Patho 303 Exam Review

A 62-year-old man is discovered to have hyperlipidemia on screening tests after a routine physical examination. Laboratory studies show total serum cholesterol of 285 mg/dL, LDL of 215 mg/dL, HDL of 50 mg/dL, and triglycerides of 300 mg/dL. This patient is most at risk of developing an aneurysm in which of the following anatomic locations?

Abdominal aorta

A 60-year-old man presents with a 6-month history of increasing fatigue. Physical examination reveals marked pallor, and a CBC shows a macrocytic anemia. Which of the following is the most likely cause of anemia in this patient?

Alcoholism

A 2-year-old boy is brought to the emergency room with a 3-hour history of intense abdominal pain. Physical examination reveals a tender abdomen without ascites. The child dies 24 hours after admission. Torsion (volvulus) of the small bowel is discovered at autopsy. The small bowel appears dilated, gangrenous, and hemorrhagic (shown). Which of the following hemodynamic disorders best explains these autopsy findings?

Arterial occlusion

A 67-year-old man presents with sudden left leg pain, absence of pulses, and a cold limb. His past medical history is significant for coronary artery disease and a small aortic aneurysm. Which of the following is most likely responsible for development of a cold limb in this patient?

Arterial thromboembolism

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 fluid. What is the appropriate term used to describe this fluid?

Ascites

A 55-year-old man suffers from an acute myocardial infarction after occlusion of the left anterior descending coronary artery. The patient undergoes coronary bypass surgery 3 days later. Which of the following is the most frequent cause of saphenous vein graft failure several years following coronary bypass surgery?

Atherosclerosis

A 66-year-old woman develops sudden substernal chest pain. Laboratory studies and ECG confirm acute myocardial infarct of the left ventricle. Despite vigorous therapy, the patient cannot maintain her blood pressure and expires. Autopsy reveals occlusion of the left main coronary artery. What is the most important underlying cause of coronary artery blockage in this patient?

Atherosclerosis

A 50-year-old man presents with sudden weakness in his left leg. He has felt well lately and has no past medical history of coronary artery disease, hyperlipidemia, or hypertension, and no family history of myocardial infarction or stroke. Physical examination reveals motor weakness in the left leg, with no other neurologic deficits, and no cardiac murmur. Magnetic resonance imaging of the brain demonstrates a small ischemic infarct in the arterial distribution of the brain correlating with motor control of the left leg. Angiography and echocardiography reveal normal coronary arteries, normal valves with no vegetations, and a small right-to-left shunt. Which of the following is most likely associated with this scenario?

Atrial septal defect

A heart murmur is noted during the preschool physical examination of a 4-year-old girl. An echocardiogram reveals a defect between the right and left atrium involving the limbus of the foramen ovale. What is the most likely diagnosis?

Atrial septal defect

A heart murmur is noted during the preschool physical examination of a 4-year-old girl. An echocardiogram reveals a defect between the right and left atrium involving the limbus of the foramen ovale. What is the most likely diagnosis?

Atrial septal defect, ostium secundum

A 34-year-old intravenous drug abuser presents to the emergency room with a 24-hour history of fever and shaking chills. His temperature is 38.7°C (103°C), pulse rate is 110/min, and blood pressure is 140/80 mm Hg. Physical examination reveals a harsh systolic murmur. The patient rapidly develops headache and right-arm paralysis. Which of the following is the most likely underlying cause of stroke in this patient?

Bacterial endocarditis

A 10-year-old boy with a 2-week history of an upper respiratory infection was admitted to the hospital with malaise, fever, joint swelling, and diffuse rash. The patient is treated and discharged. However, the patient suffers from recurrent pharyngitis and, a few years later, develops a heart murmur. This patient's heart murmur is most likely caused by exposure to which of the following pathogens?

Beta-hemolytic streptococcus

A 44-year-old man presents to the emergency room with acute chest pain. The ECG is normal. Analysis of which pair of serum markers would be most helpful in excluding a diagnosis of acute myocardial infarction?

CK-MB and cardiac troponin-I

A 78-year-old man with a history of recurrent syncope undergoes surgery for aortic valve disease. A hard, markedly deformed valve is observed, but the patient expires during surgery. The aortic valve at autopsy is shown. What is the appropriate diagnosis?

