Chapter 7 Q&A

Question 1

1. A 60-yo man with history of multiple MIs is hospitalized for shortness of breath. Physical exam reveals marked JD, hepatomegaly, ascites, and pitting edema. CXR reveals cardiomegay. Patient dies of cardiorespiratory failure. Exam of lungs at autopsy would most likely disclose which pathologic change?

Answer 1

Vascular congestion and hemosiderin-laden macrophages; LV failure leads to chronic passive congestion of the lungs. Blood leaks from congested pulmonary capillaries into the alveoli. Alveolar macrophages degrade the RBCs and accumulate hemosiderin.

Question 2

2. 92 yo woman is unconscious in ER from nursing home. BP is 70/30 mm Hg, she is febrile, tachypneic, WBC count of 22,000/uL with 92% neutrophils. Urinalysis shows Gram-neg organisms. What accounts for patient’s signs and symptoms?

Answer 2

Septic shock; consider the fever, tacycardia, tachypnea, leukocytosis, also multiple organ dysfunction syndrome; also the gram-negative organisms

Question 3

3. 21-yo pregnant woman deals with abruptio placentae at 37 weeks of gestation, has severe vaginal bleeding that is difficult to control. Five mos later; patient has letahrgy, pallor, muscle weakness, failure of lactation, and amenorrhea. What explains this pituitary insufficiency?

Answer 3

Infarction; enlargement of pituitary during this time renders it susceptible to infarction; could lead to the hypotension

Question 4

4. 62-yo man with history of hypertension rushed to ER with severe tearing pain of anterior chest. BP is 80/50 mm Hg. PE shows pallor, diaphoresis, aortic regurgitation murmur. Labs and ECG show no evidence of acute MI. 4 hrs later, patient goes into cardiac arrest. ECG reveals electromech dissociation. How do you explain cardiac tamponade?

Answer 4

Hemorrhage; here due to dissecting aortic aneurysm; pressure in pericardial cavity exceeds filling pressure of heart; here, heart rhythm not producing a pulse, when it normally should

Question 5

5. 58 yo woman brought into ED 4 hours after vomiting blood and experiencing bloody stools. Patient diagnosed with alcoholic cirrhosis 2 years ago. Endoscopy reveals large esophageal varices. How to explain dilated esophageal veins?

Answer 5

Increased intravascular hydrostatic pressure; portal hypertension

Question 6

6. 69 yo retired man; ED, sudden onset of left-sided hest pain, exacerbated upon inspiration; PE with dyspnea and hemoptysis; temp 38, pulse 110, RR 35, BP 158/100; lateral chest wall friction rub, left leg edematous with Homans’ sign; C XR with left pleural effusion.

Answer 6

Thromboembolism; symptoms depend on extent of blockage of pulmonary arterial tree, if there is cardiopulmonary disease, and if pulmonary infarction occurs

Question 7

7. 22 yo construction worker falls 30 ft and fractures several bones, including femoral shafts. Later develops shortness of breath and cyanosis. What caused these problems?

Answer 7

Fat embolism (originates from adipose tissue in medulla of fracture long bones; fat eventually enters arterial blood

Question 8

8. Patient with severe headache; PE shows small red spots on extremities and stiff neck; lumbar puncture shows purulent fluid, segmented neutrophils, gram-neg organisms resembling meningococci. Which proteins mediates the injury?

Answer 8

TNF alpha

Question 9

9. 69 yo man has visual difficulty and weakness; retinal hemorrhages bilaterally; thromboembolus going to left MCA and smaller emboli go to retinal arteries. Where di it orginate?

Answer 9

Heart

Question 10

10. What causes birefringence for the pulmonary lesion in homeless man?

Answer 10

IV drug use!

Question 11

11. 25 yo woman deliver healthy baby; later, mother with severe SOB and appears cyanotic; What is the mech of her death?

Answer 11

Amniotic fluid embolism; amniotic fluid with fetal cells and debris enters materal circulation through open uterine and cervical veins.

Question 12

12. Had the 25 yo woman survived, what is she at risk of?

Answer 12

Disseminated intravascular coagulation (DIC); thrombotic microangiopathy and fibrin thrombi form in small bv’s because of uncontrollable coagulopathy

Question 13

13. 68 yo man with swollen legs, enlarged liver, fluid in pleural spaces; history of ischemic heart disease and smoking with increased SOB. What explains hepatomegaly?

Answer 13

Chronic passive congestion.

Question 14

14. If the 68 yo man were to die of a massive heart attack and expire, what would liver show at autopsy?

Answer 14

Sinusoids dilated with blood

Question 15

15. 33 yo woman with black stools; lab studies show hypochromic microcytic anemia; upper GI shows duodenal ulcer; what describes the stools?

Answer 15

Melena

Question 16

16. 53 yo man in hospital after neck injury in automobile accident; develops painful swelling and erythema of left calf; has DVT; what caused thrombosis?

Answer 16

Stasis (because he’s been hospitalized and placed in cervical traction)

Question 17

17. 23 yo man with hemophilia wheelchair bound; why?

Answer 17

Hemarthrosis (bleeding into joint cavity; crippling complication of hemophilia)

Question 18

18. 50 yo fire fighter has 3rd degree burns over 70% of body and dies; why?

