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Pathophysiology Revision
December 2015
Case 1
• A 60-year-old man with a history of multiple myocardial
infarctions in the past years is hospitalized for shortness of
breath. He has marked jugular distention, hepatomegaly,
ascites and pitting edema. A chest X-ray reveals cardiomegaly.
The patient subsequently dies of cardio- respiratory failure.
Examination of the lungs at autopsy would most likely show
which of the following pathologic changes?
A. Diffuse alveolar damage with hyaline membrane
B. Intra-alveolar purulent exudates
C. Lymphocytic interstitial pneumonia
D. Vascular congestion with hemosiderin laden macrophages
Case 2
• A 53-year-old man is hospitalized after injuring his
neck in an automobile accident and was bedridden
for several days. The patient develops painful
swelling and redness of the calf region of his left leg.
Which of the following is the most likely cause for
the development of this condition in this patient’s
leg?
A. Age
B. Endothelial injury
C. Hypercoagulability
D. Stasis
Case 3
• A 15-year-old girl incurs a cut to her left foot after
stepping on broken glass. A superficial 0.5 cm
laceration stops bleeding 5 minutes after
application of local pressure. Which of the
following substances is released by platelets and
is involved in platelet aggregation at this site of
injury?
A. Adenosine diphosphatase
B. Thromboxane A2
C. Tissue plasminogen activator
D. Prostacyclin
Case 4
• After suffering of acute myocardial infarction, a 53year-old man presents to the emergency room 1 week
later with sharp pain in the left side of his chest. The
patient is anxious and sweating. His heart rate is 100
per minute. He dies within minutes. At autopsy, cardiac
tamponade and hemopericardium were found. What is
the most likely mechanism of this complication?
A. Ventricular rupture
B. Ventricular fibrillation
C. Pericarditis
D. Dissecting aortic aneurysm
Case 5
• A 32-year-old woman returns to her physician for
follow-up of hypertension that has been poorly
controlled in spite of numerous antihypertensive
medications. It is decided to evaluate the patient
for possible “secondary” hypertension. Which of
the following is a well-known cause of secondary
hypertension?
A. Obesity
B. Renal artery stenosis
C. Smoking
D. Stress
Case 6
• A 52-year-old man is brought to the emergency
room with severe chest pain. Angiography
demonstrates a severe coronary occlusion. A
thrombolytic agent is administered to re-establish
perfusion. Which of the following does the
thrombolytic agent activate?
A. Heparin-like molecule
B. Plasminogen
C. Prothrombin
D. Fibrinogen
Case 7
• All of the following are possible complications
of atherosclerosis, which are related to acute
changes of the atherosclerotic plaque, with
the exception of:
A. Myocardial infarction
B. Renal artery stenosis
C. Gangrene of extremities
D. Prinzmetal angina
Case 8
• A 25-year-old woman presents with history of
losing 4 pregnancies in the past 5 years. She also
has a history of recurrent pains in her legs
secondary to recurrent thrombosis. Her
symptoms are most likely due to a deficiency in
which of the following substances?
A. t-PA inhibitors
B. Protein C
C. Thrombin
D. Von Willibrand factor
Case 9
• A 27-year-old man is on a scuba diving trip to the Red Sea.
After 30 minutes, he has a malfunction in his equipment
and quickly returns to the boat on the surface. He
experiences difficulty breathing, with dyspnea and
substernal chest pain, followed by a severe headache and
vertigo. He develops severe myalgia and arthralgia. Which
of the following mechanisms is the most likely cause of
these symptoms?
A. Disseminated intravascular coagulation
B. Venous thrombosis
C. Nitrogen emboli
D. Fat globules in arterioles
Case 10
• A 60-year-old man, who is recovering from a
surgery to correct an abdominal aneurysm,
suddenly develops acute chest pain and dies. A
thromboembolism at the bifurcation of the left
and right pulmonary arteries is noted at autopsy.
Which of the following is the most likely cause of
this patient’s pulmonary embolism?
A. Mural cardiac thrombus
B. Complicated atherosclerotic plaque
C. Deep venous thrombosis
D. Paradoxical embolism
Case 11
• A 92-year-old woman is brought unconscious to the
emergency room. Her blood pressure is 70/30mmHg.
She is febrile (380C) with rapid respiration. Laboratory
studies demonstrate a high white blood cell count
(22000/ul). Urine and blood analysis reveals numerous
gram negative organisms. Which of the following most
likely accounts for this patient’s signs and symptoms?
A. Septic shock
B. Hypovolemic shock
C. Anaphylactic shock
D. Cardiogenic shock
Case 12
• A 44 year old man presents to the emergency
room with acute chest pain. The ECG is normal.
analysis of which pair of serum markers given
below would be most helpful in excluding a
diagnosis of acute myocardial infarction in this
patient?
A. Troponin I and myoglobin
B. CK-BB and myoglobin
C. CK-MB and Troponin I
D. CK-MM and LDH-1
Case 13
• A 61-year-old man presents with a 5-year history
of pain in both legs during exercise. He has been
treated for diabetes for 8-years. His fasting blood
glucose level is 280mg/dL (normal less than
100mg/dl). Which of the following best explains
the pathogenesis of this pain in this patient?
A. Atherosclerosis
B. Malignant hypertension
C. Peripheral neuropathy
D. Autoimmune vasculitis
Case 14
• Which of the following substances decreases
thrombus propagation by activating protein C?