Calcific aortic stenosis

A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows clinical evidence of pulmonary edema, enlargement of the left atrium, and calcification of the mitral valve. A CT scan demonstrates a large mass in the left atrium. Before open heart surgery can be performed, the patient expires of an ischemic stroke. The heart at autopsy is shown. Which of the following is the most likely diagnosis?

Cardiac myxoma

A 70-year-old woman with a 2-year history of angina pectoris is admitted to hospital with excruciating substernal chest pain that is not relieved by medication. Physical examination shows a blood pressure of 100/80 mmHg, respiratory rate of 30/min, diaphoresis (sweating), and dyspnea. Results of laboratory studies include WBC of 13,000/mL, CK-MB of 6.8 ng/mL, and troponin I of 3.0 ng/mL. The patient expires 6 days later. A section through the heart at autopsy is shown. What was the most likely cause of death?

Cardiac tamponade

After suffering an acute myocardial infarction, a 54-year-old man presents to the emergency room 3 weeks later complaining of sharp pain on the left side of his chest. On physical examination, the patient is apprehensive and sweating. His blood pressure is 80/40 mm Hg, and the pulse rate is 100/min. The patient dies within minutes. The ventricular wall at autopsy is shown. What is the most likely cause of death?

Cardiac tamponade

A 68-year-old obese woman (BMI = 32 kg/m2) with a history of angina pectoris presents with substernal chest pain. The following day, she develops a mild fever of 38°C (101°F). Results of laboratory studies and ECG confirm the diagnosis of myocardial infarction of the left ventricular wall. The patient expires 24 hours after admission. A cross section of the heart at autopsy is shown. What was the most likely cause of death?

Cardiogenic shock

A 42-year-old man is seen because of a long history of slowly developing congestive heart failure. His blood pressure is normal. Coronary artery angiography reveals no vascular disease. No heart murmurs are heard. The white blood cell count, differential, and erythrocyte sedimentation rate are normal. The most likely diagnosis is...

Cardiomyopathy

An 80-year-old man with a history of myocardial infarction dies in his sleep. At autopsy, the pathologist finds a laminated thrombus adherent to the wall of the left ventricle (shown). During life, this patient was at risk for which of the following conditions?

Cerebral infarction

A 68-year-old man with ischemic heart disease complains of increasing shortness of breath. On physical examination, the patient has swollen legs, an enlarged liver, and fluid in the pleural spaces. Which of the following hemodynamic disorders explains the pathogenesis of hepatomegaly in this patient?

Chronic passive congestion

A 39-yom dies during cardiac surgery. He had a history of long-standing rheumatic heart with mitral stenosis. At autopsy, the pathologists reports findings consistent with mitral stenosis and noted the presence of "heart failure cells." This findings result from

Chronic passive congestion of the lungs

Yesterday, a 60-year-old man presented to the emergency department with dyspnea, diaphoresis, and crushing substernal chest pain that radiated to his neck and left arm. When asked to describe the pain, he put his fist to the center of his chest and stated that it felt "as if someone is squeezing my heart." An electrocardiogram demonstrated changes consistent with myocardial infarction, and serum troponin I levels were elevated. If the patient unexpectedly dies today, which of the following would almost certainly be found on histologic examination of the affected myocardium?

Coagulative necrosis with neutrophil infiltration

An 8-month-old girl with Turner syndrome is brought to the emergency room by her parents, who complain that their daughter is breathing rapidly and not eating. Physical examination reveals tachypnea, pallor, absent femoral pulses, and a murmur heard at the left axilla. There is hypertension in the upper extremities and low blood pressure in both legs. A chest x-ray shows notching or scalloping of the ribs. What is the appropriate diagnosis?

Coarctation of aorta

For the patient described above with rheumatic fever, which of the following is the most common life-threatening complication of his valvular heart disease?

Congestive heart failure

A 53-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, edema in the legs and feet, and fatigue. She has no history of angina, other signs of coronary artery disease, hypertension, or valvular disease. Echocardiography reveals cardiomegaly, with four-chamber hypertrophy and dilation. Which of the following is the most likely diagnosis?

Congestive or dilated cardiomyopathy

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

Fluid is aspirated from the grossly distended abdomen of a 35-yo chronic alcoholic man. The fluid is straw colored and clear and is found to have a protein content (largely albumin) of 2.5 g/dL. Which of the following is a major contributor to the fluid accumulation in this patient?