Answer 18

Here, it’s hypovolemic shock; fluid loss from severe burns and wept large amounts of plasma

Question 19

19. 23 yo woman complains of yellowing of skin and abdo girth; PE shows jaundice and ascites. US shows hepatic vein thrombosis. Liver biopsy shows sinusoidal dilation in centrilobular regions. What causes this?

Answer 19

Passive hyperemia (chronic passive congestion); could be confined to limb or organ as a result of localized obstruction to venous drainage)

Question 20

20. 42 yo woman has face lift; later, has bluish hemorrhages around her eyes; why?

Answer 20

Ecchymosis; a larger superficial hemorrhage in skin; this will turn green and yellow before resolving

Question 21

21. 19 yo woman has swelling of eyelids, abdomen, ankles; CXR with bilateral pleural effusions. Has 4+ proteinuria; minimal change nephrotic syndrome. What causes the soft tissue edema?

Answer 21

Decreased intravascular oncotic pressure (Loss of albumin)

Question 22

22. 50 yo alcoholic has esophageal varies; protruding abdomen has large volume of serous fluid.

Answer 22

Ascites

Question 23

23. 1 yo girl has fever and diarrhea for 3 days; CBC shows normal WBC count and increased crit; why the increased crit?

Answer 23

Dehydration (secondary to diarrhea0

Question 24

24. 40 yo man with history bacterial endocarditis and sees pinpoint hemorrhages around eye orbit. What describes this?

Answer 24

Petechiae; pinpoint hemorrhages, representing rupture of capillary or arteriole that occurs in conjunction with vasculitis and coagulopathy

Question 25

25. 67 yo man with sudden left leg pain; absence of pulses, cold limb; PMH with CAD and small aortic aneurysm. Why the cold limb?

Answer 25

Arterial thromboembolism

Question 26

26. 78 yo woman dies in her sleep. Prussian blue stain of lungs shows what?

Answer 26

Chronic failure of LV and leads to impediment to exit of blood from lungs and chornic passive congestion of lungs; the heart failure cells are labeled

Question 27

27. 60 yo man develops acute chest pain and dies. Thromboembolus at bifurcation of left and right pulmonary arteries noted at autopsy.

Answer 27

DVT

Question 28

28. 20 yo man brought to ER after rupturing spleen in motorcycle accident; BP is 80/60; arterial blood gasses shows metabolic acidosis; what is the problem?

Answer 28

Hypovolemic shock: prounounced decrease in blood or plasma volume; caused by hemorrhage, severe burns, diarrhea, excess urine formation, perspiration, trauma!!!

Question 29

29. 72 yo man collapses at home and dies; renal cortical infarcts and we see arcuate artery; what caused atheroembolus in terms of arteries?

Answer 29

Abdo aorta

Question 30

30. 72 yo woman with SOB on exertion; she has orthopnea; PE with mild obesity, blateral pitting leg edema, hepato and splenomegaly; rales; CXR with cardiomegaly

Answer 30

Pulmonary heart failure (CHF)

Question 31

31. 63 yo man with massive stroke and dies; laminated thrombus adherent to wall of LV; cause?

Answer 31

MI: most common cause of mural thrombi in LV

Question 32

32. For 63 yo man dying of stroke; there are growth of fibroblasts and deposition of collagen in mural thrombus; what is term?

Answer 32

Organization: the invasion of CT elements, casuing thrombus to become firm and appear grayish white

Question 33

33. 50 yo woman with fatigue and SOB; PE with evidence of PE, LA enlarged, mitral valve calcified; CT with large mass in LA; how to describe stroke?

Answer 33

Arterial embolism; cardiac myxoma is most commmon primary tumor of heart

Question 34

34. 50 yo woman had radical mastectomy and axillar node dissection for breast cancer; arm swollen by end of the day

Answer 34

Lymphedema!

Question 35

35. 68 yo man with sudden, severe substernal chest pain; confirmed acute MI; what is the soft yellow area of necrosis in LV?

Answer 35

Cardiogenic shock; casued by myocardial pump failure; usually due to large MI or possible myocarditis

Question 36

36. 80 yo woman with history of hypertension and has chest pain; bilateral pitting leg edema, hepatosplenomegaly, rales at bases of both lungs; patient apprehensive and sweating; you see the blood overflow, why?

Answer 36

Increased intravascular hydrostatic pressure

Question 37

37. 9 mo old infant has intense abdo pain and bloody diarrhea; PE with tender abdomen without ascites; child dies with torsion of small bowel; what descrbies the bowel's really dark appearance?

Answer 37

Infarct (because of all the twisting and turning)

Question 38

38. 70 yo woman has subendocardial circumferential infarct of LV

Answer 38

Hypovolemic shock; can't get enough oxygen through the coronary arteries leading to subendocardial infarction

Question 39

39. 76 yo woman has onset of two episodes of hemoptysis and left-sided chest pain, exacerbated on inspiration; temp is 38, pulse 110, RR 35, BP 158/100; suffers massive stroke; pulonary infarct color is what it is why?

Answer 39

Hemorrhage from bronchial arteries (red because of the dual blood supply, like with the lung; red infarcts sharply circumscribed, firm, dark red to purple

Question 40

40. 22 yo woman gives baby at 29 weeks of gestation; neonate dies of respiratory insufficiency. What explains the respiratory distress syndrome?

Answer 40

Anoxic injury (the brain looks really black, probably because of a lack of oxygen); lack of surfactant!!!