In Part III of the case study, it is mentioned that blood flow to the pulmonary capillaries is increased due to the inflammation and bacteria present in the area. What is the most likely reason for the increased blood flow? a. Increased cardiac output b. Pulmonary arteriole vasoconstriction caused by the sympathetic division c. Pulmonary arteriole vasodilation caused by the sympathetic division d. Pulmonary arteriole vasodilation caused by paracrine signals e. Decrease venous pressure
QUESTION 10
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In Part III of the case study, it is mentioned that blood flow to the pulmonary capillaries is increased due to the inflammation and bacteria present in the area. What is the most likely reason for the increased blood flow?
a. Increased cardiac output
b. Pulmonary arteriole vasoconstriction caused by the sympathetic division
c. Pulmonary arteriole vasodilation caused by the sympathetic division
d. Pulmonary arteriole vasodilation caused by paracrine signals
e. Decrease venous pressure
Part I – Symptoms
Callie was 26 years old when she opened a bakery called “Callie’s Cupcakes” in downtown San Francisco with her
f ancé, Jeremy. Despite the competitive market, her business was booming; everyone loved the clever recipes and the
trendy atmosphere. Between running their fast-growing business and planning for their wedding, Callie hadn’t been
able to keep to her usual eight hours of sleep a night. Although she had always lived a very healthy lifestyle, exercising
daily and eating healthy, she just hadn’t been feeling herself lately. She was tired all the time, had dif culty breathing,
felt stressed, coughed up sputum, consistently ran a low-grade fever, and had lost weight as her appetite decreased.
None of these symptoms alone had been particularly alarming so she had put of seeing her physician for a few weeks.
Part II – The Diagnosis
As each day passed Callie’s symptoms grew worse and worse. After standing for long periods of time she could barely
breathe; in fact, she couldn’t even work a full day in the bakery without feeling like she was going to pass out. When
it got to the point that extreme exhaustion and high fever prevented her from getting out of bed, Jeremy was alarmed.
“Callie, I’m taking you to see your doctor,” he said, and got her an appointment for the next morning.
Once there, Callie explained to her physician, Dr. Nayak, that she had been tired, fatigued, stressed, and that she
hadn’t been sleeping well. She also mentioned that she had lost some weight and just didn’t have an appetite. T e
worst part was the shortness of breath and the cough. Her breathing troubles and coughing had lasted for about three
weeks and seemed to be getting worse. As a precaution, Dr. Nayak decided to provide Callie a surgical mask in case
she had an infectious respiratory disease. She then proceeded to do a basic physical exam as well as a chest x-ray and a
sputum analysis.
Dr. Nayak then asked Callie if she had traveled out of the country within the past three months. Callie looked confused, and said “no.” T e doctor followed this up by asking whether Callie had come into contact with anyone who
had been out of the country. T inking about it for a moment she replied, “Well, one of the employees in our bakery is
from South Africa and she frequently visits her family back at home; she’s actually in South Africa visiting right now. I
work with her weekly. Could that really be a factor?”
“Yes, it could,” Dr. Nayak said. “Did your employee have any symptoms that you can recall?”
Callie ref ected a moment and said, “Yes, she does seem to always have a cough. She told me it was just allergies and
that she might be bothered by all the f our in the air.”
T e chest x-ray came back and showed nodular formations in both of Callie’s lungs near the clavicles. Based on the
x-ray and symptoms, Dr. Nayak suspected Callie had tuberculosis, more specif cally active tuberculosis, also known as
tuberculosis disease. South Africa has one of the highest incidences of active TB in the world, and knowing that Callie
had an employee who frequently visited that location made Dr. Nayak suspect TB, but they would need to run some
tests to be sure. Dr. Nayak’s local laboratory lacked the most rapid testing mechanisms, so it would take a few days to
receive results from the sputum stain and the sputum nucleic amplif cation test. Dr. Nayak also took a blood sample
for additional testing. Due to her suspicion for TB, Dr. Nayak advised Callie to stay home and not work until they
could conf rm her diagnosis. She provided Callie with some surgical masks in the event she needed to go out. After
Callie left, Dr. Nayak contacted the local health department and reported that she suspected her patient had TB.
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