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Which of the following statements regarding sickle cell disease is correct?
A:When the sickle cell gene is inherited from both parents, the patient will probably not develop the disease. B:Despite their altered shape, the red blood cells of a person with sickle cell disease are effective carriers of oxygen. C:In sickle cell disease, misshapen red blood cells can lodge in the spleen, causing it to swell and rupture. D:The red blood cells in sickle cell disease have a rounded appearance, rather than the normal oblong appearance.
Which of the following clinical presentations is MOST consistent with an acute ischemic stroke involving the left cerebral hemisphere? A:Dysarthria, confusion, right side hemiparesis, left side facial droop B:Decerebrate posturing, asymmetric pupils, hypertension, bradycardia C:Aphasia, lethargy, right side hemiparalysis, right side facial droop D:Dysphasia, confusion, left side hemiparesis, right side facial droop You selected C; The correct answer is A; Reason:
Acute ischemic strokes represent approximately 75% of all strokes. Each cerebral hemisphere controls functions on the contralateral (opposite) side of the body; therefore, sensory and motor deficits (ie, hemiparesis, hemiparalysis) are observed on the side of the body opposite the stroke. However, because the facial nerves do not decussate (cross as they leave the cerebral cortex, move through the brainstem, and arrive at the spinal cord), facial droop is typicallyobserved on the ipsilateral (same) side as the stroke. Pupillary changes, if present, will also occur on the same side as the stroke because of optic nerve crossover in the brain. Other common signs of acute ischemic stroke include dysarthria (slurred speech), dysphasia (difficulty speaking or understanding), aphasia (inability to speak or understand), and mental status changes. In contrast to acute ischemic stroke, acute hemorrhagic stroke (caused by a ruptured cerebral artery) typically presents with more ominous signs, which include a sudden, severe headache that is followed by a rapid decline in level of consciousness. Because bleeding is occurring within the brain, intracranial pressure increases, resulting in signs such as decorticate (flexor) or decerebrate (extensor) posturing, asymmetric or bilaterally dilated pupils, and Cushing's triad (hypertension, bradycardia, abnormal respiratory pattern).
C; This is correct!
Sickle cell disease is the most commonly inherited blood disorder. Although it primarily affects African-American, Puerto Rican, and European populations, it can occur in anyone. Sickle cell disease starts with a gene defect of the adult-type hemoglobin (HbA). This mutated gene can be inherited from one parent (HbS) or both parents (HbSS). When the gene is inherited from both parents, there is a high probability that the patient will be prone to sickle cells (that is, the person actually has the disease) or the sickle cell trait (the person is a carrier of the mutated gene). The defective red blood cells (RBCs) are misshapen; affected cells have an oblong (sickle) shape instead of a smooth, round shape. This shape makes the RBCs poor carriers of oxygen, which means that a person with sickle cell disease is highly susceptible to hypoxia. The odd shape may also cause RBCs to lodge in small blood vessels (thrombotic crisis) or in the spleen, causing the organ to swell and rupture, which can cause death. Sickle cell disease may also lead to other crises, such as aplastic crisis and hemolytic crisis. In aplastic crisis, RBC production temporarily stops. In hemolytic crisis, the RBCs break down quickly. In acute crises, patients often have severe pain, which will require aggressive pain management. They may also experience frequent infections, which can lead to sepsis and death.
