WebPath Tissue Repair & Hemodynamics Questions

B Left ventricle

A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of coronary arteries. In which of the following locations is a mural thrombus most likely to occur in this man? A Left atrium B Left ventricle C Right atrium D Right ventricle E Aorta F Vena cava

C Ketonuria

A 10-year-old previously healthy child has been noted by her parents to be constantly thirsty. She is consuming large amounts of soft drinks. She is urinating often. Her diet and exercise patterns have not changed, except for an increased appetite, yet she appears cachectic and has lost 7 kg over the past 4 months. On physical examination there are no abnormal findings, other than peripheral muscle wasting and weakness. Which of the following laboratory findings would you most strongly suspect is present in this girl? A Increased blood insulin B Decreased blood glucagon C Ketonuria D Increased serum osmolality E Decreased plasma H+ (alkalosis) F Decreased plasma cortisol

B Airway obstruction

A 12-year-old boy has a bleeding disorder characterized by hemarthrosis and decreased joint mobility. Laboratory studies show his prothrombin time is normal, but his partial thromboplastin time is quite elevated. His platelet count is normal. His father is also affected, but not as severely. Which of the following complications of his bleeding disorder is he most likely to develop? A Acute coronary syndrome B Airway obstruction C Chronic renal failure D Cryptococcal pneumonia E Hepatic cirrhosis

D Transfusion of factor VIII concentrate is helpful

A 12-year-old boy has had worsening problems with joint mobility involving his arms and legs, particularly his knees and ankles, for the past 6 years. He has been receiving therapy for this condition. On physical examination he has no visible petechiae or areas of purpura. Laboratory studies show that his prothrombin time is 12 seconds and his partial thromboplastin time is 52 seconds. After addition of an equivalent aliquot of normal plasma, his PTT is 40 seconds. His Hgb is 12.9 g/dL, platelet count 238,500/microliter, and WBC count 6620/microliter. Which of the following is the most appropriate statement regarding his clinical condition? A There is no family history for this condition B His sisters are affected as well C He has had episodes of mucocutaneous bleeding D Transfusion of factor VIII concentrate is helpful E He has an underlying liver disease

D Factor V Leiden mutation

A 15-year-old boy has the sudden onset of dyspnea. On physical examination he has vital signs with T 37.1°C, P 90/minute, RR 25/minute, and BP 100/60 mm Hg. A pulmonary ventilation/perfusion scan shows a large right perfusion defect. Laboratory studies show Hgb 13.9 g/dL, Hct 42%, MCV 91 fL, platelet count 238,200/microliter, and WBC count 6170/microliter. His prothrombin time is 12.7 seconds and partial thromboplastin time 26 seconds. Which of the following conditions is he most likely to have? A High molecular weight kininogen deficiency B Alpha-1-antitrypsin deficiency C Hemophilia A D Factor V Leiden mutation E vonWillebrand disease

A Prothrombin

A 19-year-old man develops a sudden episode of mental confusion and weakness. On physical examination he has 4/5 motor strength in his right arm. Laboratory studies show Hgb 14.5 g/dL, Hct 44.4%, MCV 89 fL , platelet count 227,800/microliter, and WBC count 6480/microliter. His prothrombin time is 12 seconds and partial thromboplastin time 25 seconds. A year later he develops deep venous thrombosis of his left lower leg. A mutation involving a gene encoding for which of the following is most likely to be present in this man? A Prothrombin B Factor VIII C Factor IX D vonWillebrand factor E Factor XIII

E Thromboxane

A 20-year-old man incurs blunt trauma to his upper outer arm. On physical examination, there is a 2 x 3 cm contusion. The initial soft tissue bleeding stops in a few minutes and the size of the bruise does not increase. Which of the following chemical mediators is most important in this episode of hemostasis? A Leukotriene B Prostaglandin C Prostacyclin D Plasminogen E Thromboxane

A Antiphospholipid syndrome

A 20-year-old woman was diagnosed last year with pulmonary thromboembolism. In her 6th month of her first pregnancy, she delivered a stillborn baby. Laboratory testing revealed the presence of a normal prothrombin time, normal partial thromboplastin time, platelet count of 250,000/microliter, and presence of lupus anticoagulant. These findings are most characteristic for which of the following hypercoagulable states: A Antiphospholipid syndrome B Factor V Leiden mutation C Paraneoplastic syndrome D Elevated factor VIII E Protein C deficiency

E Afibrinogenemia

A 22-year-old G2 P1 woman gives birth following an uncomplicated pregnancy to a term male infant. There is prolonged bleeding upon separation of the umbilical cord. There is prolonged bleeding with circumcision. Laboratory studies show Hgb 12.9 g/dL, Hct 39%, MCV 95 fL, platelet count 188,400/microliter, and WBC count 8155/microliter. The prothrombin time is 29 seconds, partial thromboplastin time 50 seconds, and the thrombin time is elevated. Which of the following is the most likely diagnosis? A Hemophilia A B vonWillebrand disease C Sticky platelet syndrome D Vitamin K deficiency E Afibrinogenemia

D Antithrombin III

A 22-year-old woman has had multiple episodes of sudden dyspnea, sometimes following in a day or two by chest pain, over the past 6 years. Following these episodes pulmonary ventilation/perfusion scans have shown perfusion defects. She now has developed lower extremity pain over the past day. On physical examination there is absence of the posterior tibial pulse on the right. A thrombectomy is performed. A deficiency of which of the following blood proteins is most likely to be the cause for her findings? A Alpha-2-macroglobulin B Fibrinogen C Alpha-2-antiplasmin D Antithrombin III E Factor V

A Antiphospholipid syndrome

A 22-year-old woman has the sudden onset of dyspnea. On physical examination she has right leg swelling and tenderness. Laboratory studies show her prothrombin time is 12.4 seconds with partial thromboplastin time 53 seconds. Her plasma is mixed in a ratio of 1:1 with normal plasma and the partial thromboplastin time does not normalize. Which of the following is the most likely diagnosis? A Antiphospholipid syndrome B Disseminated intravascular coagulopathy C Antithrombin III deficiency D Vitamin K deficiency E Hemophilia A

