Clincal Applications

A 35 year old man with uncomplicated coarctation of the aorta appears at the clinic with SOB and chest pain. His wife complains that he is having a heart attack. In reality, what is a likely diagnosis for this man?

Aortic Dissection

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

Artery

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 Venous thrombosis

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?

Atherosclerosis

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 Prostaglandin B Immunoglobulin G C C-reative protein D Cox 1 Enzyme

C-reactive protein

A 48-year-old previously healthy woman develops increasing malaise over the past 4 months. On physical examination there are no abnormal findings. Laboratory studies show her Hgb is 8.5 g/dL with WBC count 241,400/microliter. A bone marrow biopsy is performed and shows a 100% cellular marrow. Chromosome analysis of the cells from the marrow yields the presence of philadelphia chromosome. Which of the following is the most likely diagnosis? A) Chronic myelogenous leukemia B) Metastatic breast carcinoma C) Myeloid hyperplasia D) Granulomatous infection E) Multiple myeloma

CML

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 could represent her condition? A MI B CVA C STK D MVA

CVA (stroke)

A 41-year-old woman has noted some intermenstrual spotting of blood for the past 6 months. A pelvic examination is performed and the cervical lesion is found. She undergoes a total abdominal hysterectomy. Which of the following is the most likely risk factor that contributed to the appearance of this lesion? A) Diabetes mellitus, type II B) Vitamin A deficiency C) Human papillomavirus virus D) Syphilis

HPV

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

Cold water fish oil

A 43-year-old man has complained of heartburn for the past 5 months. On physical examination there are no abnormal findings. Upper GI endoscopy is performed. Biopsies are taken of an erythematous area of the lower esophageal mucosa. There is no mass lesion and no hemorrhage. The doctor tells him he has Barrett's Esophagus. Which of the following is most likely the cell differentiation? A) Dysplasia B) Glandular hyperplasia C) Metastatic carcinoma D) Epithelial metaplasia E) Ischemic injury

Epithelial metaplasia

A 32-year-old woman has had fatigue, fever, and night sweats for the past month. She presents with a feber and reports that she has painless right cervical adenopathy. Which of the following is the most likely diagnosis? A) Hodgkin lymphoma B) lymphocytic lymphoma C) Benign reactive lymphoid hyperplasia D) Non-hodgkin lymphoma E) CML

Hodgkin Lymphoma

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 Decreased arterial oxygen saturation D Hyperglycemia E Hypercalcemia

Hyperglycemia This is peripheral arterial vascular disease from severe atherosclerosis, which is promoted by diabetes mellitus.

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. What condition is most likely to have contributed the most to the appearance of these findings? A Protein C deficiency B Immobilization C Pregnancy D Chronic alcohol abuse E Hypertension

Immobilization

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

Ketonuria (typical of type 1 DM)\ The findings of polydipsia, polyuria, and polyphagia are present in this case. The absolute decrease in insulin leads to a catabolic state, with underutilization of carbohydrates, and lipolysis with metabolism of fatty acids to produce ketone bodies.

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 DVT C Cerebral hemorrhage E Right lower leg gangrene

Myocardial Infarction

A 25-year-old man presents to a rheumatologist with complaints of joint pain involving the large joints of the legs. On questioning, the patient indicates that exacerbations in the joint pain are frequently accompanied stiffness when he is sitting down. Which of the following is the most likely diagnosis? A OA B RA C DDD D Sjogren's Syndrome

OA

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 bone sclerosis. What is the probable diagnosis which accounts for this sclerosis? A Ankylosing spondylitis B RA C OA D trauma E Metastatic calcification

OA

A man arrives at the clinic complaining of back pain accompanied by vertigo spells and fatigue. This man likely has

RA with cervical spine involvement

A young woman is rushed to the hospital with complaints of excrutiatingly painful white fingers. She has a history of tobacco use and reports that she hasn't gotten new shoes since high school. What is her likely diagnosis?

Raynaud's

A 55-year-old man has experienced pain in his left leg for the past 7 months. On palpation he has swelling behind his left knee. Which of the following is the most likely neoplasm he has? A) Adenoma B) Carcinoma C) Lymphoma D) Sarcoma E) Teratoma

Sarcoma

A couple has a daughter who has sausage fingers and recently diagnosed with pneumonia. She also has gallstones. The couple reports that her grandfather has the Hb-SS trait. These symptoms are most likely due to

Sickle cell disease

Mike, a 43-year old construction worker, has a history of hypertension. He smokes two packs of cigarettes a day, is nervous about the possibility of being unemployed, and has difficulty coping with stress. His current concern is calf pain during minimal exercise that decreased with rest. The nurse assesses Mike's symptoms as being associated with peripheral arterial occlusive disease. The nursing diagnosis is probably: A Alteration in tissue perfusion related to compromised circulation B Dysfunctional use of extremities related to muscle spasms C Impaired mobility related to stress associated with pain D Impairment in muscle use associated with pain on exertion.

alteration in tissue perfusion related to compromised circulation

A 50 year old man is complaining of chest pain that radiates to his back accompanied by dizziness. He has a history of HTN and was recently diagnosed with atherosclerosis. What is likely to be his diagnosis?

aortic aneurysm

A 60-year-old woman has become increasing tired and 'run down' over the past 6 months. On physical examination she has a palpable spleen tip and non-tender axillary lymphadenopathy. Laboratory studies show Hgb 10.1 g/dL, Hct 30.5%, MCV 90 fL, platelet count 89,000/uL, and WBC count 31,300/uL. Which of the following is the most likely diagnosis? A) Infectious mononucleosis B) Chronic lymphocytic leukemia C) Iron deficiency anemia D) Bacterial septicemia E) Systemic lupus erythematosus

chronic lymphocytic leukemia

3. Buerger's disease is characterized by all of the following except: Arterial thrombosis formation and occlusion Lipid deposits in the arteries Redness or cyanosis in the limb when it is dependent Venous inflammation and occlusion

lipid deposits in arteries