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?
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.
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?
Septic shock; consider the fever, tacycardia, tachypnea, leukocytosis, also multiple organ dysfunction syndrome; also the gram-negative organisms
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?
Infarction; enlargement of pituitary during this time renders it susceptible to infarction; could lead to the hypotension
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?
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
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?
Increased intravascular hydrostatic pressure; portal hypertension
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.
Thromboembolism; symptoms depend on extent of blockage of pulmonary arterial tree, if there is cardiopulmonary disease, and if pulmonary infarction occurs
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?
Fat embolism (originates from adipose tissue in medulla of fracture long bones; fat eventually enters arterial blood
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?
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?
10. What causes birefringence for the pulmonary lesion in homeless man?
IV drug use!
11. 25 yo woman deliver healthy baby; later, mother with severe SOB and appears cyanotic; What is the mech of her death?
Amniotic fluid embolism; amniotic fluid with fetal cells and debris enters materal circulation through open uterine and cervical veins.
12. Had the 25 yo woman survived, what is she at risk of?
Disseminated intravascular coagulation (DIC); thrombotic microangiopathy and fibrin thrombi form in small bv's because of uncontrollable coagulopathy
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?
Chronic passive congestion.
14. If the 68 yo man were to die of a massive heart attack and expire, what would liver show at autopsy?
Sinusoids dilated with blood
15. 33 yo woman with black stools; lab studies show hypochromic microcytic anemia; upper GI shows duodenal ulcer; what describes the stools?
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?
Stasis (because he's been hospitalized and placed in cervical traction)
17. 23 yo man with hemophilia wheelchair bound; why?
Hemarthrosis (bleeding into joint cavity; crippling complication of hemophilia)
18. 50 yo fire fighter has 3rd degree burns over 70% of body and dies; why?
Here, it's hypovolemic shock; fluid loss from severe burns and wept large amounts of plasma
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?
Passive hyperemia (chronic passive congestion); could be confined to limb or organ as a result of localized obstruction to venous drainage)
20. 42 yo woman has face lift; later, has bluish hemorrhages around her eyes; why?
Ecchymosis; a larger superficial hemorrhage in skin; this will turn green and yellow before resolving
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?
Decreased intravascular oncotic pressure (Loss of albumin)
22. 50 yo alcoholic has esophageal varies; protruding abdomen has large volume of serous fluid.
23. 1 yo girl has fever and diarrhea for 3 days; CBC shows normal WBC count and increased crit; why the increased crit?
Dehydration (secondary to diarrhea0
24. 40 yo man with history bacterial endocarditis and sees pinpoint hemorrhages around eye orbit. What describes this?
Petechiae; pinpoint hemorrhages, representing rupture of capillary or arteriole that occurs in conjunction with vasculitis and coagulopathy
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?
26. 78 yo woman dies in her sleep. Prussian blue stain of lungs shows what?
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
27. 60 yo man develops acute chest pain and dies. Thromboembolus at bifurcation of left and right pulmonary arteries noted at autopsy.
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?
Hypovolemic shock: prounounced decrease in blood or plasma volume; caused by hemorrhage, severe burns, diarrhea, excess urine formation, perspiration, trauma!!!
29. 72 yo man collapses at home and dies; renal cortical infarcts and we see arcuate artery; what caused atheroembolus in terms of arteries?
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
Pulmonary heart failure (CHF)
31. 63 yo man with massive stroke and dies; laminated thrombus adherent to wall of LV; cause?
MI: most common cause of mural thrombi in LV
32. For 63 yo man dying of stroke; there are growth of fibroblasts and deposition of collagen in mural thrombus; what is term?
Organization: the invasion of CT elements, casuing thrombus to become firm and appear grayish white
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?
Arterial embolism; cardiac myxoma is most commmon primary tumor of heart
34. 50 yo woman had radical mastectomy and axillar node dissection for breast cancer; arm swollen by end of the day
35. 68 yo man with sudden, severe substernal chest pain; confirmed acute MI; what is the soft yellow area of necrosis in LV?
Cardiogenic shock; casued by myocardial pump failure; usually due to large MI or possible myocarditis
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?
Increased intravascular hydrostatic pressure
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?
Infarct (because of all the twisting and turning)
38. 70 yo woman has subendocardial circumferential infarct of LV
Hypovolemic shock; can't get enough oxygen through the coronary arteries leading to subendocardial infarction
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?
Hemorrhage from bronchial arteries (red because of the dual blood supply, like with the lung; red infarcts sharply circumscribed, firm, dark red to purple
40. 22 yo woman gives baby at 29 weeks of gestation; neonate dies of respiratory insufficiency. What explains the respiratory distress syndrome?
Anoxic injury (the brain looks really black, probably because of a lack of oxygen); lack of surfactant!!!