C Familial hypercholesterolemia

A 25-year-old man experiences chest pain on exercise when he attempts to climb three flights of stairs. This pain is relieved by sublingual nitroglycerin. He is 178 cm tall and weighs 101 kg. His blood pressure is 130/85 mm Hg. Laboratory studies show a total serum cholesterol of 550 mg/dL with an HDL cholesterol component of 25 mg/dL. The blood glucose is 120 mg/dL. He is worried about these findings because his brother died of a myocardial infarction at age 34. Which of the following conditions is this man most likely to have? A Diabetes mellitus, type II B Hypertensive emergency C Familial hypercholesterolemia D Cushing syndrome E Morbid obesity

E Placental insufficiency

A 25-year-old previously healthy primigravida is in the first trimester of pregnancy. During two successive prenatal visits, she has fasting serum glucose levels of 127 and 131 mg/dL. Prior to this pregnancy, her fasting serum glucose was 80 mg/dL. A hemoglobin A1C level is 8.1% at the last visit, at 18 weeks gestation. She feels well and has no major health problems. Which of the following problems is most likely to become apparent in the latter part of her pregnancy? A Intrauterine fetal growth retardation B Ketoacidosis C Hyperosmolar coma D congenital anomalies E Placental insufficiency

B Bone marrow failure

A 27-year-old previously healthy woman notes bruises on her body with little or no trauma over the past 3 months. On examination purpuric areas involve mainly extremities. No other physical findings are noted. Laboratory studies show Hgb 7.1 g/dL, Hct 22%, MCV 95 fL , WBC count 2500/microliter, and platelet count 9,000/microliter. Her prothrombin time is 12.1 seconds, and partial thromboplastin time is 25 seconds. Her peripheral blood smear shows reduced numbers of normal appearing platelets. Which of the following is the most likely explanation for her findings? A Alcohol abuse B Bone marrow failure C Dietary imbalance D HIV infection E Inherited gene mutation

D Hypoglycemia

A 27-year-old woman had a hemoglobin A1C of 7.9% noted during a prenatal visit. She gives birth to a 4350 gm baby at 37 weeks gestation. Just after the delivery, the baby becomes irritable and displays seizure activity. Which of the following laboratory findings is most likely to be found in the baby: A Decreased hemoglobin A1C B Increased serum osmolality C Hyperlipidemia D Hypoglycemia E Ketoacidosis

D Glycoprotein Ib-IX

A 28-year-old woman has a history of easy bruising with minor trauma, frequent nosebleeds, and menorrhagia. On examination purpuric areas are noted on her extremities. Laboratory studies show a normal PT and normal PTT. Her Hgb is 12.8 g/dL, Hct 39.7%, MCV 91 fL, platelet count 88,500/microliter, and WBC count 8160/microliter. Platelet function studies show that her platelets do not aggregate in response to ristocetin. Which of the following deficiencies most likely explains her disease? A Ascorbic acid B ADAMTS13 C Fibrinogen (PTT) D Glycoprotein Ib-IX E Granule-bound ADP

D Anti-platelet antibodies

A 28-year-old woman has noted the appearance of pinpoint hemorrhages on her skin for the past 3 weeks. On physical examination she has petechiae on her torso and extremities. She is afebrile. Laboratory studies show Hgb 12.8 g/dL, Hct 38.4%, MCV 88 fL , platelet count 17,250/microliter, and WBC count 5285/microliter. No schistocytes are seen on her peripheral blood smear. Her prothrombin time is 12.2 seconds and her partial thromboplastin time is 26 seconds. Which of the following is most likely to cause her disease? A Splenomegaly B Megakaryocytic hypoplasia C Chronic renal failure D Anti-platelet antibodies E Blood loss

D Lactic acid of 4.8 mmol/L

A 29-year-old woman is involved in a motor vehicle accident that results in severe lacerations to her lower extremities, along with blunt abdominal trauma. In the emergency room she is noted to have cool, pallid skin. She has vital signs showing T 36.9°C, P 110/minute, RR 26/minute, and BP 70/30 mm Hg. She has decreased urine output. Which of the following laboratory findings on a blood sample from this patient is most likely to be present? A Hematocrit of 54% B Glucose of 181 mg/dL C PaO2 of 20 mm Hg D Lactic acid of 4.8 mmol/L E Troponin I of 4 ng/mL

B von-Willebrand disease

A 30-year-old man experiences excessive bleeding following a wisdom tooth extraction. There is a family history of similar problems. His mother had a history of menorrhagia. His sister has frequent nosebleeds. Laboratory studies on this man show he has a normal PT, PTT, and platelet count. Which of the following is the most likely diagnosis? A Antiphospholipid syndrome B vonWillebrand disease C Vitamin K deficiency D Hemophilia B E Protein C deficiency

E vonWillebrand disease

A 30-year-old man experiences excessive bleeding following a wisdom tooth extraction. There is a family history of similar problems. His mother had menorrhagia. His sister has frequent nosebleeds. Laboratory findings show he has a normal PT and platelet count, but a prolonged PTT. The PTT corrects with addition of an equal volume of normal plasma. Platelet aggregation in response to ristocetin is reduced. Which of the following is the most likely diagnosis? A Antiphospholipid syndrome B Hemophilia B C Protein C deficiency D Vitamin K deficiency E vonWillebrand disease

B Insudation of lipid

A 30-year-old man goes to his physician for a routine health checkup. On physical examination there are no abnormal findings. Laboratory test findings include serum glucose 80 mg/dL, hemoglobin A1C 4%, total cholesterol 240 mg/dL, LDL cholesterol 180 mg/dL, and HDL cholesterol 20 mg/dL. Through which of the following mechanisms is endothelial vascular injury in this patient most likely to occur? A Accumulation of sorbitol B Insudation of lipid C Inflammation with neutrophils D Deposition of immunoglobulins E Activation of complement

