Chapter 7: Hemodynamic Disorders Flashcards
(40 cards)
A 60-year-old man with a history of multiple myocardial
infarcts is hospitalized for shortness of breath. Physical examination
reveals marked jugular distension, hepatomegaly,
ascites, and pitting edema. A chest X-ray reveals cardiomegaly.
The patient subsequently dies of cardiorespiratory failure.
Examination of the lungs at autopsy would most likely disclose
which of the following pathologic changes?
- Vascular congestion and hemosiderin-laden
macrophages.
A 92-year-old woman is brought unconscious to the emergency
room from a nursing home. Her blood pressure is 70/30 mm
Hg. She is febrile (38°C/100.5°F) and tachypneic. Laboratory
studies demonstrate a WBC count of 22,000/μL with 92%
neutrophils. Urinalysis reveals numerous Gram-negative
organisms. Which of the following most likely accounts for
this patient’s signs and symptoms?
- Septic shock.
A 21-year-old pregnant woman experiences abruptio placentae
at 37 weeks of gestation and develops severe vaginal bleeding
that is diffi cult to control. Five months later, the patient
presents with profound lethargy, pallor, muscle weakness,
failure of lactation, and amenorrhea. Which of the following
best explains the pathogenesis of pituitary insuffi ciency in this
patient?
- Infarction.
A 62-year-old man with a history of hypertension is rushed
to the emergency room with severe “tearing pain” of the
anterior chest. His blood pressure is 80/50 mm Hg. Physical examination shows pallor, diaphoresis, and a murmur of aortic
regurgitation. Laboratory studies and ECG show no evidence
of acute myocardial infarction. Four hours later, the patient
goes into cardiac arrest. An ECG reveals electromechanical
dissociation. Which of the following best explains the
pathogenesis of cardiac tamponade in this patient?
- Hemorrhage.
A 58-year-old woman is brought to the emergency department
4 hours after vomiting blood and experiencing bloody stools.
The patient was diagnosed with alcoholic cirrhosis 2 years
ago. Endoscopy reveals large esophageal varices, one of which
is actively bleeding. Which of the following best explains the
pathogenesis of dilated esophageal veins in this patient?
- Increased intravascular hydrostatic pressure.
A 69-year-old retired man is brought to the emergency
department because of the sudden onset of left-sided chest
pain, which is exacerbated upon inspiration. Physical
examination reveals dyspnea and hemoptysis. His temperature
is 38°C (101°F), pulse 110 per minute, respirations 35 per
minute, and blood pressure 158/100 mm Hg. A lateral chest
wall friction rub is present on auscultation. The left leg is
markedly edematous with a positive Homans’ sign. A chest
X-ray reveals a left pleural effusion. What is the most likely
cause of this patient’s pulmonary condition?
- Thromboembolism.
A 22-year-old construction worker falls 30 ft and fractures
several bones, including his femoral shafts. Six hours later,
the patient develops shortness of breath and cyanosis. Which
of the following hemodynamic disorders best explains the
pathogenesis of shock in this patient?
- Fat embolism.
Fat emboli originate from
adipose tissue in the medulla of fractured long bones. Fat
carried by venous blood reaches the lungs, fi lters through
the pulmonary circulation, enters arterial blood, and is
disseminated throughout the body. The occlusion of cerebral
capillaries is accompanied by petechial hemorrhages in the
brain and is the most important complication of fat embolism.
A 20-year-old woman presents to the emergency room complaining
of having had a severe headache for 4 hours. Physical
examination reveals numerous small red spots on the extremities
and a stiff neck. Her temperature is 38.7°C (103°F).
Lumbar puncture returns purulent fl uid, with segmented
neutrophils and Gram-negative organisms resembling meningococci.
A few hours later, the patient goes into shock and
becomes comatose. Severe endothelial injury in this patient is
primarily mediated by which of the following proteins?
- Tumor necrosis factor-a (TNF-a).
A 69-year-old man is brought to the emergency room
complaining of visual diffi culty and weakness. On physical
examination, the patient is aphasic with a right-sided
hemiplegia. Retinal hemorrhages are seen bilaterally. You
suspect that a thromboembolus coursed to the left middle
cerebral artery and smaller emboli traveled to the retinal
arteries. Which of the following anatomic sites is the most
likely source for these emboli in this patient?
- Heart
The body of a 28-year-old homeless man is brought to the
coroner’s offi ce. Histologic examination of the lungs under
polarized light is shown. Which of the following is the most
likely cause of the birefringence observed in this pulmonary
lesion?
