Download INTEGRATED PATHOPHYSIOLOGY BTECH TEST 1 MARCH 2007

INTEGRATED PATHOPHYSIOLOGY
BTECH
TEST 1 MARCH 2007
QUESTION ONE
1.1 Define the term thrombosis.
(1)
1.2 Discuss Virchow’s triad.
(15)
1.3 Briefly explain the therapy and prophylaxis of thrombosis.
(5)
1.4 Discuss the pathogenesis of a moderate sized pulmonary thrombo-embolism.
(12)
1.5 A 49-year-old man has the sudden onset of substernal chest pain with radiation to his left arm.
This persists for the next 6 hours. He goes to the emergency department and on examination is
afebrile. Laboratory studies show a serum troponin I of 18 ng/mL and CK-MB of 8%. Angiography
reveals a thrombosis of the left anterior descending coronary artery. During the next 24 hours, which
of the following is the most likely complication he will experience?
A Constrictive pericarditis
B Cardiac arrhythmia
C Hepatic necrosis
D Thromboembolism
E Myocardial rupture
(1)
1.6 In your own words explain infarction in the intestine.
(6)
1.7 Outline by means of a flow diagram the pathogenesis of ascites.
(5)
[45]
QUESTION TWO
2.1 List two (2) causes of hypovolaemic shock.
(2)
2.2 Outline the events leading up to shock associated peritonitis.
(5)
2.3 Define “shock lung” / ARDS.
(3)
2.4 Describe in detail the pathogenesis of right ventricular failure (RVF) with left ventricular
failure (LVF) as aetiology.
(14)
2.5 Explain the significance of a pink frothy sputum in a patient who has had a
severe myocardial infarct.
(6)
2.6 List five (5) circulatory effects of RVF.
(5)
[45]
QUESTION THREE
3.1 Define arteriolosclerosis.
(1)
3.2 A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a
large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left
ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and
microscopically they demonstrate small renal arterioles that have lumenal narrowing from concentric
intimal thickening. Which of the following is the most likely diagnosis?
A Dominant polycystic kidney disease
B Arterial changes with diabetes mellitus
C Vascular disease with hyperlipidemia
D Malignant hypertension
E Arteriosclerosis
(1)
3.3 Discuss the pathogenesis of an atheromatous plaque.
(16)
3.4 List the haemodynamic factors that contribute to systolic blood pressure and name one
pathology that affects this portion of the blood pressure.
(4)
3.5 List four (4) causes of secondary hypertension.
(4)
3.6 List the complications associated with a myocardial infarction.
(9)
3.7 Briefly outline the histology of the vascular lesions associated with malignant hypertension and
commonly found in the kidney.
(4)
3.8 A 25-year-old previously healthy woman has had worsening fatigue with dyspnea, palpitations,
and fever over the past week. On physical examination her vital signs show T 38.9 C, P 103/minute,
R 30/minute, and BP 95/65 mm Hg. Her heart rate is slightly irregular. An ECG shows diffuse ST-T
segment changes. A chest x-ray shows mild cardiomegaly. An echocardiogram shows slight mitral
and tricuspid regurgitation but no valvular vegetations. Laboratory studies show a troponin I of 12
ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following
laboratory test findings best explains the underlying etiology for these events?
A Anti-streptolysin O titer of 1:512
B Total serum cholesterol of 537 mg/dL
C Coxsackie B serologic titer of 1:160
D Blood culture positive for Streptococcus, viridans group
(1)
3.9 Briefly outline the pathogenesis of rheumatic fever.
(5)
[45]
QUESTION FOUR
The following questions relate to the data projector slides being demonstrated in the front of
the class.
4.1. This is a heart What is the diagnosis?
A.
amyloidosis
B.
dilated cardiomyopathy
C.
D.
hypertrophic cardiomyopathy
old infarct(s)
(1)
4.2 This is the pericardial space. What is the diagnosis?
A. Fibrinous pericarditis
B. Hemorrhagic pericarditis
C. Hemopericardium
D. Myocarditis
E. Rheumatic
(1)
4.3 This is the myocardium of a patient with rheumatic fever associated myocarditis. Name the
encircled lesion?
A. Atherosclerotic plaque
B. Fibrinoid necrosis
C. Aschoff body
D. Endocardial vegetations
(1)
4.4 Look at the aortic valve. What is the diagnosis?
A. Acute rheumatic fever
B. Bacterial endocarditis
C. Dissecting aneurysm
D. Metastatic carcinoma
E. Syphilis
(1)
4.5 This is the heart. What morphological pattern of thrombosis is associated with this pathology?
A.
RED THROMBUS
B.
WHITE THROMBUS
C.
BOTH RED & WHITE COMBINED
(1)
4.6 This is lung. What is the diagnosis?
A.
bacterial pneumonia
B.
eosinophilic granuloma
C.
mesothelioma
D.
pulmonary embolism
E.
viral pneumonia
(1)
4.7 This is H&E of myocardium. What is the diagnosis?
A.
Bacterial myocarditis
B.
Bronchioloalveolar cell
carcinoma
C.
Rhuematic heart disease
D.
Bacterial Endocarditis
E.
Viral myocarditis
(1)
4.8 This is a coronary artery. What is the diagnosis?
A. Medial arteritis
B. Atheromatous plaque with thrombosis
C. Thrombosis
D. Bacterial endarteritis
E. Hyaline arteriolosclerosis
(1)
4.9 This is the heart. The most likely underlying cause is?
A. Myocardial infarction
B. Chest trauma
C. Myocarditis
D. Empyema
E. Metastatic carcinoma
(1)
[9]
ADDENDUM - NORMAL VALUES
Creatinine
0.6 - 1.2 mg/dL
Glucose
Tested after fasting: 70 - 110 mg/dL
Hematocrit
Male: 45 - 62%
Female: 37 - 48%
Hemoglobin
Male: 13 - 18 gm/dL
Female: 12 - 16 gm/dL
Mean Corpuscular Volume (MCV)
76 - 100 cu µm
Platelet Count
150,000 - 350,000/mL
Potassium
3.5 - 5.0 mmol/L
Urea Nitrogen (BUN)
7 - 18 mg/dL
Chloride
98 - 106 mmol/L
Carbon Dioxide Pressure
35 - 45 mm Hg
Sodium
135 - 145 mEq/L
White Blood Cell Count (WBC)
4,300 - 10,800 cells/µL/cu mm
Thyroid-Stimulating Hormone (TSH)
0.5 - 6.0 µ units/mL
Bicarbonate
18 - 23 mEq/L (carbon dioxide content)
Osmolality
280 - 296 mOsm/kg water
Serum Alkaline Phosphatase
50 - 160 units/L (normally higher in infants and
adolescents) (alkaline)
Thyroxine (T4), serum
5-12 ug/dL
64-155 nmol/L
A resting adult pulse should be between 60 and 100 beats per minute.
The normal adult rate is 12 to 20 breaths per minute
Normal temperatures measured by mouth range from 97°F (36°C) to 99°F (37°C) or slightly higher.
CSF Normal Values
 Pressure: 50 to 180 mm H20
 Appearance: clear, colorless
 CSF total protein: 15 to 45 mg/100 ml
 Gamma globulin: 3 to 12% of the total protein
 CSF glucose: 50 to 80 mg/100 ml (or approximately 2/3 of serum glucose level)
 CSF cell count: 0 to 5 white blood cells (WBC), no red blood cells (RBC)
 chloride: 110 to 125 mEq per liter