A 64-year-old post-menopausal woman has been recently diagnosed with breast cancer stage II. After necessary investigations, surgical excision of the tumor was performed and the excised tissue was sent for histopathological examination, which showed that her tumor cells were positive for estrogen receptors. She was prescribed combination of tamoxifen and cytotoxic chemotherapy. On her follow up after 6 weeks, she complained of hot flashes and vaginal bleeding. The physician explained that the symptoms were due to side effects of tamoxifen. After complete physical examination, her blood sample was sent for follow up laboratory examination, which showed an electrolyte imbalance.
Provided that her other medications are not interfering with electrolyte balance, which of the following electrolyte defects is most likely caused by tamoxifen?
A 55-year-old man presents to physician with complain of difficulty in breathing for last two weeks. He mentions that he coughs frequently over last five years, but he has ignored the symptom because he thought it was due to smoking. He is a chronic smoker for last fifteen years. There is no history of fever or chest pain. On physical examination, his temperature is 98.8ºF (37.1ºC), respirations are 28/minute, pulse rate is 88/minute, and blood pressure is 124/84 mm Hg. Auscultation of chest reveals wheezing and decreased intensity of breath sounds over suprascapular and supramammary regions bilaterally. Hyperresonance is present over the same areas on percussion. Chest radiogram of the man shows hyperinflation of upper lobes of both the lungs. His pulmonary function testing shows FEV1 82% of predicted and FEV1/FVC 0.65. His total lung capacity is increased and diffusing capacity is reduced. His serum α1-antitrypsin level is normal. Which of the following parts of lower respiratory tract is most likely to be affected maximally in the patient?
B. Terminal bronchioles
C. Respiratory bronchioles
D. Alveolar ducts
E. Alveolar sacs
A 68-year-old man presents to physician with complain of fever, cough, and difficulty in breathing for last three days. He mentions that his expectorations are rust-colored. He has no known medical disorder and is otherwise a healthy man. On physical examination, his temperature is 103.7ºF (39.8ºC), pulse rate is 92/minute, blood pressure is 128/82 mm Hg, and respirations are 24/minute. Auscultation of his chest reveals decreased intensity of breath sounds and presence of crepitations over right infrascapular region. The physician orders his sputum examination, which shows predominant polymorphonuclear neutrophils and a few epithelial cells. Gram staining of sputum confirms presence of Gram-positive cocci in pairs. Chest radiogram of the man shows lobar consolidation in lower zone of the right lung. Which of the following best describes pathological changes in the affected area of the lung?
A. Neutrophil-rich exudate filling bronchi, bronchioles, and adjacent alveoli
B. Widening of alveolar septa and mononuclear inflammatory infiltrate
C. Fibrin strands in alveolar spaces and extravasation of red blood cells
D. Intra-alveolar fluid and vascular engorgement
E. Fibromyxoid masses rich in fibroblasts and macrophages