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HTLH 2501 Pathophysiology

tag 0 Download 18 Pages / 4,321 Words tag 14-07-2021


Although the chief symptom of dyspnea leads us to think first of pulmonary disease, it is important to have a broad differential diagnosis that includes extrapulmonary processes. Intrinsic lung disease can be divided into three categories: disease of the vessels, disease of the airways, and disease of the parenchyma (i.e., the alveoli and interstitium). Pleural effusions that cause sufficient compressive atelectasis may lead to a mismatch between ventilation and perfusion that can be manifested as dyspnea. Cardiac causes of dyspnea include coronary ischemia and congestive heart failure. Dyspnea is rarely the initial manifestation of neuromuscular conditions, but they should be considered, especially in patients who have a primary ventilatory defect on blood gas analysis.
Exertional dyspnea can occur in patients with anemia when the oxygen-carrying capacity of the blood fails to meet the
body’s metabolic demands. Patients with metabolic acidosis often experience shortness of breath because alveolar ventilation increases to compensate for decreased blood pH values. Anxiety should be considered as the cause of dyspnea only after organic causes have been ruled out.

At 47 years of age, the patient had received a diagnosis of high-grade invasive ductal carcinoma of the left breast, clinical stage 2. Tests for estrogen receptor and progesterone receptor were negative, and human epidermal growth factor receptor type 2 (HER2) was not overexpressed. This is often referred to as triple-negative breast cancer. She participated in a clinical trial that provided treatment with neoadjuvant cisplatin and bevacizumab, followed by a partial mastectomy and axillary lymph-node dissection. Pathological analysis revealed a poorly differentiated tumor, measuring 2.5 cm in diameter, with extensive lymphovascular invasion and positive margins and a positive result in 1 of 17 lymph nodes, all of which indicated stage 2B metastatic disease.
She completed a course of adjuvant dose-dense chemotherapy with doxorubicin and cyclophosphamide, followed by concurrent administration of paclitaxel and bevacizumab, as directed by the protocol. The patient then underwent complete mastectomy of the left breast, with no residual carcinoma detected on analysis of the tissue sample, followed by irradiation of the chest wall.

a new mammographic density was detected on examination of the patient’s right breast. A biopsy was performed, and analysis of the specimen revealed triple-negative invasive ductal carcinoma. Staging studies were negative for distant recurrence of disease.
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Total 18 pages

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