69yrs woman with crushing substernal chest pain and nausea. Lab studies show elevated serum levels of cardiac proteins (CK-MB=8.5ng/mL; troponin 1= 3.2ng/ml. a diagnosis of myocardial infarction confirmed by ECG. Despite treatment, patient becomes hypotensive and resuscitation attempts unsuccessful. Cross section image shown. Which pathological changes are evident?
Atherosclerosis and Thrombosis
Diagnosis- Myocardial Infarction
How would Calcification appear?
irregular blue material with H&E stain
A 60-year-old man presents with dizziness, nausea, and severe shortness of breath of several months’ duration. Physical examination shows hepatomegaly, ascites, and anasarca. His blood pressure is 200/115 mm Hg. An X-ray film of the chest demonstrates cardiomegaly and mild pulmonary oedema. Although different mechanisms may have contributed to the pathogenesis of hypertension in this patient, the common end-result for all of them is which of the following?
Increased peripheral vascular resistance
systemic hypertension always leads to this
Diagnosis: hypertensive heart disease
what do most cases of hypertension show?
imbalance between renal function and sodium homeostasis
vasodilation
decreases blood pressure
cystic medial necrosis
factor in aortic dissecting aneurysm
A 65-year-old man presents with a 2-week history of abdominal discomfort. Physical examination reveals a pulsatile abdominal mass in the periumbilical region. A CT scan shows a segment of abdominal aorta proximal to the bifurcation that is dilated (5 cm) and calcified. The patient is scheduled for corrective surgery but suffers a massive stroke and expires. The abdominal aorta is examined at autopsy (shown in the image). Which of the following is the most likely underlying cause of this patient’s abdominal mass?
Atherosclerosis
diagnosis: aneurysm, atherosclerotic
Aneurysms
increase in the vessel’s diameter by 50%
3 forms of aneurysm- saccular, fusiform, dissecting
aneurysms dilated more than 5cm rupture within 5yrs
A 79-year-old man presents with a history of extensive ulcers on both legs for 4 years. A photograph of the patient’s legs is shown in the image. What is the appropriate diagnosis?
Varicose Veins
what represents diseases of the lymphatic system?
Lymphangitis and Milroy disease
A 48-year-old man with a longstanding history of chronic constipation complains of anal itching and discomfort toward the end of the day. He describes perianal pain when sitting and finds himself sitting sideways to avoid discomfort. Physical examination reveals painful varicose dilatations in the anal region, associated with oedema. Which of the following is the most likely diagnosis?
haemorrhoids
-dilation of veins of the rectum and anal canal
-can also result from venous obstruction by rectal tumours
A 68-year-old obese woman (BMI = 32 kg/m²) presents with substernal chest pain and a history of recurrent angina pectoris and intermittent claudication. The following day, she develops a fever of 38°C (101°F). Results of laboratory studies include an elevated WBC count (13,000/µL), CK-MB of 6.6 ng/mL, and troponin I of 2.5 ng/mL. ECG confirms a myocardial infarction of the left ventricular wall. Which of the following mechanisms is most likely responsible for the myocardial infarction in this patient?
Coronary Artery Thrombosis
-most common cause for acute myocardial infarction and secondary to rupture of atherosclerotic plaque
A 48-year-old man complains of chest pain upon exertion. He had been well until 4 months previously, when he first developed chest discomfort while jogging. His symptoms have progressed to the point that he now develops chest pain after climbing a single flight of stairs. He has a history of diabetes controlled by diet and a 25 pack-year history of cigarette smoking. His father and maternal grandfather both died of heart disease before the age of 60.
On the 5th hospital day, the patient develops chest pain during periods of mild activity, which is minimally responsive to sublingual nitroglycerin. Results of laboratory studies include a WBC count of 8,100/µL, CK-MB of 4.5 ng/mL, and troponin I of 0.5 ng/mL.
Which of the following is the most likely diagnosis?
Unstable Angia
-refers to a pattern of pain that occurs progressively with increasing frequency
diagnosis- ischemic heart disease
A 60-year-old woman with a 30 pack-year history of smoking and a 10-year history of emphysema expires of congestive heart failure. There is no evidence of coronary artery disease or valvular heart disease. The heart at autopsy is shown in the image. Which of the following is the most likely cause of right ventricular hypertrophy?
Pulmonary hypertension
diagnosis- cor pulmonale
A 72-year-old man presents with difficulty breathing. He reports becoming short of breath at night unless he uses three pillows to prop himself up. Measurements of vital signs reveal normal temperature, mild tachypnea, and a blood pressure of 180/100 mm Hg. Physical examination discloses obesity, bilateral 2+ pitting leg edema, hepatosplenomegaly, and rales at the bases of both lungs.
