Image questions

Question 1

50 yom with chest pain for 24 hours: (a fib/ventricular tachycardia/ventricular bigeminy)

Answer 1

ventricular bigeminy: a ventricular premature beat follows each normal beat

Question 2

55 yom with 4 hours of crushing chest pain. (anterior wall MI/inferior wall MI/anteroseptal MI/RV MI/L lateral wall MI)

Answer 2

inferior wall MI.

The electrocardiogram shows the early hyperacute injury phase of inferior wall myocardial infarction. This is reflected by the marked slope elevation of the ST segments, and the increased amplitude of the T waves in Standard leads II and III, and lead aVF. Reciprocal ST segment depression occurs in Standard leads I, lead AVL and leads V 4 to V6.

Question 3

lipid deposition and smooth muscle cell hyperplasia (accumulation in intima)

Answer 3

atherosclerosis

Question 4

two findings

Answer 4

atherosclerosis and thrombus

Question 5

Answer 5

dissecting aorta

Question 6

medium sized arteries, smoking history

Answer 6

Buerger disease (thromboangiitis obliterans)

Question 7

what vessel does syphilitic aneurysm typically affect

Answer 7

ascending aorta (vasa vasorum)

Question 8

xanthomas in which disease

Answer 8

familial cholesterolemia (foamy macrophages, ApoE involved, lacks LDL receptor)

Question 9

filarial worm infestation causing obstruction of what

Answer 9

lymph nodes (elephantiasis)

Question 10

biopsy of skin lesion in 25yow patient with proteinuria, recent hx of Hep B infection, P-ANCA, elevated erythrocyte sed rate

Answer 10

polyaderitis nodosa (medium sized and smaller muscular arteries, fibrinoid necrosis)

Question 11

AIDS patient with multiple purple-colored skin nodules on hands and feet. What virus is implicated

Answer 11

HHV 8 (Kaposi sarcoma)

Question 12

70yow with throbbing unilateral headache and vision problems, mandibular pain

Answer 12

Giant cell arteritis

Question 13

Answer 13

cavernous hemangioma

Question 14

thoracic aorta with aldehyde fuchsin stain

Answer 14

cystic medial necrosis (dissecting aneurysm). focal loss of elastic and muscle fibers in the aortic media leads to cystic spaces filled with pools of metachromatic myxoid material

Question 15

Answer 15

aneurysm

Question 16

coronary artery section in pt with familial hypercholesterolemia. what’s in it?

Answer 16

platelets and RBCs + fibrin = thrombus (at an early age)

Question 17

fever, skin rash, mucosal inflammation, lymph node enlargement. usually self limited but may involve coronary arteries and lead to aneurysm

Answer 17

Kawasaki

Question 18

renal biopsy. (papillary necrosis/polyarteritis nodosa/monckeberg medial sclerosis/hyaline ateriolosclerosis)

Answer 18

hyaline ateriolosclerosis

Question 19

Answer 19

varicose veins

Question 20

excessive collagen deposition in the skin, subintimal fibromuscular thickening, renal biopsy. what is the disease

Answer 20

scleroderma

Question 21

infant heart. (cardiac amyloidosis/endocardial fibroelastosis/hypoplastic left heart syndrome)

Answer 21

endocardial fibroelastosis (fibroelastotic thickening of the endocardium of the left ventricle, may also affect valves)

Question 22

left main coronary artery 2 days after an MI. what histologic changes are present?

Answer 22

two days after MI: heart muscle will show myofiber necrosis, edema, and focal hemorrhage. this artery shows necrosis of cardiac myocytes and infiltrates of neutrophils

Question 23

35 yom with MI, L main coronary artery two days later. what underlying disease does the patient have?

Answer 23

familial hypercholesterolemia

Question 24

ruptured myocardial wall causes what

Answer 24

cardiac tamponade

Question 25

this infarct was caused by thrombotic occlusion of which coronary artery

Answer 25

LAD (most common) supplies anterior wall and anterior septum of LV

Question 26

image shows hemopericardium. myocardial rupture and hemorrhage into the pericardial sac is most commonly seen when after an MI

Answer 26

between 1 to 4 days after MI

Question 27

this heart shows mural thrombosis in the aneursym. what is a likely complication?

Answer 27

stroke

Question 28

RV hypertrophy and dilation secondary to pulmonary HTN

Answer 28

cor pulmonale (MCC is COPD)

Question 29

presence of sterile vegetations on apparently normal cardiac valves in assoc with cancer or some other wasting disease

Answer 29

nonbacterial thrombotic endocarditis/marantic endocarditis

Question 30

78yom with hx of recurrent syncope. aortic valve disease (bacterial endocarditis/calcific aortic stenosis/hypertrophic subaortic stenosis/marantic endocarditis)

Answer 30

calcific aortic stenosis

Question 31

the boxcar nuclei in the myocardium on the right indicate what?