B Immune thrombocytopenic purpura

A 31-year-old woman has developed easy bruisability, even with minor trauma, to her skin over the past month. On physical examination she has multiple contusions of varying ages seen over her torso and extremities. She has no difficulty with movement. No neurologic deficits are noted. There is no hepatosplenomegaly. Her PT and PTT are normal. Her Hgb is 13.3 g/dL with Hct 42.1% and MCV 95 fL , platelet count 25,000/microliter, and WBC count is 7500/microliter. Which of the following is the most likely diagnosis? A Hemophilia A B Immune thrombocytopenic purpura C vonWillebrand disease D Acute promyelocytic leukemia E Anti-phospholipid syndrome

C D-dimer

A 33-year-old woman is in the intensive care unit following delivery of a stillborn fetus. Fetal demise had occurred 3 weeks previously. On physical examination her vital signs include T 37.2°C, P 101/minute, RR 18/minute, and BP 80/44 mm Hg. Laboratory studies show Hgb 10.5 g/dL, Hct 31.7%, MCV 96 fL , platelet count 45,000/microliter, and WBC count 11,700/microliter. Examination of her peripheral blood smear shows that schistocytes are present. Which of the following laboratory tests is most likely to confirm her diagnosis? A Hemoglobin electrophoresis B Serum ferritin C D-dimer D Bone marrow biopsy E Reticulocyte count

D Thrombocytopenia

A 34-year-old previously healthy woman notes that she has bruises form on her arms and legs with just minor trauma. Physical examination reveals areas of purpura from 1 to 3 cm in size over her trunk and extremities, but no swelling, warmth, or erythema. Peripheral pulses are all palpable and full. Her blood pressure is 110/70 mm Hg. An ultrasound examination of her lower extremities with Doppler flow measurement reveals no evidence for thrombosis. Laboratory findings include serum urea nitrogen of 16 mg/dL, LDH 300 U/L, total protein 6.9 g/dL, albumin 5.3 g/dL, alkaline phosphatase 50 U/L, AST 40 U/L, and ALT 20 U/L. Which of the following additional laboratory findings is most likely to be present in this patient? A Hyperglycemia B Hypercholesterolemia C Lactic acidosis D Thrombocytopenia E Hypoprothrombinemia F Anemia

A Thrombotic thrombocytopenic purpura (TTP)

A 35-year-old man has had fever for the past 5 days. Yesterday he developed difficulty speaking. On physical examination he has petechial hemorrhages on his lower extremities. His temperature is 37.7°C. Laboratory studies show Hgb 8.4 g/dL, Hct 25.9%, MCV 100 fL , platelet count 9000/microliter, and WBC count 9800/microliter. Examination of his peripheral blood smear shows schistocytes. His prothrombin time is 18 seconds and his partial thromboplastin time is 44 seconds. His serum creatinine is 2.6 mg/dL, haptoglobin is 2 mg/dL, and total bilirubin 5.5 mg/dL. He died despite plasmapheresis. At autopsy, platelet thrombi are observed in the small arteries of the kidneys, heart, and brain. Which of the following is the most likely diagnosis? A Thrombotic thrombocytopenic purpura (TTP) B vonWillebrand disease (vWD) C Malaria D Systemic lupus erythematosus (SLE) E Alcoholic liver disease F Antiphospholipid syndrome

C XII

A 35-year-old man undergoes a pre-operative workup for a hernia repair. He has no history of a bleeding disorder. On physical examination there are no abnormal findings other than the right inguinal hernia. Laboratory studies show Hgb 14.8 g/dL, Hct 45%, MCV 92 fL , WBC count 8500/microliter, and platelet count 275,000/microliter. His prothrombin time is 12.6 seconds, and his partial thromboplastin time is 48 seconds. After a mixing study with addition of normal plasma to his plasma in a 1:1 ratio, the PTT is 25 seconds. A deficiency of which of the following coagulation factors is most likely to be present in this man? A IX B VIII C XII D X E XIII

C Scurvy

A 35-year-old woman has noted small hemorrhages on her skin increasing in number over the past month. On physical examination she has petechiae involving skin surfaces of her torso and extremities. Laboratory studies show a normal PT and normal PTT. Her Hgb is 9.8 g/dL, Hct 29.4%, MCV 80 fL, platelet count 276,300/microliter, and WBC count 7290/microliter. Platelet function studies are normal. Which of the following is the most likely diagnosis? A vonWillebrand disease B Uremia C Scurvy D Aspirin ingestion E Chronic alcoholism

E Acetylsalicylic acid

A 35-year-old woman undergoes an elective vaginal hysterectomy. During this procedure, there is significant loss of blood with oozing from small vessels. Coagulation tests not ordered would have shown a normal PT, PTT, and platelet count--but a prolonged bleeding time. What over-the-counter drug the patient took just prior to the procedure is the most probable cause for these findings? A Acetaminophen B Phenylpropanolamine C Codeine D Ephedrine E Acetylsalicylic acid

D von-Willebrand disease

A 38-year-old man has frequent nosebleeds that are difficult to stop. On physical examination there are no abnormal findings. Laboratory studies show Hgb 13.5 g/dL, Hct 40.4%, MCV 84 fL, platelet count 248,500/microliter, and WBC count 7350/microliter. His prothrombin time is 12.1 seconds and partial thromboplastin time is 40 seconds. Which of the following conditions is he most likely to have? A Massive hepatic steatosis B Coumadin therapy C Vitamin K deficiency D vonWillebrand disease E Hemophilia B

D Hirudin

A 43-year-old man being treated with heparin is noted to have oozing of blood from a recent incision. He also has coldness and numbness of his left upper extremity. His platelet count has fallen from 217,300/microliter to 98,000/microliter over the past 5 days. The heparin is stopped. Which of the following drugs is most useful for emergently treating this patient? A Abciximab B Aspirin C Coumadin D Hirudin E Paclitaxel F Sirolimus

