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Pathology - hemodynamic disorders, thromboembolic diseases, and shock

Terms in this set (12)

While shaving one morning, a 23-year-old man nicks his lip with a razor. Seconds after the injury, the bleeding stops.Which of the following mechanisms is most likely to reduce blood loss from a small dermal arteriole?
□ (A) Protein C activation
□ (B) Vasoconstriction
□ (C) Platelet aggregation
□ (D) Neutrophil chemotaxis
□ (E) Fibrin polymerization
B
A 73-year-old man was diagnosed 1 year ago with pancreatic adenocarcinoma. He now sees his physician because of a transient ischemic attack. On auscultation of the chest, a heart murmur is heard. Echocardiography shows a 1-cm nodular lesion on the superior aspect of the anterior mitral valve leaflet. The valve leaflet appears to be intact. The blood culture is negative. Which of the following terms best describes this mitral valve lesion?
□ (A) Adenocarcinoma
□ (B) Atheroma
□ (C) Chronic passive congestion
□ (D) Mural thrombus
□ (E) Petechial hemorrhage
□ (F) Phlebothrombosis
□ (G) Vegetation
G
A 25-year-old woman has had multiple episodes of deep venous thrombosis during the past 10 years and one episode of pulmonary thromboembolism during the past year. Prothrombin time, partial thromboplastin time, platelet count, and platelet function studies all are normal. Which of the following risk factors has most likely contributed to the patient's condition?
□ (A) Factor V mutation
□ (B) Antithrombin III deficiency
□ (C) Mutation in protein C
□ (D) Hyperhomocysteinemia
□ (E) Smoking cigarettes
A
A 76-year-old woman is hospitalized after falling and fracturing her left femoral trochanter. Two weeks later, the left leg is swollen, particularly below the knee. She experiences pain on movement of the leg; on palpation, there is tenderness. Which of the following complications is most likely to occur after these events?
□ (A) Gangrenous necrosis of the foot
□ (B) Hematoma of the thigh
□ (C) Disseminated intravascular coagulation
□ (D) Pulmonary thromboembolism
□ (E) Fat embolism
B
Within 1 hour after a gunshot wound to the abdomen, a 19-year-old man exhibits tachycardia. His skin is cool and clammy to the touch, and blood pressure is 80/30 mm Hg. Which of the following organ-specific changes is most likely to occur within 2 days after this injury?
□ (A) Acute hepatic infarction
□ (B) Cerebral basal ganglia hemorrhage
□ (C) Renal passive congestion
□ (D) Pulmonary diffuse alveolar damage
□ (E) Gangrenous necrosis of the lower legs
D
A 76-year-old woman is hospitalized after falling and fracturing her left femoral trochanter. Two weeks later, the left leg is swollen, particularly below the knee. She experiences pain on movement of the leg; on palpation, there is tenderness. Which of the following complications is most likely to occur after these events?
□ (A) Gangrenous necrosis of the foot
□ (B) Hematoma of the thigh
□ (C) Disseminated intravascular coagulation
□ (D) Pulmonary thromboembolism
□ (E) Fat embolism
B
A 56-year-old man with a history of diabetes mellitus goes to the emergency department because he has had left-sided chest pain that radiates to the arm for the past 5 hours. Serial measurements of serum creatine kinase-MB levels show an elevated level 24 hours after the onset of pain. Partial thromboplastin time and prothrombin time are normal. Coronary angiography shows occlusion of the left anterior descending artery. Which of the following mechanisms is the most likely cause of thrombosis in this patient?
□ (A) Antibody inhibitor to coagulation
□ (B) Damage to endothelium
□ (C) Decreased antithrombin III level
□ (D) Decreased tissue plasminogen activator
□ (E) Mutation in factor V gene
□ (F) Stasis of blood flow
B
An experiment is conducted in which platelet function is analyzed. A substance is obtained from the dense bodies (delta granules) of normal pooled platelets from healthy blood donors. When this substance is added to platelets obtained from patients with a bleeding disorder, no platelet aggregation occurs. Adding the substance to platelets from a normal control group induces platelet aggregation. Which of the following substances is most likely to produce this effect?
□ (A) Adenosine diphosphate
□ (B) Antithrombin III
□ (C) Fibronectin
□ (D) Fibrinogen
□ (E) Plasminogen
□ (F) Thromboxane A2
□ (G) Von Willebrand factor
A
A 70-year-old man with a history of diabetes mellitus died of an acute myocardial infarction. At autopsy, the aorta, opened longitudinally, appeared as shown in the figure. Which of the following complications associated with aortic disease would most likely have been present during his life?
□ (A) Renal infarction
□ (B) Pulmonary thromboembolism
□ (C) Edema of the left leg
□ (D) Thrombocytopenia
□ (E) Popliteal arterial occlusion
E
A 58-year-old man with hyperlipidemia and severe atherosclerosis has had anginal pain for the past 24 hours. Laboratory findings show no increase in serum troponin I or creatine kinase-MB. The patient is in stable condition 2 weeks later and has no chest pain, but a small artery in the epicardium has undergone the changes seen in the figure. Which of the following terms best describes this finding in the epicardial artery?
□ (A) Air embolus
□ (B) Cholesterol embolus
□ (C) Chronic passive congestion
□ (D) Fat embolus
□ (E) Mural thrombus
□ (F) Organization with recanalization
□ (G) Phlebothrombosis
F
A 15-year-old girl incurs a cut to the sole of her foot after stepping on a piece of broken glass. On examination, there is a superficial 0.5-cm laceration that ceases to bleed in 5 minutes after application of local pressure. Which of the following substances is most likely to limit thrombus formation to the local area of injury by inhibiting platelet activation?
□ (A) Phospholipid
□ (B) Platelet-activating factor
□ (C) Prostacyclin
□ (D) Tissue-type plasminogen activator
□ (E) Thrombomodulin
□ (F) Thromboxane
C
A 7-year-old boy has had increasing lethargy for a week. On physical examination he has periorbital edema and pitting edema at the ankles, but is normotensive and afebrile. Laboratory studies show marked albuminuria. He is given a thiazide diuretic and his urine output increases and his edema resolves. Which of the following changes in his blood most likely potentiated his edema?
□ (A) Decreased aldosterone
□ (B) Decreased antidiuretic hormone
□ (C) Decreased renin
□ (D) Increased albumin
□ (E) Increased cortisol
□ (F) Increased sodium
F
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