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Similar thought process over here, didn't get a whole lot from the MRI other than lack of symmetry, but pt with alcohol problems was the key for me. Just played the odds
crackles are heard bilaterally so there is pulm patho which leads to increased pulm vascular resistance, since systemic blood flows into the lungs.
any block in the flow ahead (lungs) will increase resistance in flow behind ( systemic )
This patient is hypoxic increased diffusion distance. This causes pulmonary vasoconstriction. Ordinarily this response is designed to shunt blood to parts of the lungs that are well ventilated, but the response is maladaptive in global hypoxia
I dont believe decreased venous oxygen tension would lead to pulmonary vasoconstriction (this is typically in the setting of low PAO2 you see this; shunting blood away from poorly oxygenated alveoli). You can get to increased pulmonary vascular resistance due to pulm edema from Left heart failing leading to fluid overload in pulm vasculature).
Essential thrombocythemia presents with platelets > 1 million, not reactive thrombocytosis