A Hyperplastic arteriolosclerosis

A 44-year-old African-American man has had elevated blood pressure for years which has not been treated. He now has severe headaches. On physical examination his blood pressure is 275/150 mm Hg. Laboratory studies show Hgb 13.8 g/dL, serum glucose 76 mg/dL, and creatinine 3.5 mg/dL. These findings are most likely to be associated with which of the following pathologic lesions involving his kidneys? A Hyperplastic arteriolosclerosis B Hyaline arteriolosclerosis C Monckeberg medial calcific sclerosis D Atherosclerosis E Thrombophlebitis

E Disseminated intravascular coagulopathy

A 44-year-old man in acute distress is noted to have multiple ecchymoses of the skin that have developed over the past 48 hours. His prothrombin time (PT) is 38 seconds and partial thromboplastin time (PTT) 55 seconds. A CBC shows a WBC count of 5300/microliter, hemoglobin 8.1 g/dL, hematocrit 24.9%, MCV 99 fL, and platelet count 16,300/microliter. His D-Dimer test is very high. Which of the following is the most likely diagnosis? A Hemophilia A B Afibrinogenemia C Vitamin K deficiency D vonWillebrand disease E Disseminated intravascular coagulopathy

D Cold water fish oil

A 44-year-old woman has a family history of heart disease. Her father and mother both developed myocardial infarction and congestive heart failure as a result of occlusive coronary atherosclerosis. A dietary modification to include consumption of which of the following is most likely to reduce her risk for ischemic heart disease? A 40% of total caloric intake as fat B Increased saturated fat C Foods with cholesterol D Cold water fish oil E Fat found in beef products F Hydrogenated oils with trans-fats

D Renin

A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. On microscopic examination his renal artery branches have concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage of the renal parenchyma. An elevation in which of the following substances in his blood is most likely to be associated with these findings? A Ammonia B Calcium C Cholesterol D Renin E Troponin I F Triglyceride G C-reactive protein

D Troponin

A 45-year-old man feels some crushing chest pain along with numbness in his left arm after shoveling 15 cm of snow off his driveway. Three hours later he collapses and is taken to the emergency room. Which of the following laboratory tests run on a blood specimen is most useful in this situation? A Total white blood cell count B Glucose C Platelet count D Troponin E Lipase

D Hydrochlorothiazide

A 45-year-old woman undergoes mitral valve replacement with a mechanical prosthesis as treatment for chronic rheumatic valvulitis with mitral stenosis. She is started on coumadin therapy. Her INR is 2. Which of the following additional drugs is most safely taken by this woman without affectding the INR? A Atorvastatin B Aspirin C Gemfibrozil D Hydrochlorothiazide E Sulfamethoxazole

E Factor VII deficiency

A 46-year-old man has noted increasing numbers of blotchy areas of purple discoloration on his skin over the past 5 months. On physical examination there are areas of purpura but no petechiae. Laboratory studies show Hgb 12.5 g/dL, Hct 37.4%, MCV 85 fL, platelet count 251,300/microliter, and WBC count 8140/microliter. His prothrombin time is 22 seconds and his partial thromboplastin time is 25 seconds. Which of the following is most likely to explain his findings? A Heparin therapy B Lupus anticoagulant C Factor XI deficiency D Severe vonWillebrand disease E Factor VII deficiency

C Atherosclerosis

A 49-year-old woman has experienced marked pain in her lower extremities on ambulation more than 300 meters for the past 5 months. On physical examination, her lower extremities are cool and pale, without swelling or erythema. No dorsalis pedis or posterior tibial pulses are palpable. Her body mass index is 32. She is a smoker. Which of the following abnormalities of the vasculature is most likely to account for these findings? A Lymphatic obstruction B Arteriolosclerosis C Atherosclerosis D Medial calcific sclerosis E Venous thrombosis

E Chronic viral hepatitis

A 52-year-old man has an episode of severe hematemesis. On physical examination there are no abnormal findings. An abdominal CT scan shows a small, nodular liver. Laboratory studies show Hgb 10.5 g/dL, Hct 31.1%, MCV 70 fL, platelet count 199,400/microliter, and WBC count 7370/microliter. His prothrombin time is 24 seconds and his partial thromboplastin time is 33 seconds. Which of the following is most likely to explain his findings? A Myeloproliferative disorder B von-Willebrand disease C Abnormal fibrinolysis D Hemophilia E Chronic viral hepatitis

D Glucose

A 52-year-old man has an ulcerated area on the sole of his foot that has not healed for 2 months. He is 180 cm tall, weighs 126 kg, and has continued to gain weight gradually. He has not had any major illnesses. His blood pressure is normal. Which of the following laboratory tests performed on serum from a blood sample would be most useful in elucidating the underlying cause for his problem: A Antithrombin III B Cortisol C Creatine kinase D Glucose E Carcinoembryonic antigen

C Disseminated intravascular coagulation

A 52-year-old woman has a history of urinary tract infections. Recently, one of these episodes was complicated by acute pyelonephritis involving her kidneys. She became septic, and a blood culture grew Escherichia coli. She developed severe hypotension. She had purpuric areas on her skin. A stool for occult blood was positive. She had a prothrombin time of 50 sec (control 12), partial thromboplastin time of 100 sec (control 25), platelet count of 20,000/microliter, and D-dimer of 4 microgm/mL. These findings are most characteristic for which of the following conditions: A Hemophilia A B Von Willebrand disease C Disseminated intravascular coagulation D Antiphospholipid syndrome E Acute fulminant hepatitis

D Response to thrombolytic therapy

A 52-year-old woman has experienced marked substernal, crushing chest pain for the past 3 hours. Her vital signs show T 36.9°C, P 90/minute, RR 18/minute, and BP 100/60 mm Hg. Laboratory studies include a serum creatine kinase MB fraction of 10 microgram/L as well as a serum troponin I of 4.5 ng/mL. Which of the following findings is the best evidence for the presence of a coronary arterial thrombus as the etiology for her chest pain? A Total serum cholesterol of 300 mg/dL B Large size of the infarction by scintigraphic scanning C 80% coronary occlusion by angiography D Response to thrombolytic therapy E Hemoglobin A1C of 10.1%