A chest X-ray shows mild enlargement of the heart and a mild pleural effusion. Echocardiography reveals left ventricular hypertrophy without valvular heart defects. Which of the following is the most likely diagnosis?
Hypertensive heart disease
A 52-year-old woman presents with swelling of her ankles of 6 weeks’ duration. Physical examination reveals an obese woman (BMI = 32 kg/m²) with pitting edema of the lower extremities and periorbital edema. Laboratory studies show hyperlipidemia and hypoalbuminemia. Urinalysis discloses 3+ proteinuria and 3+ glucosuria, with no evidence of inflammatory cells or red blood cells.
A kidney biopsy stained with PAS (periodic acid–Schiff stain), shown in the image, demonstrates a prominent increase in the mesangial matrix forming nodular lesions, along with thickening of the capillary basement membranes. Which of the following is the most likely pathologic diagnosis?
Diabetic glomerulosclerosis
related to diabetes check serum levels of?
hyperglycaemia - increased levels of blood glucose
A 58-year-old man with a history of coronary artery disease, peripheral vascular disease, and a recent myocardial infarction suddenly develops painless hematuria. He subsequently suffers a massive stroke and expires. The patient’s kidney at autopsy is shown in the image. Which of the following is the most likely diagnosis?
Cortical infarct
-caused by arterial obstruction
A 60-year-old man undergoes resection of an abdominal aneurysm complicated by massive hemorrhage. Two days after surgery, he develops acute renal insufficiency. He is placed on dialysis but subsequently suffers a massive myocardial infarction and dies.
Microscopic examination of the kidneys at autopsy reveals necrotic epithelial cells within the lumina of some tubules, as shown in the image. The arrows identify enlarged, regenerative epithelial cells. What is the appropriate diagnosis?
Acute tubular necrosis
A 70-year-old obese woman (BMI = 34 kg/m²) presents with a 3-month history of progressive renal insufficiency. She has a longstanding history of hypertension. An intravenous pyelogram shows that both kidneys are small, and the pelves and calyces appear dilated. The patient subsequently suffers a massive stroke and dies.
Examination of the kidneys at autopsy reveals symmetrically shrunken, small kidneys with a uniformly finely granular surface, as shown in the image. Which of the following is the appropriate diagnosis?
Nephrosclerosis
A 60-year-old man presents with acute renal insufficiency. He treated his garden last week with several herbicides and insecticides, some of which may have contained heavy metals. Laboratory studies confirm oliguria and elevated levels of BUN (54 mg/dL) and creatinine (3.7 mg/dL). A renal biopsy is shown. What is the most likely diagnosis?
acute tubular necrosis
A 45-year-old man undergoes renal biopsy for evaluation of chronic renal failure. The patient is obese (BMI = 37 kg/m²) and admits to smoking two packs of cigarettes per day for 30 years. Physical examination reveals a blood pressure of 190/110 mm Hg. An echocardiogram shows marked left ventricular hypertrophy.
Renal biopsy discloses pathologic changes in small renal arteries, including “onion-skinning” and fibrinoid necrosis. Laboratory studies show a hematocrit of 40%, hemoglobin of 18.7 g/dL, serum cholesterol of 250 mg/dL, BUN of 45 mg/dL, and serum creatinine of 5.5 mg/dL. Which of the following is the most likely underlying cause of chronic renal failure in this patient?
Malignant hypertension
- severely elevated bp results in progressive vascular disease in brain, heart, kidney
A 58-year-old man with a history of hyperlipidemia and hypertension presents to the emergency department with headaches and blurred vision. His blood pressure is 200/115 mm Hg, and his pulse is 95 beats per minute. Funduscopic examination reveals several small retinal microaneurysms and cotton-like areas of retinal edema and necrosis.
Intravenous pyelography demonstrates bilaterally small kidneys. Renal arteriography shows stenoses of both renal arteries. Hypertension in this patient is caused by the renal release of which of the following hormones?
Renin
diagnosis- renovascular hypertension
A 60-year-old man with small cell carcinoma of the lung is brought to the emergency department in a coma after experiencing a clonic–tonic seizure. His temperature is 37°C (98.6°F), blood pressure is 100/50 mm Hg, and pulse is 88 beats per minute. Laboratory studies reveal a serum sodium level of 103 mmol/L, normal serum BUN and creatinine levels, and dilute but otherwise normal urine. A CT scan of the head is normal.
Which of the following is the most likely cause of seizures in this patient?
syndrome of inappropriate ADH secretion