Decreased oncotic pressure

A 64-year-old woman presents with dependent peripheral edema in her ankles and feet. She has long-standing chronic obstructive lung disease and a long history of cigarette smoking. Further investigation reveals that she has cor pulmonale with right-sided heart failure. Which of the following is the most likely cause of the right-sided heart failure in this patient?

Disease of the lungs or pulmonary vessels

A 79-year-old man is brought to the emergency department because of the sudden onset of left-sided chest pain, which is exacerbated upon inspiration. He had two episodes of hemoptysis. His temperature is 38°C (101°F), pulse is 110/min, respirations are 35/min, and blood pressure is 158/100 mmHg. The patient suffers respiratory insufficiency and expires 48 hours later. An autopsy reveals thromboembolism and pulmonary infarction. Which of the following best explains the color of this pulmonary infarct?

Dual blood supply to the lungs

A 42-year-old woman undergoes a face lift. Two days later, she presents for follow-up care with confluent bluish hemorrhages in the skin around her eyes ("black eyes"). Which of the following best describes these superficial skin hemorrhages?

Ecchymoses

A 68-year-old obese woman (BMI = 31 kg/m2) suffers a massive stroke while recovering from a myocardial infarct. The patient's brain is examined at autopsy (shown). What was the most likely cause of this brain lesion?

Embolism from mural thrombus

A 35-year-old man presents with acute chest pain and nausea. ECG and laboratory studies confirm the diagnosis of myocardial infarction. The patient expires 2 days later. A photomicrograph of his left main coronary artery is shown. This patient most likely suffered from which of the following hereditary diseases?

Familial hypercholesterolemia

A 20-yom undergoes surgery for fracture of the pelvis and left femur resulting from a high-speed motor vehicle accident. The following day he develops dyspnea, speech difficulties, and a petechial skin rash. Which of the following types of embolism is the likely cause of these findings?

Fat

A 40-year-old woman is involved in an automobile accident in which she fractured her femur. She does well postoperatively, but 48 hours after surgery, she develops mental status changes, petechial hemorrhages, and respiratory difficulties and expires. A fast red stain of lung tissue at autopsy is shown. Which of the following best characterizes the red material in the lungs of this patient?

Fat

A 22-year-old construction worker falls 30 feet 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

A 62-year-old man presents with pallor, fatigue, and dyspnea on exertion. A complete blood count reveals microcytic hypochromic anemia. The most likely cause of these findings is

Gastrointestinal bleeding

A 69-year-old man is brought to the emergency room complaining of visual difficulty 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

Two days following cholecystectomy, a 30-year old hospitalized woman has sudden onset of dyspnea, pleural pain, and cough productive frothy, blood-tinged sputum. Ventilation-perfusion test indicates a perfusion defect. If it were possible to examine a portion of the affected lung, which of the following would most likely have been found?

Hemorrhagic (red) infarct

A 48-year-old man with a longstanding history of chronic constipation complains of anal itching and discomfort toward the end of the day. He describes perianal pain when sitting and finds himself sitting sideways to avoid discomfort. Physical examination reveals painful varicose dilations in the anal region, associated with edema. Which of the followings is the most likely diagnosis?

Hemorrhoids

A 67-year-old woman with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical examination shows marked jugular venous distension, hepatomegaly, ascites, and pitting edema. A chest x-ray shows cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Histologic examination of the lungs at autopsy is shown. Which of the following pigments has accumulated in the cytoplasm of these pulmonary macrophages?

Hemosiderin

A 29-year-old woman complains of a 3-month history of nervousness and weakness. She feels hot and sweaty and has experienced a 9-kg (20-lb) weight loss over the past 2 months, despite increased caloric intake. She frequently finds her heart racing and can feel it pounding in her chest. Physical examination reveals an enlarged thyroid, warm hands, and bulging eyes. This patient is at risk of developing which of the following cardiovascular complications?

High-output heart failure

A 19-year-old woman is brought to the emergency room following a skiing accident. X-ray films of the extremities reveal broken bones, and a CT scan of the abdomen reveals extensive internal injury. The patient's blood pressure is 80/60 mmHg. This patient may be suffering from which of the following forms of shock?

Hypovolemic

A 50-year-old fire fighter 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

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 68-year-old man complains of increasing pain under the right costal margin and chest pain on exertion. Physical examination reveals hepatomegaly and swollen legs. The patient subsequently suffers myocardial infarction and expires. The liver is examined at autopsy (shown). Which of the following hemodynamic disorders best explains these pathologic findings?