C Abnormal platelet function

A 53-year-old man experiences a severe nosebleed. On physical examination he has a ruddy complexion. He is afebrile. His stool is positive for occult blood. Laboratory studies show Hgb 19.7 g/dL, Hct 59.8%, MCV 93 fL, platelet count 445,000/microliter, and WBC count 22,460/microliter. His prothrombin time is 13 seconds and his partial thromboplastin time is 27 seconds. Which of the following abnormalities of the coagulation system is most likely to cause his bleeding? A Anti-platelet antibodies B Bernard-Soulier syndrome C Abnormal platelet function D Metastatic carcinoma E Disseminated intravascular coagulopathy

D Left ventricle

A 53-year-old man has the sudden onset of chest pain. He is found to have a serum troponin I of 5 ng/mL. A year later he has reduced exercise tolerance. An echocardiogram reveals an akinetic segment of left ventricle, and he has reduced cardiac output, with an ejection fraction of 25%. He then experiences a transient ischemic attack (TIA). His serum troponin I is now <0.5 ng/mL. Thrombus formation involving which of the following locations is most likely to have put him at greatest risk for the TIA? A Cerebral vein B Vertebral artery C Superior vena cava D Left ventricle E Coronary artery F Saphenous vein

D Plasma renin activity of 4.8 ng/mL/hr supine

A 53-year-old woman is found on a routine physical examination to have vital signs with T 37°C, P 78/minute, RR 16/minute, and BP 165/110 mm Hg. There are no other significant findings. She has an abdominal ultrasound examination that shows the right kidney to be atrophic. Angiography reveals markedly reduced blood flow to the right renal artery from an occlusion at the orifice in the abdominal aorta. Which of the following laboratory findings is she most likely to have? A Serum sodium of 161 mmol/L B Serologic evidence of anti-cardiolipin antibody C Prothrombin time of 25 seconds D Plasma renin activity of 4.8 ng/mL/hr supine E Serum lactic acid of 5.5 mmol/L

A Elevated hemoglobin A1C level

A 54-year-old man with diabetes mellitus has had 3 urinary tract infections during the past year. He now sees the physician for an ulceration on his right big toe which has not healed in 2 months. Laboratory studies on each of his doctor visits over the past year show blood glucose levels below 110 mg/dL. This situation could be best explained by which of the following laboratory findings? A Elevated hemoglobin A1C level B Increased urine ketones C Elevated serum osmolarity D Decreased plasma insulin E Elevated titer of anti-insulin antibodies

C Immobilization

A 54-year-old previously healthy woman is hospitalized for pneumonia. On the 10th hospital day she is found to have swelling and tenderness of her right leg, which has developed over the past 48 hours. Raising the leg elicits pain. An ultrasound examination reveals findings suggestive of femoral vein thrombosis. Which of the following conditions is most likely to have contributed the most to the appearance of these findings? A Trousseau syndrome B Protein C deficiency C Immobilization D Pregnancy E Chronic alcohol abuse F Hypertension

E Myeloproliferative disorder

A 54-year-old woman has a pre-operative workup performed prior to a total abdominal hysterectomy for uterine leiomyomata. On physical examination she has no abnormal findings. Laboratory studies show a Hgb of 12.1 g/dL, Hct 35.8%, MCV 90 fL, platelet count of 1,000,000/microliter, and WBC count 3850/microliter. Her prothrombin time is 13 seconds and partial thromboplastin time 28 seconds. Which of the following is the most likely diagnosis? A Anti-phospholipid syndrome B vonWillebrand disease C Hereditary spherocytosis D Chronic liver disease E Myeloproliferative disorder

E Urokinase

A 54-year-old woman who has been hospitalized for two weeks develops swelling of her right leg. Raising the leg elicits pain. The leg feels warm on palpation. An ultrasound examination reveals evidence for thrombosis in the deep veins of the right leg. Within a day, she has the sudden onset of dyspnea, and a day later has left-sided chest pain on inspiration. Which of the following is the best initial therapy for this woman? A Coumadin B Heparin C Aspirin D Prednisone E Urokinase

E Thrombin time

A 55-year-old woman with a history of atrial fibrillation had a transient ischemic attack a year ago. She was prescribed dabigatran. Which of the following laboratory tests would best serve as an indicator for adherance to the treatment plan? A Antithrombin III assay B Factor V Leiden assay C Partial thromboplastin time D Prothrombin time E Thrombin time

D Atherosclerosis

A 56-year-old reports reduced exercise tolerance over the past 5 years. In the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. On examination he has a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include a total serum cholesterol of 245 mg/dL with an HDL cholesterol of 22 mg/dL. Which of the following vascular abnormalities is he most likely to have? A Hyperplastic arteriolosclerosis B Lymphedema C Medial calcific sclerosis D Atherosclerosis E Deep venous thrombosis F Plexiform arteriopathy

A Hyaline arteriolosclerosis

A 57-year-old man has had blood pressure measurements in the range of 160/95 to 180/110 mm Hg for many years. He has taken no medications. A renal scan reveals kidneys of normal size for age. These findings with benign nephrosclerosis are most likely to occur with which of the following vascular changes? A Hyaline arteriolosclerosis B Monckeberg's medial calcific sclerosis C Complex calcified atherosclerosis D Arterial mural thrombosis E Hyperplastic arteriolosclerosis

D Homocysteinemia

A 57-year-old woman has experienced episodes of altered mental status for the past month. On physical examination, she has bilateral carotid artery bruits. She is given folic acid supplementation. Which of the following laboratory test findings is she most likely to have? A Factor V Leiden mutation B Factor VIII deficiency C Increased carcinoembryonic antigen D Homocysteinemia E Increased HDL cholesterol