Answer 31

hypertension

Question 32

sudden death in young athletes

Answer 32

hypertrophic cardiomyopathy--cardiac hypertrophy is out of proportion to the hemodynamic load placed on the heart, autosomal dominant

Question 33

most common type of cardiomyopathy

Answer 33

dilated cardiomyopathy

Question 34

heart with CHF shows biventricular dilation and hypokinesis, patchy interstitial mononuclear inflam infiltrate composed of T lymphocytes and macrophages

Answer 34

viral myocarditis

Question 35

most common primary tumor of the heart

Answer 35

cardiac myxoma, most arise in LA

Question 36

chronic fibrosing disease of the pericardium that compresses heart and restricts inflow (results from an exuberant healing response)

Answer 36

constrictive pericarditis

Question 37

higher risk for cerebral embolism

Answer 37

mitral valve prolapse

Question 38

mitral valve. (bacterial endocarditis/carcinoid heart disease/Libman-Sacks endocarditis/marantic endocarditis/mitral valve prolapse)

Answer 38

bacterial endocarditis

Question 39

72 yow dies of CHF. aortic valve at autopsy

Answer 39

chronic rheumatic valvulitis (fusion of commissures!)

Question 40

alcoholic patient, 40yom currant jelly sputum, diffuse pulmonary consolidation. (atypical/broncho/interstitial/lobar) PNA

Answer 40

lobar PNA

Question 41

interstitial PNA in infants and immunocompromised pts. alveolar cells are large, show basophilic nuclear inclusions, peripheral halo and multiple cytoplasmic basophilic inclusions

Answer 41

CMV

Question 42

pt undergoing chemo. cough, fever, multiple areas of consolidation and a large cavity in the RUL

Answer 42

invasive aspergillosis

Question 43

38 yow with SLE being treated with corticosteroids who breeds pigeons. granulomas and budding yeast forms, stain positively for polysaccharides (actinomycosis/coccidiomycosis/cryptococcosis/histoplasmosis)

Answer 43

cryptococcosis--pigeon droppings

Question 44

pt with AIDS, CXR shows bilat and diffuse infiltrates

Answer 44

pneumocystis jiroveci

Question 45

(atelectasis/bronchiectasis/bronchoPNA/lobar PNA/pulmonary fibrosis)

Answer 45

pulmonary fibrosis

Question 46

alveoli are filled with granular, proteinaceous, eosinophilic material, PAS positive, assoc with compromised immunity, leukemia, lymphoma

Answer 46

alveolar proteinosis aka lipoproteinosis

Question 47

COPD in a young woman, long history of SOB, chronic cough, sputum production, wheezing

Answer 47

alpha 1 AT deficiency

Question 48

status asthmaticus. what histo is present

Answer 48

smooth muscle hyperplasia and basement membrane thickening

Question 49

numerous small, fibrotic nodules in both lungs

Answer 49

silicosis

Question 50

worked on ships. pulmonary fibrosis and iron stains of lung tissue show numerous ferruginous bodies

Answer 50

asbestosis (diffuse interstitial fibrosis)

Question 51

25 yo black woman with 3 month hx of cough and SOB on exertion. elevated ACE

Answer 51

sarcoidosis

Question 52

rare pneumonitis that occurs in Sjogren and HIV

Answer 52

lymphocytic interstitial PNA (LIP)

Question 53

23yom with nasal obstruction, serosanguinous discharge, cough, bloody sputum. CXR shows cavitated lesions and multiple nodules over both lung fields. Obliteration of maxillary sinuses. Hematuria, C-ANCA

Answer 53

Wegener granulomatosis--aseptic necrotizing granulomatous inflammation and vasculitis

Question 54

pulmonary eosinophilic granuloma due to what disease

Answer 54

langerhans cell histiocytosis

Question 55

patient responds favorably to antiestrogen and antiprogesterone tx. rare interstitial lung disease that occurs in women of childbearing disease

Answer 55

lymphangioleiomyomatosis

Question 56

22yom with 6 months of increasing SOB and rusty sputum. linear deposits of IgG and C3 are detected in the alveolar basement membrane by immunofluorescence

Answer 56

Goodpasture

Question 57

28 yom with 6 days of fever and SOB. pt does not respond to standard antibiotics. (lipid/pneumococcal/pneumocystis/eosinophilic/usual interstitial) PNA

Answer 57

eosinophilic PNA

Question 58

53yom with increasing SOB on exertion, dry cough that has developed over a period of a few years. patchy scarring with extensive areas of honeycomb cystic change

Answer 58

usual interstitial PNA

Question 59

55yow with sudden onset fever, dry cough, SOB. seen for flu like symptoms 6 weeks ago. biopsy shows inflamed airways with plugs of fibrous tissue

Answer 59

cryptogenic organizing PNA (bronchiolitis obliterans organizing PNA)

Question 60

45yow with severe kyphoscoliosis with fatigue, SOB on exertion, fainting, bloody sputum. CXR shows enlargement of the central pulmonary arteries

Answer 60

pulmonary HTN

Question 61

popcorn pattern of calcification

Answer 61

pulmonary hamartoma

Question 62

what type of cancer in the lung

Answer 62

squamous cell carcinoma

Question 63

history of smoking, peripheral subpleural mass

Answer 63

adenocarcinoma

Question 64

lung cancer, stains for keratin and chromogranin are negative

Answer 64

large cell undifferentiated

Question 65

primary pulmonary adenocarcinoma originating from stem cells in the terminal bonchioles

Answer 65

bronchioalverolar carcinoma

Question 66

"oat cell" carcinoma, exhibits neuroendocrine features, Cushing Syndrome

Answer 66

small cell carcinoma (carcinoid tumor is also neuroendocrine BUT no Cushing syndrome)

Question 67

neuroendocrine granules within tumor cells in the lung

Answer 67

carcinoid tumor

Question 68

the heart of a patient who died in uremia displays what type of pericarditis

Answer 68

fibrinous pericarditis