Ch. 4 path Hemodynamic disorders

In an experiment, platelet function is analyzed. A substance is obtained from the dense body 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 these effects? A- Adenosine diphosphate B- Antithrombin III C- Fibronectin D- Fibrinogen E- Plasminogen F- Thromboxane A2

A- Adenosine diphosphate

An 85-year-old man falls in the bathtub and strikes the back of his head. Over the next 24 hours, he becomes increasingly somnolent. A head CT scan shows an accumulation of fluid beneath the dura, compressing the left cerebral hemisphere. Which of the following terms best describes this collection of fluid? A- Congestion B- Ecchymosis C- Hematoma D- Petechiae E- Purpura

C- Hematoma

A 45-year-old woman who work while standing for long periods notices at the end of her 8-hour shift that her lower legs and feet are swollen, although there are no swelling at the beginning of the day. There is no pain or erythema associated with this swelling. She is otherwise healthy and take no medications; laboratory testing reveals normal liver and renal function. Which of the following mechanisms best explains this phenomenon? A- Excessive free water intake B- Hypoalbuminemia C- Increased hydrostatic pressure D- Lymphatic obstruction E- Secondary aldosteronism

C- Increased hydrostatic pressure

A 31-year-old man is on a scuba diving trip and descends to a depth of 50 m in the Blue Hole off the coast of Belize. After 30 minutes, he has a malfunction in his equipment and quickly returns to the boat on the surface. He develops difficulty breathing within 5 minutes, with dyspnea and substernal chest pain, followed by a severe headache and vertigo. An hour later, he develops severe, painful myalgia and arthralgias. These symptoms abate within 24 hours. Which of the following occluding his arterioles is the most likely cause of his findings? A- Fat globules B- Fibrin clots C- Nitrogen gas bubbles D- Platelet thrombi E- Rupture atheromatous plaque

C- Nitrogen gas bubbles

An 80-year-old woman with dysuria for 1 week now has a fever. On examination, her temperatures is 37.9 degrees C, pulse 103/min, and blood pressure 80/40 mm Hg. She has right flank pain. A urinalysis shows numerous WBCs. Her plasma lactate is increased. Urine culture and blood culture grow Escherichia coli. Which of the following is most likely to contribute to her cardiovascular collapse by triggering Toll-like cell receptors? A- Complement C3b B- Lipopolysaccharide C- Nitric oxide D- Platelet-activating factor E- Toxic shock syndrome toxin-1

B- Lipopolysaccharide

A 26-year-old woman has a history of frequent nosebleeds and increased menstruated blood flow. On physical examination, petechiae and purpura are present on the skin of her extremities. Laboratory studies show normal partial thrombophlebitis time (PTT), prothrombin time (PT), and platelet count, but decreased von Willebrand factor activity. This patient most likely has a derangement in which of the following steps in hemostasis? A- Fibrin polymerization B- Platelet adhesion C- Platelet aggregation D- Prothrombin generation E- Prothrombin inhibition F- Vasoconstriction

B- Platelet adhesion

A 15-year-old girl incurs a cut to the sole of her foot after stepping on a piece of broken glass. On examination, a superficial 0.5-cm laceration ceases to bleed within 5 minutes after application of local pressure. Which of the following substances is released by endothelium and is most likely to counteract platelet aggregation near this site of injury? A- Glycoproteins IIb/IIIa B- Platelet-activating factor C- Prostacyclin D- Tissue-type plasminogen activator E- Thrombomodulin F- Thromboxane

C- Prostacyclin

A 55-year-old woman following major abdominal surgery has had discomfort and swelling of her left leg for the past week. Old physical examination, the leg is slightly difficult to move, and on palpating there is tenderness. A Doppler sonogram shows thrombosis of deep left leg veins. Which of the following mechanisms is most likely to contribute to her condition? A- Hypercalcemia B- Immobilization C- Ingestion of aspirin D- Nitric oxide release E- Turbulent blood flow

B- Immobilization

A 23-year-old woman has had altered consciousness and slurred speech for the past 24 hours. A head CT scan shows a right temporal hemorrhagic infarction. Cerebral angiography shows a distal right middle cerebral arterial occlusion. Within the past 3 years, she has had an episode of pulmonary embolism. A pregnancy 18 months ago ended in miscarriage. Laboratory studies show a false-positive serologic test for syphilis, normal prothrombin time (PT), elevated partial thromboplastin time (PTT), and normal platelet count. Which of the following is the most likely cause of these findings? A- Antiphospholipid antibody B- Disseminated intravascular coagulation C- Factor V mutation D- Hypercholesterolemia E- Von Willebrand disease

