Block 10 Hemodyimic Disorder MCQ's

1. A woman in the immediate post-partum period, suddenly and without warning, presents shortness of breath with deep cyanosis. Cardiovascular shock followed rapidly by clonic-tonic convulsions and profound coma and death. 80% of patients with clinical presentation as above, most probably die as a consequence of one of the following conditions:

Amniotic fluid embolism

Bilateral cortical necrosis of kidneys

Gram negative sepsis

Toxemia of pregnancy

Neurogenic shock

The given clinical presentation of sudden shortness of breath, cyanosis, cardiovascular shock, convulsions, coma, and death is highly suggestive of amniotic fluid embolism. Amniotic fluid embolism is a rare but potentially life-threatening condition in which amniotic fluid enters the maternal bloodstream, leading to an allergic-like reaction and subsequent cardiovascular collapse. This condition can cause rapid deterioration and death, with mortality rates as high as 80%. The other conditions listed, such as bilateral cortical necrosis of kidneys, gram-negative sepsis, toxemia of pregnancy, and neurogenic shock, may present with different symptoms and are less likely to cause the described clinical presentation.

Explanation

The given clinical presentation of sudden shortness of breath, cyanosis, cardiovascular shock, convulsions, coma, and death is highly suggestive of amniotic fluid embolism. Amniotic fluid embolism is a rare but potentially life-threatening condition in which amniotic fluid enters the maternal bloodstream, leading to an allergic-like reaction and subsequent cardiovascular collapse. This condition can cause rapid deterioration and death, with mortality rates as high as 80%. The other conditions listed, such as bilateral cortical necrosis of kidneys, gram-negative sepsis, toxemia of pregnancy, and neurogenic shock, may present with different symptoms and are less likely to cause the described clinical presentation.

2. A 45-year-old female, bank teller with no medical history and taking no medication; after an 8 hour-shift working, she notices there is swelling of her lower legs and feet. There is no pain or erythema associated with this swelling. Which of the following mechanisms best explains how this phenomenon occurred?

Increased hydrostatic pressure

Lymphatic obstruction

Secondary aldosteronism

Hypoalbuminemia

Excessive water intake

The swelling of the lower legs and feet without pain or erythema suggests that the swelling is due to fluid accumulation rather than inflammation. Increased hydrostatic pressure is the most likely mechanism for this phenomenon as it can cause fluid to leak out of the blood vessels and accumulate in the surrounding tissues. This can occur after prolonged standing or sitting, which may be the case for the bank teller after an 8-hour shift.

Explanation

The swelling of the lower legs and feet without pain or erythema suggests that the swelling is due to fluid accumulation rather than inflammation. Increased hydrostatic pressure is the most likely mechanism for this phenomenon as it can cause fluid to leak out of the blood vessels and accumulate in the surrounding tissues. This can occur after prolonged standing or sitting, which may be the case for the bank teller after an 8-hour shift.

3. A 38 year old woman, while recovering bedridden several days after having an abdominal hysterectomy, develops an acute onset of chest pain and shortness of breath. Physical examination finds an afebrile patient who presents moderate respiratory distress. She is somewhat anxious, is breathing quickly, and calf tenderness is present. What would be the most important predisposing factor for the cause of current condition in this patient?

Prothrombin gene mutation

Anti-phospholipid antibody syndrome

Factor V Leiden mutation

Stasis of blood in lower extremity

Surgical removal of pelvis vein plexus

The most important predisposing factor for the patient's current condition is stasis of blood in the lower extremity. This is indicated by the presence of calf tenderness, which suggests a possible deep vein thrombosis (DVT). After undergoing abdominal surgery, the patient may have been immobile for several days, leading to blood pooling and stasis in the lower extremities. This stagnant blood can form a clot, which can then travel to the lungs and cause a pulmonary embolism, resulting in chest pain and shortness of breath.

Explanation

The most important predisposing factor for the patient's current condition is stasis of blood in the lower extremity. This is indicated by the presence of calf tenderness, which suggests a possible deep vein thrombosis (DVT). After undergoing abdominal surgery, the patient may have been immobile for several days, leading to blood pooling and stasis in the lower extremities. This stagnant blood can form a clot, which can then travel to the lungs and cause a pulmonary embolism, resulting in chest pain and shortness of breath.

4. 68 year old man was taken to the ER after he experienced severe episode of chest pain. He had cardiac arrest and resuscitation maneuvers failed. An autopsy was done and a sample of myocardium was taken. On microscopic examination of this tissue section showed a bright eosinophilic staining area with loss of nuclei and cross striations of myocardial cells. There was no inflammatory infiltrate of hemorrhage. Which of the following conditions was most probably the cause of changes seen in the myocardium?