- Intravenous drug use.
A 25-year-old woman delivers a healthy baby at 39 weeks of
gestation. Six hours later, the mother develops severe shortness
of breath and appears cyanotic. Despite resuscitation, she
dies 2 hours later. A section of lung at autopsy is shown in the
image. These pathologic fi ndings are associated with which of
the following mechanisms of disease?
- Amniotic fluid embolism.
If the patient described in Question 11 had survived the acute
episode of cyanosis and shock, she would have been at risk for
developing which of the following life-threatening complications?
- Disseminated intravascular coagulation
DIC
A 68-year-old man with ischemic heart disease and a history
of smoking complains of increasing shortness of breath. On
physical examination, the patient has swollen legs, an enlarged
liver, and fl uid in the pleural spaces (bubbly rales are heard on
oscultation). Which of the following hemodynamic disorders
explains the pathogenesis of hepatomegaly in this patient?
- Chronic passive congestion
The patient described in Question 13 suffers a massive heart
attack and expires. Microscopic examination of the liver at
autopsy would most likely reveal which of the following histopathologic
changes?
- Sinusoids dilated with blood.
A 33-year-old woman presents with black stools. Laboratory
studies demonstrate a hypochromic, microcytic anemia.
Upper GI endoscopy reveals a duodenal ulcer. Which of the
following best describes the stools in this patient with peptic
- Melena
A 53-year-old man is hospitalized after injuring his neck in
an automobile accident. He is placed in cervical traction. One
week later, the patient develops painful swelling and erythema
of his left calf. Doppler imaging discloses deep venous thrombosis.
Which of the following is the most likely cause for the
development of thrombosis in this patient
- Stasis
A 23-year-old man with hemophilia is recently wheelchair
bound. Which of the following best accounts for this development?
- Hemarthrosis
A 50-year-old fi re fi ghter emerges from a burning house with
third-degree burns over 70% of his body. The patient expires
24 hours later. Which of the following was the most likely
cause of death?
- Hypovolemic shock.
Hypovolemic shock
may be caused by hemorrhage, fl uid loss from severe burns,
diarrhea, excessive urine formation, perspiration, or trauma.
In the case of burns or trauma, direct damage to the microcirculation
increases vascular permeability. Persons with
third-degree burns weep large amounts of plasma. The other
choices are unlikely causes of death in an acute burn victim.
A 23-year-old woman complains of a recent onset of yellowing
of her skin and increasing abdominal girth. Physical examination
reveals jaundice and ascites. Ultrasound examination of
her abdomen demonstrates thrombosis of the hepatic veins.
A liver biopsy discloses severe sinusoidal dilation within the
centrilobular regions. This pathologic fi nding is caused by
which of the following hemodynamic disorders?
- Passive hyperemia
A 42-year-old woman undergoes a face lift. Two days later, she
presents for follow-up care with confl uent bluish hemorrhages
in the skin around her eyes (“black eyes”). Which of the following
best describes this pattern of superfi cial skin hemorrhage?
- Ecchymosis
A 19-year-old woman complains of swelling of her eyelids,
abdomen, and ankles. At bedtime, there are depressions in her
legs at the location of the elastic in her socks. A chest X-ray
shows bilateral pleural effusions. Urine protein electrophoresis
demonstrates 4+ proteinuria. A percutaneous needle biopsy of
the kidney establishes the diagnosis of minimal change nephrotic
syndrome. Soft tissue edema in this patient is most likely
caused by which of the following mechanisms of disease?
- Decreased intravascular oncotic pressure.
A 50-year-old alcoholic is rushed to the hospital with bleeding
esophageal varices and expires. At autopsy, the patient’s
protruding abdomen is found to contain a large volume of
serous fl uid. What is the appropriate term used to describe
this fl uid?
- Ascites.
A 1-year-old girl is brought to the emergency room by her parents
who report she has had a fever and diarrhea for 3 days. Her temperature
is 38°C (101°F). The CBC shows a normal WBC count
and increased hematocrit (48 g/dL). Which of the following is the
most likely cause of increased hematocrit in this patient?
- Dehydration.
A 40-year-old man with a history of bacterial endocarditis
notices numerous pinpoint hemorrhages around the orbit of his
eyes (shown in the image; see arrows). What is the appropriate
term used to describe this form of superfi cial hemorrhage?
- Petechia.