A- Antiphospholipid antibody

A 63-year-old woman has had a fever and felt faint for the past 2 days. On physical examination, her temperature is 38.4 degrees C, pulse is 101/min, respiration's are 17/min, and blood pressure is 85/40 mm Hg. She has marked peripheral vasodilation. The serum lactic acid level is 6.8 mg/dL. Which of the following laboratory findings is most likely related to the cause of her clinical condition? A- Blood culture positive for Citrobacter B- Decreased hematocrit C- Elevated serum creatine kinase D- Increased blood urea nitrogen E- Reduced PO2 on blood gas measurement

A- Blood culture positive for Citrobacter

A 12-year-old boy has a 10-year history of multiple soft tissue hemorrhages and acute upper airway obstruction from hematoma formation in the neck. On physical examination, he has decreased range of motion of the large joints, particularly the knees and ankles. He has not petechiae or purpura of the skin. Laboratory studies show normal prothrombin time,, elevated partial thromboplastin time (PTT), and normal platelet count, but markedly decreased factory VIII activity. Which of the following mechanisms best describes the development of his disease? A- Decrease in production of thrombin B- Decrease in membrane phospholipid C- Failure of platelet aggregation D- Failure of fibrin polymerization E- Inability to neutralize antithrombin III F- Inability of platelets to release Thromboxane A2

A- Decrease in production of thrombin

A 59-year-old woman with a history of diabetes mellitus had a myocardial infarction 3 months ago. Her BMI is 35. She is now taking a low dose of aspirin to reduce the risk for recurrent arterial thrombosis. On which of the following steps in hemostasis does aspirin have its greatest effect? A- Adhesion of platelets to collagen B- Aggregation of platelets C- Production of tissue factor D- Synthesis of von Willebrand factor E- Synthesis of antithrombin III

B- Aggregation of platelets

A 22-year-old woman with an uncomplicated pregnancy develops sudden dyspnea with cyanosis and hypotension intrapartum during routine vaginal delivery of a term infant. She has a generalized seizure and becomes comatose. Her condition does not improve over the next 2 days. Which of the following findings is most likely to be present in her peripheral pulmonary arteries? A- Aggregates of platelets B- Amniotic fluid C- Fat globules D- Gas bubbles E- Thromboemboli

B- Amniotic fluid

A 60-year-old woman with a history of diabetes mellitus has had left-sided chest pain radiating 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 (PTT) and prothrombin time (PT) are normal. Coronary angiography shows occlusion of the left anterior descending artery. Which of the following mechanisms is most likely to 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- Damage is endothelium

A 21-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. Laboratory tests show that her prothrombin time (PT), partial thromboplastin time (PTT), platelet count, and platelet function studies all are normal. Which of the following risk factors is the most common cause for such a coagulopathy? A- Antithrombin III deficiency B- Factor V mutation C- Hyperhomocysteinemia D- Mutation in protein C E- Occult malignancy F- Oral contraceptive use G- Smoking cigarettes

B- Factor V mutation

A 32-year-old man is involved in a vehicular accident and sustains fractures of the right femur and tibia and the left humerus. The fractures are stabilized surgically. He is in stable condition for 2 days, but then suddenly becomes severely dyspneic. Which of the following complications from his injuries is the most likely cause of his sudden respiratory difficulty? A- Cardiac tamponade B- Fat embolism C- Pulmonary edema D- Pulmonary infarction E- Right hemothorax

B- Fat embolism

A 30-year-old man is cutting wood alone in the forest and incurs a deep cut to his leg from his chain saw. He loses a large amount of blood. He is not found until the next day. A marked increase in which of the following blood analyses is most likely to indicate that he has reached an irreversible stage of shock? A- Antidiuretic hormone B- Bicarbonate C- Catecholamines D- Lactate dehydrogenase E- Prothrombin

D- Lactate dehydrogenase

A 28-year-old woman with a 15-year history of recurrent thrombosis from a prothrombin gene mutation develops septicemia after a urinary tract infection with pseudomonas aeruginosa. She develops multiple infarcts and organ failure over the next 2 weeks. Which of the following organs is most likely to be spared from the effects of ischemic injury in this woman? A- Brain B- Heart C- Kidney D- Liver E- Spleen

