mitral valve leaflets were thickened with restricted motion and mild focal calcification.  The mitral valve area was calculated at 1.0 cm² (normal 4-6 cm²) with a moderate degree of mitral regurgitation.  The aortic valve was trileaflet without stenosis or regurgitation.  There was moderate tricuspid regurgitation with an estimated pulmonary artery systolic pressure of 72 mm Hg, consistent with severe pulmonary hypertension (normal < 30 mm Hg) .
Which of the following is a contraindication to percutaneous mitral balloon valvotomy in this patient?

• A)Atrial fibrillation
• B)Calcification of mitral valve
• C)Degree of mitral regurgitation
• D)Enlarged left atrium
• E)Severity of pulmonary hypertension

Understand the principles and processes involved in the termination, assignment, and delegation of contracts.

Differentiate between various types of conditions in contracts and their implications.

Identify the legal effects of contract delegation and assignment on the parties involved.

Comprehend the legal requirements and effects of transferring rights or duties under a contract.

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Definitions:

Collective Action

The collaborative effort of a group to achieve a common objective or address a social or political issue.

Informal Groups

Informal groups are naturally formed social structures within an organization, based on personal relationships and shared interests, not defined by formal boundaries or roles.

Unofficial Groups

Informal groupings of individuals within an organization formed based on personal relationships rather than formal work assignments.

Emergent Groups

Groups that arise spontaneously based on shared interests or goals, often in response to specific situations or challenges.