A Artery

A 57-year-old woman has had episodes of abdominal pain following meals for the past year. Her BMI is 31. She has hypertension. Her total serum cholesterol is increased. Which of the following types of blood vessel is the most likely location for the pathologic abnormality causing her pain? A Artery B Arteriole C Capillary D Venule E Vein

A Placement of a hip prosthesis

A 58-year-old woman has the sudden onset of severe dyspnea with chest pain and diaphoresis. A chest CT scan shows areas of decreased attenuation within the main pulmonary arteries. Her D-dimer assay is elevated. Her acute event is most likely to be a consequence of which of the following? A Placement of a hip prosthesis B Marked thrombocytopenia C Chronic alcoholism D Infection with the human immunodeficiency virus E Rheumatoid arthritis

B Intravenous heparin, then coumadin

A 60-year-old woman develops pain in her left leg over the past week. On physical examination she has swelling of her left leg. A doppler ultrasound scan shows decreased flow with deep venous thrombosis. A pulmonary ventilation/perfusion scan is normal. Which of the following sequential therapies is most appropriate for treatment of this woman? A Aspirin, then coumadin B Intravenous heparin, then coumadin C A fibrinolytic agent, then coumadin D Subcutaneous heparin, then coumadin E A fibrinolytic agent, then aspirin

B Hyperosmolar coma

A 60-year-old woman has become increasingly obtunded over the past day. She was found by her daughter in a stuporous condition and brought to the emergency department. On physical examination, she has poor skin turgor. She is afebrile. Her vital signs reveal a blood pressure of 90/40 mm Hg, respirations 15 and shallow, pulse 95, and temperature 36°C. Laboratory studies show a hemoglobin A1C of 10%. Her serum electrolytes show sodium 144 mmol/L, potassium 5 mmol/L, chloride 95 mmol/L, CO2 22 mmol/L, and glucose 940 mg/dL. Which of the following is the most likely diagnosis? A Insulin overdose B Hyperosmolar coma C Hyperlipidemia D Ketoacidosis E Overeating

C Reperfusion injury

A 61-year-old man has the sudden onset of severe chest pain. Vital signs include T 37°C, P 102/minute, RR 20/minute, and BP 80/40 mm Hg. An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. He is given thrombolytic therapy with tissue plasminogen activator (tPA) 3 hours after the onset of chest pain. However his serum creatinine kinase is found to be 450 U/L 3 hours after this therapy. Which of the following cellular events has most likely occurred? A Cellular regeneration B Drug-induced necrosis C Reperfusion injury D Increased synthesis of creatine kinase E Myofiber atrophy

A Myocardial infarction

A 63-year-old man has had increasing exercise intolerance for the past 6 years so that he now becomes short of breath upon climbing a single flight of stairs. Laboratory studies have shown fasting blood glucose measurements from 145 to 210 mg/dL for the past 25 years, but he has not sought medical treatment. If he dies suddenly, which of the following is most likely to be the immediate cause of death? A Myocardial infarction B Nodular glomerulosclerosis C Cerebral hemorrhage D Hyperosmolar coma E Right lower leg gangrene

C Mesenteric artery occlusion

A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is indicated by the laboratory finding of hemoglobin A1C 10.1%. He has noted episodes of abdominal pain following meals. These episodes have worsened over the past year. On physical examination, there are no masses and no organomegaly of the abdomen, and he has no tenderness to palpation. Which of the following pathologic findings is most likely to be present in this man? A Ruptured aortic aneurysm B Hepatic infarction C Mesenteric artery occlusion D Acute pancreatitis E Chronic renal failure

E Metabolic syndrome

A 65-year-old man has had increasing lower leg swelling along with reduced exercise tolerance for the past 5 years. He has chest pain on exertion. He has not experienced dyspnea. He has had 4 transient ischemic attacks in the past year. He has experienced abdominal pain in the past 2 months. Vital signs show T 37°C, P 82/min, RR 16/min, and BP 130/85 mm Hg. He has pitting edema to the knees bilaterally. The lower extremities have palpable pulses, no tenderness, and no erythema. An abdominal CT scan shows dilation of the abdominal aorta to 5 cm, filled with mural thrombus. Other family members have had similar problems. Which of the following underlying conditions is the most likely risk factor for his findings? A Factor V Leiden mutation B Adenocarcinoma of the colon C Multiple blunt trauma D Vasculitis E Metabolic syndrome

A Embolism

A 66-year-old man with Parkinson disease develops pleuritic chest pain. On exam, he has guarding over the right lower lung with dullness to percussion. A chest CT scan shows a focal, wedge-shaped pleural baesed area of hemorrhage in the right lower lobe. Which of the following is the most likely cause for his pulmonary lesion? A Embolism B Atherosclerosis C Vasculitis D Arteriolosclerosis E Thrombosis

C Oxidized LDL

A 66-year-old woman has the sudden loss of movement on part of the left side of her body. She has smoked a pack of cigarettes a day for the past 45 years. She has vital signs including T 37.1°C, P 80/minute, RR 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery. Laboratory findings include a hemoglobin A1C of 9%. Which of the following components of blood lipids is most important in contributing to her disease? A Chylomicrons B Lipoprotein lipase C Oxidized LDL D VLDL E HDL cholesterol

B Adenocarcinoma of the pancreas

A 68-year-old woman has survived multiple episodes of pulmonary thromboembolism during the past three months. On physical examination there are no abnormal findings. Which of the following is the most likely underlying condition leading to this patient's recurrent pulmonary thromboembolism? A Micronodular cirrhosis of the liver B Adenocarcinoma of the pancreas C Thrombocytopenia D Familial hypercholesterolemia E Mitral valve endocarditis F Type II diabetes mellitus