D- Liver

A 37-year-old woman has noticed a lump in her left breast over the past 2 months. On physical examination, the skin overlying the left breast is thickened, reddish orange, and pitted. Mammography shows a 3-cm underlying density. A fine-needle aspirate of the density is performed and on microscopic examination shows carcinoma. Which of the following mechanisms best explains the gross appearance of the skin of her left breast? A- Chronic inflammation B- Chronic passive congestion C- Ischemic necrosis D- Lymphatic obstruction E- Venous thrombosis

D- Lymphatic obstruction

A 56-year-old woman diagnosed with cancer in her left breast underwent a mastectomy with axillary lymph node dissection. Postoperatively, she develops marked swelling of the left arm that has persisted for 6 months. Now on physical examination, her temperature is 36.9 degrees C. Her left arm is not tender or erythematous, and it is not painful with movement or to touch,, but it is enlarged with a doughy consistency. Which of the following is the most likely mechanism for these findings? A- Cellulitis B- Congestive heart failure C- Decreased plasma oncotic pressure D- Lymphedema E- Sodium and water retention F- Phlebothrombosis

D- Lymphedema

A 20-year-old man develops palpitations within 1 hour after a gunshot wound to the abdomen. On examination his heart rate is 112/minute and blood pressure 80/30 mm Hg. His skin is cool and clammy to the touch. 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- Gangrenous necrosis of the lower legs D- Pulmonary diffuse alveolar damage E- Renal passive congestion

D- Pulmonary diffuse alveolar damage

A 66-year-old woman has the sudden onset of chest pain that radiates to her neck and left arm. On examination 30 minutes later, she is diaphoretic and hypotension. Her serum troponin I level is elevated. Which of the following drugs is most likely to be administered emergent LH as thrombolytic therapy for this woman? A- Acetylesalicylic acid (aspirin) B- Low-molecular-weight heparin C- Nitric oxide D- Tissue plasminogen activator E- Vitamin K

D- Tissue plasminogen activatory

A 75-year-old man is hospitalized after falling and fracturing his left femoral trochanter. Two weeks later, the left leg is swollen, particularly below the knee. He experiences pain on movement of the leg; on palpating, there is swelling and tenderness. Which of the following complications is most likely to occur in this man? A- Disseminated intravascular coagulation B- Fat embolism syndrome C- Gangrenous necrosis of the foot D- Hematoma of the thigh E- Pulmonary thromboembolism

E- Pulmonary thromboembolism

In an experiment, thrombus formation is studied in areas of vascular damage. The propagation of a thrombus in an area of vascular injury to adjacent normal arteries is prevented. Which of the following substances diminishes thrombus propagation by activating protein C? A- Calcium B- Fibrin C- Platelet factor 4 D- Prothrombin E- Thrombomodulin F- Tumor necrosis factor (TNF)

E- Thrombomodulin

A superficial puncture wound from a needlestick injury leads to a small amount of bleeding in a healthy person. Seconds after this injury occurs, the bleeding stops. Which of the following mechanisms is most likely to stop small arteriolar blood loss from this injury? A- Fibrin polymerization B- Neutrophil chemotaxis C- Platelet aggregation D- Protein C activation E- Vasoconstriction

E- Vasoconstriction

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 thiazides diuretic and his urine output increases and his edema resolves. Which of the following changes most likely potentiated his edema? A- Decreased aldosterone B- Decreased renin C- Increased albumin D- Increased cortisol E- Decreased antidiuretic hormone F- Increased salt retention

F- Increased salt retention

A 77-year-old woman has a brief fainting episode. She was diagnosed 1 year ago with pancreatic adenocarcinoma. On auscultation of her chest, a heart murmur is heard. Echocardiography shows a 1-cm nodular lesion on the superior aspect of an intact anterior mitral valve leaflet. A blood culture is negative. Which of the following terms best describes this mitral valve lesion? A- Atheroma B- Chronic passive congestion C- Mural thrombus D- Myxoma E- Phlebothrombosis F- Vegetation

F- Vegetation

A 58-year-old man has had episodes of prolonged epitaxis in the past 6 months. On examination he has occult blood detected in his stool. Coagulation studies show that his prothrombin time is elevated, but his partial thromboplastin time (PTT), platelet count, and platelet function are all normal. When his plasma is mixed with an equal amount of normal plasma, the prothrombin time corrects to normal. Which of the following underlying diseases is most likely to be associated with these findings? A- Antiphospholipid syndrome B- Factor V Leiden mutation C- Hemophilia A D- Scurvy E- Sepsis with Escherichia coli F- Vitamin K deficiency

F- Vitamin K deficiency