Increased intravascular hydrostatic pressure

A 76-year-old woman with a 4-year history of ischemic heart disease presents to the emergency room complaining of crushing substernal chest pain. On physical examination, the patient is apprehensive and sweating. The patient loses consciousness and dies of a cardiac arrhythmia within minutes. The lungs are examined at autopsy (shown). Which of the following hemodynamic disorders best explains the pathology illustrated in this slide?

Increased intravascular hydrostatic pressure

A 68-year-old man undergoes surgery for an abdominal aortic aneurysm. During the operation, the patient's blood pressure drops to dangerously low levels (70/20 mmHg). A loop of small intestine is observed to turn dark bluish-red. Which of the following is the most likely pathologic diagnosis for this intestinal lesion?

Infarct

A 21-year-old pregnant woman experiences abruptio placentae at 37 weeks of gestation and develops severe vaginal bleeding that is difficult 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 insufficiency in this patient?

Infarction

A 50-yom with unstable angina (a form of acute coronary syndrome) is treated intravenously with glycoprotein IIb-IIIa inhibitor. The mechanism of action of this agent is its ability to :

Inhibit platelet aggregation

A 25-year-old man presents with a progressive illness of several days' duration characterized by nonproductive cough, fever, and malaise. A lateral view chest radiograph reveals platelike atelectasis. Elevated titers of cold agglutinins are detected. Which of the following is the most likely type of pneumonia in this patient?

Interstitial pneumonia, most likely caused by Mycoplasma pneumoniae

A 38-year-old woman with type I diabetes mellitus presents with skin lesions. Physical examination shows xanthomas on the dorsal surface of both hands (shown) and xanthelasmas of the eyelids. Laboratory studies reveal serum cholesterol of 820 mg/dL and significantly elevated serum triglycerides and LDL. The patient most likely carries a mutation in a gene that encodes which of the following proteins?

LDL receptor

A 50-year old man seeks medical attention because of shortness of breath (SOB) on minimal exertion. A chest X-ray reveals a right-sided pleural effusion. The aspirated fluid is straw colored and clear. The protein concentration is low and the specific gravity is 1.011. Microscopic examination reveals an occasional mesothelial cell. Which of the following is the most likely cause of the effusion.

Left ventricular heart failure

A bedridden elderly patient experiences a sudden onset of pleuritic pain and hymoptysis. The underlying lesion that led to this complication was most likely located in which of the following sites.

Lower extremity veins

A 26-year-old woman from East Africa presents with a 2-month history of swelling of her right leg. Laboratory studies demonstrate a parasitic infestation. Soft tissue swelling of the lower extremities caused by filarial worms (elephantiasis) is caused by which of the following mechanisms of disease?

Lymphatic obstruction

A 50-year-old woman complains that her left upper arm is often swollen. Her past medical history is significant for a radical mastectomy for breast cancer 2 years ago. Which of the following is the most likely explanation for tissue swelling in this patient?

Lymphatic obstruction

A 60-year-old man presents with dyspnea on exertion and a nonproductive cough. He has never smoked, but he worked as a shipbuilder, with known asbestos exposure approximately 20 years ago. To which of the following conditions is this patient especially predisposed?

Malignant mesothelioma of the pleura

A 40-year-old woman with a history of rheumatic fever presents with shortness of breath, weight loss, fatigue, and abdominal distension. Physical examination shows rales in the lungs, hepatosplenomegaly, and 2+ pitting edema of the legs. A chest x-ray reveals left atrial enlargement and pulmonary edema. What is the most likely cause of pulmonary edema in this patient?

Mitral valve stenosis

A 60-year-old man with a history of emphysema returns home from the hospital after suffering a myocardial infarction involving the apex of the left ventricle. Six months later, an echocardiogram reveals the development of a ventricular bulge that does not contract during systole. The patient subsequently suffers a massive stroke and suddenly expires. Which of the following is an expected pathologic finding at autopsy?

Mural thrombi

A 60-year-old man with a history of emphysema returns home from the hospital after suffering a myocardial infarction involving the apex of the left ventricle. Six months later, an echocardiogram reveals the development of a ventricular bulge that does not contract during systole. The patient subsequently suffers a massive stroke and suddenly expires. Which of the following is an expected pathologic finding at autopsy?