B Endothelial cell injury

A 69-year-old woman has had flank pain and a high fever for a week. On physical examination her temperature is 38°C. There is left costovertebral angle tenderness. A urine culture is positive for Escherichia coli. She then has a drop in blood pressure and in urine output. A blood culture grows Escherichia coli. Her prothrombin time is 34 seconds and her partial thromboplastin time 59 seconds. Her platelet count is 11,000/microliter. Her D-dimer is elevated. Which of the following is the most likely mechanism for development of her laboratory findings? A Venous thrombosis B Endothelial cell injury C Increased factor VIII levels D Splenic sequestration E Arterial bleeding

A Age

A 70-year-old healthy woman has a check of her health status. On examination her blood pressure is 125/80 mm Hg and BMI 24 kg/m2. Laboratory studies show her serum total cholesterol is 180 mg/dL with LDL cholesterol 90 mg/dL. There is a family history of cancer. Which of the following is a constitutional risk factor for atherosclerotic vascular disease in this woman? A Age B Blood pressure C Family history D Gender E Hyperlipidemia F Weight

D Hyperglycemia

A 70-year-old man has noted coldness and numbness of his lower left leg, increasing over the past 4 months. He also experiences pain in this extremity when he tries walking more than the distance of half a city block. On physical examination, his dorsalis pedis, posterior tibial, and popliteal artery pulses are not palpable. Which of the following laboratory test findings is he most likely to have? A Protein S deficiency B Blood culture with Staphylococcus aureus C Decreased arterial oxygen saturation D Hyperglycemia E Hypercalcemia

B Carotid bruit

A 71-year-old woman experiences a transient ischemic attack (TiA). She had an acute myocardial infarction 5 years ago. Which of the following physical examination findings is most likely to be associated with her TIA? A Blood pressure 140/90 mm Hg B Carotid bruit C Heart rate of 100/minute D Leg swelling E Pulsatile abdominal mass F Radial pulse 1+

C Natriuretic peptide

A 72-year-old man suffered a myocardial infarction involving half the left ventricular free wall 3 months ago. He now has increasing dyspnea and orthopnea. On echocardiography his ejection fraction is 29%. On examination he has poor capillary filling in hands and feet. A chest x-ray shows pulmonary edema. Which of the following laboratory test analytes is most likely to be increased in this man at this point in time? A Sodium B Creatine kinase C Natriuretic peptide D Hematocrit E Sedimentation rate

B Calcific medial sclerosis

A 73-year-old woman who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries lateral to her uterus. What is the probable vascular lesion which accounts for this calcification? A Ulcerative atherosclerosis B Calcific medial sclerosis C Metastatic calcification D Trauma E Dystrophic calcification

D Hemarthrosis (bleeding into joints)

A clinical study is conducted comparing patients diagnosed with vonWillebrand disease (VWD) to patients diagnosed with hemophilia A. Both groups of patients have documented problems of hemostasis over a 10 year period. Which of the following complications is most likely to be seen more frequently in the patients with hemophilia A? A Petechiae B Epistaxis (nosebleed) C Excessive bleeding from wounds D Hemarthrosis (bleeding into joints) E Menorrhagia (excessive menstrual hemorrhage)

C Elevated factor VIII level

A clinical study is conducted with subjects who are adult women from 30 to 45 years of age who have been taking oral contraceptives for at least 10 years. The medical records for these subjects are reviewed to determine if vascular problems occurred. It is observed that there is a slight but significant increase in thrombotic and thromboembolic events in these subjects, compared to an age-matched control group not taking oral contraceptives. Which of the following mechanisms is most likely to increase the risk for thrombosis in this group of women? A Anti-platelet antibody B Anti-cardiolipin antibody C Elevated factor VIII level D Homocystinemia E Antithrombin III deficiency

D Adenocarcinoma

A clinical study is performed with subjects from ages 10 to 90 who developed deep venous thrombosis to determine risk factors for the thrombotic event. Demographic, clinical, and laboratory findings are reviewed and statistically analyzed for significance. These subjects are compared to an age-matched control group of patients without a history of deep venous thrombosis. Which of the following underlying conditions is most likely to increase the risk for deep venous thrombosis? A Chronic renal failure B Pulmonary emphysema C Diverticulosis D Adenocarcinoma E Ischemic heart disease

C Factor IX deficiency

A clinical study is performed with subjects who are found to have laboratory test abnormalities involving the coagulation system. Review of patient records reveals that some of these subjects have had problems with bleeding while others have not. Patients with which of the following laboratory test abnormalities are most likely to have bleeding? A Lupus anticoagulant B Factor XII deficiency C Factor IX deficiency D Prekallikrein deficiency E High-molecular-weight kininogen deficiency

B Conversion of fibrinogen to fibrin

A clinical study is performed with subjects who have thrombocytopenia <10,000/microliter. These patients are observed to have defects in coagulation with spontaneous bleeding characterized by multiple petechiae and purpura and stool samples positive for occult blood. Which of the following coagulation functions is most likely to remain largely intact in these patients? A Adherence to injured vascular walls B Conversion of fibrinogen to fibrin C Induction of vasoconstriction D Increase in surface sites for coagulation E Release of substances that neutralize heparin

C C-reactive protein

A longitudinal study is conducted to detect serum markers that predict risk for death from acute coronary syndromes. A marker is identified that is synthesized and released from the liver in response to formation of cytokines in atheromatous plaques. This marker increases endothelial adhesiveness to platelets. What is this marker most likely to be? A Prostacyclin B Immunoglobulin G C C-reactive protein D Alpha-1-antitrypsin E Acetoacetate

C Stroke

A study is performed involving persons who have a history of diabetes mellitus type 1 or type 2. These patients are found to have cellular injury that results from glycosylation end products and from sorbitol accumulation within cells. The same patients are also shown to have ischemic tissue damage from accelerated and advanced atherosclerosis. Which of the following complications is most likely to result from atherosclerosis in these patients? A Hepatic failure B Impotence C Stroke D Cataracts E Retinopathy

