A 57-Year-Old Woman Comes to the Physician Because of Severe

question 628

Multiple Choice

A 57-year-old woman comes to the physician because of severe heartburn.  She has a history of gastroesophageal reflux disease treated with lansoprazole; however, lately the medication seems to provide little relief.  She was also seen in the clinic one year ago for joint pains which responded to non-steroidal anti-inflammatory agents.  She suffers from chronic back pain.  She denies any abdominal pain, weight loss, or black stools.  She has no family history of gastrointestinal cancer.
Her blood pressure is 110/65 mm Hg, pulse is 74/min, and respirations are 14/min.  Examination shows clear lung fields.  Extremity examination reveals skin hardening of the fingertips as well as a few whitish lumps measuring 1 cm each over both forearm surfaces.  Small red blanching lesions are seen over her face.
Laboratory work-up shows the following:

Which one of the following disorders is the patient at greatest risk for developing?

• A)Dilated cardiomyopathy
• B)End-stage renal disease
• C)Liver cirrhosis
• D)Non-Hodgkin's lymphoma
• E)Pulmonary hypertension

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Definitions:

Similarities

Characteristics or aspects that are alike between two or more items, individuals, or concepts.

Objective Probability

The likelihood of an event occurring based on factual, measurable data, unaffected by personal feelings or opinions.

Hard Facts

Concrete, verified information that is undeniable and based on real, tangible evidence.

Specific Result

An outcome that is clearly defined or identified, often in contrast to more general or vague outcomes.