Mural thrombus

A 60-year-old-man is discharged after being observed in the hospital for 4 days following a myocardial infarction. He returns to his normal activities, which include sedentary work only. This point in time following a myocardial infarct is noteworthy for the special danger of which of the following?

Myocardial rupture

. A 9-year-old girl is diagnosed with acute rheumatic fever. Instead of recovering as expected, her condition worsens, and she dies. Which of the following is the most likely cause of death?

Myocarditis

A 56-year-old woman presents with dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema. She also presents with severe dizziness and syncope, fatigue, weight loss, and arthralgias. After undergoing several tests, she is diagnosed with a primary heart tumor that is causing a "ball-valve obstruction" of her mitral valve. Which of the following is the most likely tumor?

Myxoma

A 56-year-old man presents to the emergency room with 1 hour of chest pain. Laboratory studies show an increased leukocyte count and increased serum levels of cardiac enzymes. ECG confirms a massive transmural myocardial infarction of the left ventricle. The patient dies 2 days later. Histologic examination of the left main coronary artery at autopsy is shown. Examination of injured heart muscle would be expected to show which of the following pathologic changes by light microscopy?

Necrosis of cardiac myocytes and infiltrates of neutrophils

A 70-year-old woman has a long history of metastatic colon cancer, and she donates her body for use in medical school anatomy courses. At death, the body is emaciated and cachectic, and gross dissection reveals small fibrin deposits arranged around the line of closure of the leaflets of the mitral valve. The valvular lesions most likely represent?

Nonbacterial thrombotic (marantic) endocarditis

A 2-week-old boy is irritable and feeding poorly. On physical examination, the infant is irritable, diaphoretic, tachypneic, and tachycardic. There is circumoral cyanosis, which is not alleviated by nasal oxygen. A systolic thrill and holosystolic murmur are heard along the left sternal border. An echocardiogram reveals a heart defect in which the aorta and pulmonary artery form a single vessel that overrides a ventricular septal defect. What is the appropriate diagnosis?

Patent ductus arteriosus

A 60-year-old man presents with headaches and pruritis. Physical examination reveals splenomegaly but no lymphadenopathy. A CBC demonstrates elevated hemoglobin of 19.5 g/dL, WBC of 12,800/μL, and platelets of 550,000/μL. The bone marrow displays hypercellularity of all lineages and depletion of marrow iron stores. Which of the following is the most likely diagnosis?

Polycythemia vera

A 60-year-old man is brought to the emergency department 4 hours after vomiting fresh (red) blood and experiencing bloody stools. The patient was diagnosed with alcoholic cirrhosis 2 years ago. He subsequently goes into shock and expires. The histologic appearance of the esophagus at autopsy is shown. What is the underlying cause of dilated esophageal veins (varices) in this patient with alcoholic liver disease?

Portal hypertension

A 72-year-old woman complains of shortness of breath on exertion. She states that she also becomes short of breath at night unless she uses three pillows (orthopnea). Physical examination reveals mild obesity, bilateral pitting leg edema, an enlarged liver and spleen, and fine crackling sounds on inspiration (rales). A chest x-ray shows cardiomegaly. What is the most likely cause of orthopnea in this patient?

Pulmonary edema

A 15-year-old girl is brought to the emergency room with heart palpitations and dyspnea. Her past medical history is significant for an unrepaired atrial septal defect (ASD). Physical examination reveals cyanosis, distended jugular veins, hepatosplenomegaly, and a systolic ejection murmur. This patient has most likely developed which of the following complications of congenital heart disease?

Pulmonary hypertension

A 65-year-old man undergoes surgery for acute appendicitis. Four days after surgery, the patient gets out of bed for the first time since surgery, collapses, and cannot be resuscitated. What is the most likely pathologic finding at autopsy?

Saddle embolus

A 25-year-old African-American woman presents with fatigue, dyspnea, nonproductive cough, and chest pain. She does not smoke. A chest radiograph reveals prominent bilateral hilar lymphadenopathy ("potato nodules") and diffuse reticular densities in the interstitium of the lung. Laboratory studies reveal polyclonal hypergammaglobulinemia, hypercalcemia, and increased serum angiotensin-converting enzyme. Which of the following is the most likely diagnosis?

Sarcoidosis

A 28-year-old man with a history of malignant lymphoma has recently completed a course of chemotherapy. He presents with a 1-day history of diarrhea and a skin rash. The rash progresses visibly in the time he is in the emergency room. The patient's blood pressure drops to 80/60 mmHg, and his pulse increases to 120/min. His rash spreads down his arm. His temperature is 38.5°C, and his white blood cell count is 2000/mL, with 60% lymphocytes. The patient may be suffering from which of the following forms of shock?