A. Fibrin
B. Heparin-like molecule
C. Prothrombin
D. Thrombomodulin
Case 15
• A 55-year-old woman presents with complaints of chest
pain. She states that the chest pain predictably occurs
when she climbs four flights of stairs to reach her
apartment or when she has been jogging for more than
10 minutes. She is particularly concerned because her
mother died of a myocardial infarction at 50 years of age.
Which of the following best describes this patient’s
lesions in the coronary arteries?
A. A 70% coronary obstruction by atheroma
B. A plaque disruption with superimposed thrombosis
C. Complete obstruction by an occlusive thrombus
D. Severe spasm in the absence of atheroma
Case 16
• Cardiac mural thrombus can form in the
course of all the following conditions, except
A. Mitral valve stenosis
B. Myocardial infarction
C. Ventricular aneurysm
D. None of the above
Case17
• A 35-year-old previously healthy woman has
bruises on her arms and legs that form with just
minor trauma. There is no swelling, warmth, or
erythema. Peripheral pulses are all palpable. You
expect to find which of the following laboratory
finding in this patient?
A. Protein C deficiency
B. Factor V Leiden
C. Lactic acidosis
D. Thrombocytopenia
Case 18
• Vascular damage associated with malignant
hypertension is characterized by fibrinoid
deposits and vessel wall necrosis.
A. True
B. False
Case 19
• Mönckeberg arteriosclerosis is characterized
by the presence of calcific deposits in the
arterial walls with severe narrowing of the
vessel’s lumen.
A. True
B. False
Case 20
• Aldosterone-secreting adrenal tumors are a
known cause of secondary hypertension
associated
with
hypernatremia
and
hypokalemia
A. True
B. False
Case 21
• A previously healthy 58-year-old man was hospitalized for
prostatectomy. 10 days after surgery, he exhibits decreased
mental status, with right hemiplegia. His left leg was swollen,
painful and warm. Head CT scan shows an acute cerebral
infarction in the distribution of the left middle cerebral artery.
Chest imaging reveals cardiac enlargement and signs
consistent with pulmonary hypertension. You attribute the
acute cerebral infarction to which of the following?
A. Atherosclerosis
B. Paradoxical embolism
C. Mitral valve stenosis
D. Fat embolism
Case 22
• A 1-year-old girl is brought to the emergency room
by her parents who report that she had a fever and
diarrhea for 3 days. The child's temperature is 38°C
(101°F). The CBC shows a normal WBC count and
increased hematocrit. Which of the following could
complicate the most this clinical picture?
A. Cardigenic shock
B. Septic shock
C. Hypovolemic shock
D. Neurogenic shock
Case 23
• A 48 years old man complain of chest pain upon exercise . He has been well
until 4 months previously, when he first developed chest discomfort while
jogging . His symptoms has developed to the point that he now develops chest
pain while climbing a single flight of stairs. He has history of diabetes
controlled by diet and a 25 years old history of cigarette smoking and he has
positive family history of heart disease. On the 5th hospital day, the patients
develops chest pain during mild activity , which was minimally responsive to
nitroglycerine . Lab Results shows CK-MB 4.5ng/ml (0-3ng/ml) and troponin-1
of 0.5ng/ml (normal less than 0.4 ng/ml ).
A. Acute myocardial infarction
B. Cardiac arrhythmia
C. Unstable angina
D. Pulmonary thromboembolism
Case 24
A subendocardial infarct affecting the inner part
of the myocardium might occur in all the
following conditions , with the exception of
A. Diffuse coronary atherosclerosis
B. Hypotensive shock
C. Severe hypoxia
D. Atherosclerosis with prolonged thrombotic
occlusion
Case 25
A 19-year-old offensive tackle for a major university
football team fractures his right femur during the first
game of the season. He is admitted to the hospital and
over the next several days develops progressive
respiratory problems. Despite extensive medical
intervention, he dies 3 days later. At the time of autopsy
oil red positive material is seen in the small blood vessels
of the lungs and brain. Which of the following is the most
likely diagnosis?
A. Air emboli
B. Amniotic fluid emboli
C. Fat emboli
D. Paradoxical emboli
E. Saddle emboli
Point of
comparison
Alzheimer disease
Parkinson Disease
Huntington Disease
Site of CNS
affection
hippocampus and neocortex
substantia nigra to the
striatum
caudate and putamen
Genetics
Mutations in APP (Late)
Presenilin-1 or presenilin-2 .
(Late)
ApoE4 and Extra 21
chromosome ( Early onset)
sporadic
Familial :AD and AR
gene encoding α-synuclein
(point mutuation )
AD
Expansion of CAG copies
Clinical picture
Dementia and loss of cognitive
functions
tremors
Rigidity
bradykinesia instability
jerky movements
writhin
Chorea,depression,
anxiety, anger irritability
Dementia
Plus the clinical picture figure
Pathogenesis
Aβ aggregates, plaques and tau
tanglesNeuritic plaques:
Neurofibrillary tangles
Lewy bodies
Lewy neurites
Dementia
Pallor of the substantia
nigra
loss of the pigmented
dopaminergic neurons
Loss of neurons
Intranuclear inclusions
ubiquitinated huntingtin
Cause of Death
Intercurrent infection
Trauma and intercurrent
infection
Suicide and intercurrent
infection