B Endothelial dysfunction

A study of atherogenesis is performed. There is a propensity for atheromas to form at muscular arterial branch points, such as the carotid and aortic bifurcations. Which of the following events in the arteries at these locations is most likely to initiate atherogenesis? A Collagen synthesis B Endothelial dysfunction C Lactic acidosis D Cholesterol breakdown E Hypoxemia

C Ketoacidosis

A study of pathologic findings in the islets of Langerhans is performed. It is observed that insulitis may occur in the islets. The inflammatory infiltrate is predominantly composed of T lymphocytes. Which of the following is most likely to occur as a consequence of insulitis? A Neoplasia B Malabsorption C Ketoacidosis D Obesity E Sepsis

E Sodium retention

A study of persons with essential hypertension is performed. They have blood pressures in the range of 140/90 to 160/100 mm Hg. Laboratory studies show normal serum electrolyte values. Which of the following physiologic abnormalities is most likely to account for their hypertension? A Hyperreninemia B Hyperaldosteronism C Decreased natriuretic peptide D Decreased angiotensin converting enzyme E Sodium retention F Catecholamine excess

C Altered blood flow with stasis

An 81-year-old woman has the sudden onset of dyspnea and palpitations with chest pain. A pulmonary ventilationperfusion scan is performed and indicates a high probability for a perfusion defect involving right segmental pulmonary arterial branch. Of the following findings or conditions, which is the most important factor favoring development of these findings? A An increased white blood cell count B Cirrhosis of the liver C Altered blood flow with stasis D An increased platelet count E Generalized atherosclerosis

B Hypertension

An autopsy study is conducted involving the gross appearance of the aorta of adults ranging in age from 60 to 90. In some of these patients, the aorta demonstrates atheromatous plaques covering from 70 to 95% of the intimal surface area, mainly in the abdominal portion, with ulceration and calcification. Which of the following contributing causes of death are these patients most likely to have? A Hyperparathyroidism B Hypertension C Marfan syndrome D Thrombophlebitis E Vasculitis F Colonic adenocarcinoma G Systemic lupus erythematosus

B Fatty streak

An autopsy study reveals that evidence for atheroma formation can begin even in children. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence for the formation of an atheroma? A Thrombus B Fatty streak C Calcification D Hemorrhage E Exudate F Ulceration

E XIII

An infant born at term is noted to have bleeding from the umbilical cord stump. In childhood, he has poor wound healing. After puberty, is found to have infertility. As a teenager he develops an intracerebral hemorrhage. Laboratory studies include a prothrombin time 12 seconds, partial thromboplastin time 25 seconds, platelet count 244,000/microliter, and positive clot solubility test in 5 molar urea solution. He is most likely to have a deficiency of which of the following coagulation factors? A VII B VIII C IX D XII E XIII

D Fondiparinux

An orthopedic surgery service is evaluating methods to reduce the incidence of pulmonary thromboembolism in geriatric patients undergoing hip replacement for femoral fracture. A pharmacologic agent is identified that increases the prothrombin time and partial thromboplastin time, but does not affect platelet number or function studies. It has a half-life of less than 1 day and is mostly excreted unchanged into the urine. This agent has minimal risk for thrombosis. Which of the following drugs is this most likely to be? A Abciximab B Acetylsalicylic acid C Coumadin D Fondiparinux E Heparin

C Scleroderma

At autopsy, the kidneys of a 44-year-old woman who died suddenly are found to be of normal size. Their surfaces appear finely granular. There are small hemorrhages noted. The cortices appear pale. Microscopically, many small renal arteries and arterioles demonstrate concentric intimal thickening with marked luminal narrowing. These findings are most likely to be present as a result of which of the following underlying diseases? A Amyloidosis B Systemic lupus erythematosus C Scleroderma D Rheumatoid arthritis E Viral hepatitis F Diabetes mellitus

D Organization

During hospitalization, a 40-year-old woman develops thrombophlebitis. She recovers and is discharged. She returns to her job as an electrician. A couple of months later, which of the following terms would best describe the process seen in a femoral vein after recovery from her thrombophlebitis: A Acute inflammation B Rupture C Embolization D Organization E Propagation

B Chylomicron

Following a meal, lipids are digested and absorbed. Lipids collect within enterocytes. Which of the following chemical components of the blood is mainly responsible for transporting exogenous (dietary) triglyceride from the intestine to the liver? A Apoprotein B Chylomicron C Lipoprotein lipase D Oxidized low density lipoprotein E High density lipoprotein

D Impotence

In a clinical study of patients with diabetes mellitus, a group of patients is found who have had blood glucose measurements ranging from 140 to 180 mg/dL for at least 10 years. Rectal biopsies from these patients now show that there is a form of osmotic cellular injury present in arterioles. This form of injury is most likely to be manifested elsewhere in the body by which of the following complications? A Cerebral infarction B Gastric adenocarcinoma C Congestive heart failure D Impotence E Pyelonephritis

B Coagulative

In an experiment, a glass bead is embolized to a branch of the renal artery. A day later there is a focal area in which the renal parenchymal cells in the distribution of the occluded artery show karyolysis and karyorrhexis. The outlines of the cells are still visible, but the nuclei have lost basophilic staining and the cytoplasm is eosinophilic but pale. Which of the following types of cellular necrosis is most likely present? A Caseous B Coagulative C Fatty D Gangrenous E Liquefactive

B Tissue factor

In an experiment, initiation of the coagulation system is studied by the addition of various compounds to aliquots of normal patient plasma. After addition of a compound, the prothrombin time is measured with one aliquot and the partial thromboplastin time with another aliquot. Addition of which of the following compounds is most likely to produce clotting, as measured by the prothrombin time? A Fibrinogen B Tissue factor C Factor VIII D Factor VII E Factor XII F Factor XIII

D Neurons

Some cells demonstrate glucose uptake from the blood regardless of the plasma insulin level. In persons who have had persistent hyperglycemia for years, cellular injury can occur. Which of the following cell types is most likely to show injury from hyperglycemia? A Cardiac myocytes B Fibroblasts C Steatocytes D Neurons E Smooth muscle cells.