Septic

A 80-year old man with a history of recurrent urinary tract infection presents with fever, tachypnea, tachycardia, and reduced blood pressure. Which of the following form of shock is most likely?

Septic shock

A 55-year-old woman presents with complaints of chest pain. She states that the chest pain predictably occurs when she climbs four flights of stairs to reach her apartment or when she has been jogging for more than 10 minutes. She is particularly concerned because her mother died of a myocardial infarction at 50 years of age. Which of the following best describes this patient's state?

Stable angina pectoris

A 50-year-old man with familial hyperlipidemia undergoes resection of an abdominal aneurysm. Signs of congestive heart failure develop shortly after surgery. Despite treatment, the patient becomes hypotensive and expires 2 days later. Autopsy reveals marked narrowing of coronary arteries, without thrombosis. Multiple foci of necrosis are found circumferentially around the inner walls of both ventricles. Which of the following is the most likely cause of congestive heart failure in this patient?

Subendocardial myocardial infarction

A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents report that the baby gets "bluish" when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?

Tetralogy of Fallot

A 45-yom is surgically treated by a four-vessel coronary artery bypass graft procedure and placed on a prophylactic daily aspirin therapy. Aspirin has been shown to prevent recurrent myocardial infarction through its ability to inhibit the synthesis of:

Thromboxane A2 (TxA2)

A 10-year-old boy presents with migratory polyarthritis involving several large joints, fever, and malaise. Physical examination reveals a new heart murmur and friction rub on auscultation, and a painless nodule is detected on the extensor surface of the elbow. He had a severe sore throat approximately 2 weeks ago, apparently recovering without antibiotic therapy. The anti-streptolysin O (ASO) titer is elevated. Which of the following describes the most likely outcome for this patient?

Total recovery after 1-2 months with no further complications or sequelae

A 45-year-old man with a history of intravenous drug abuse develops rapidly progressive right-sided heart failure. These symptoms are most likely due to which of the following conditions?

Tricuspid insufficiency

A 79-year-old man presents with extensive ulcers on both legs for 4 years. A photograph of the patient's legs is shown. What is the appropriate diagnosis?

Varicose veins

A 5-year-old boy is found to have a harsh holosystolic murmur heard at the left 4th intercostal space. The child has a history of recurrent pneumonias and respiratory tract infections. An echocardiogram reveals a heart defect and biventricular cardiac hypertrophy. Cardiac catheterization discloses pulmonary hypertension. The patient likely has which of the following congenital heart diseases?

Ventricular septal defect

A 3-year-old girl presents to the emergency department with fever, hoarseness, a "seal bark-like" cough, and inspiratory stridor. Her father states that she has had a cold for the past few days, with runny nose, nasal congestion, sore throat, and cough. He is now concerned because her cough has now become loud, harsh, and brassy. Which of the following is the most likely cause of her ailment?

Virus

A patient with severe anemia has a peripheral blood smear with oval macrocytes, hypersegmented neutrophils, and decreased platelets. The most likely cause of the anemia is

Vitamin B12 or folate deficiency

A 30-year old woman dies after a short illness beginning in the late stages of labor. At autopsy, blood vessels in the lungs contained fetal debris, as did other vessels of multiple organs. Review of clinical history reveals that she had become acutely ill with dyspnea, hypotension, and seizures, and chest X-ray had demonstrated pulmonary edema. This was followed by prolonged hemorrhage from the vagina and generalized bleeding from other sites. The changes that were found within multiple blood vessels most likely are:

Widespread thrombosis

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 woman appears at your office. She was subjected to radical mastectomy and axillary node dissection for breast cancer a year ago. She now notices that her arm becomes swollen by the end of the day. What is the appropriate name for this fluid accumulation?

lymphedema

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 ulcer disease?

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 3-year-old boy presents with cyanosis and shortness of breath that develops when he plays with friends. According to his mother, the boy was born cyanotic. The boy is very small and short for his age, and he squats on the floor next to his mother. Chest radiography reveals a boot-shaped heart, normal heart size, and a right aortic arch. Echocardiography reveals a large ventricular septal defect with an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Which of the following is the most likely diagnosis?

tetralogy of Fallot