A protein deficient diet

Specific antibodies against myocardium

Blunt chest trauma

Coronary artery thrombosis

Viral infection

The changes seen in the myocardium, including bright eosinophilic staining, loss of nuclei, and cross striations of myocardial cells, are consistent with myocardial infarction. Coronary artery thrombosis, which is the formation of a blood clot in the coronary artery, is a common cause of myocardial infarction. This clot can block blood flow to the heart muscle, leading to ischemia and subsequent cell death. Therefore, coronary artery thrombosis is the most likely cause of the changes seen in the myocardium in this case.

Explanation

The changes seen in the myocardium, including bright eosinophilic staining, loss of nuclei, and cross striations of myocardial cells, are consistent with myocardial infarction. Coronary artery thrombosis, which is the formation of a blood clot in the coronary artery, is a common cause of myocardial infarction. This clot can block blood flow to the heart muscle, leading to ischemia and subsequent cell death. Therefore, coronary artery thrombosis is the most likely cause of the changes seen in the myocardium in this case.

5. A 56-year-old chronic alcoholic presents with ascites, peripheral edema and jugular venous distention. Which of the following organ: histopathology combinations would you most likely see in relation to his cardiac disease?

Kidney: hyperplastic arteriolosclerosis

Heart: amyloid angiopathy

Brain: basal ganglia hemorrhage

Liver: centrilobular sinusoidal congestion

Adrenal gland: cortical hyperplasia

In this case, the patient's presentation of ascites, peripheral edema, and jugular venous distention suggests cardiac disease. Liver involvement is common in cardiac disease, and the histopathological finding of centrilobular sinusoidal congestion is characteristic of congestive hepatopathy, which occurs due to impaired cardiac function. This congestion results from increased central venous pressure and decreased hepatic blood flow. Therefore, the most likely organ: histopathology combination in relation to the patient's cardiac disease is Liver: centrilobular sinusoidal congestion.

Explanation

In this case, the patient's presentation of ascites, peripheral edema, and jugular venous distention suggests cardiac disease. Liver involvement is common in cardiac disease, and the histopathological finding of centrilobular sinusoidal congestion is characteristic of congestive hepatopathy, which occurs due to impaired cardiac function. This congestion results from increased central venous pressure and decreased hepatic blood flow. Therefore, the most likely organ: histopathology combination in relation to the patient's cardiac disease is Liver: centrilobular sinusoidal congestion.

6. A 32 year old man involved in a motor vehicle accident sustains a fracture of his left femur. While in the hospital 2 days after the accident, he is noted to be dyspneic and disoriented, and he develops petechiae on his trunk and axilla. What is the most likely pathology diagnosis in this case?

Foreign body emboli

Pulmonary thromboembolus

Septic emboli

Air embolus

Fat embolism

The most likely pathology diagnosis in this case is fat embolism. This is suggested by the presence of dyspnea, disorientation, and the development of petechiae on the trunk and axilla. Fat embolism occurs when fat globules enter the bloodstream, often as a result of long bone fractures or trauma. These fat globules can then travel to the lungs and cause respiratory distress, as well as other systemic symptoms such as confusion and petechiae.

Explanation

The most likely pathology diagnosis in this case is fat embolism. This is suggested by the presence of dyspnea, disorientation, and the development of petechiae on the trunk and axilla. Fat embolism occurs when fat globules enter the bloodstream, often as a result of long bone fractures or trauma. These fat globules can then travel to the lungs and cause respiratory distress, as well as other systemic symptoms such as confusion and petechiae.

7. A 60 year old male teacher with diabetes mellitus and hypertension attends to the outpatient clinic complaining of difficulty breathing while walking about 30 yards across the parking lot. He also reports has required up to 3 to 4 pillows to sleep at night. Physical examination reveals bibasilar crackles, pitting edema (3 +) of lower extremities and some pressure sensation in the upper right upper quadrant of the abdomen. Which of the following changes best describes the pathophysiology involved in the production of the changes found in his lungs?

Decreased plasma oncotic pressure

Widespread endothelial damage

Increased vascular permeability

Increased hydrostatic pressure

Acute lymphatic obstruction

The increased hydrostatic pressure best describes the pathophysiology involved in the production of the changes found in his lungs. The patient's symptoms of difficulty breathing, bibasilar crackles, and pitting edema are consistent with congestive heart failure (CHF). In CHF, the heart is unable to pump blood effectively, leading to increased pressure in the pulmonary circulation. This increased pressure causes fluid to leak out into the alveoli, resulting in bibasilar crackles and difficulty breathing. The pitting edema in the lower extremities is also a consequence of increased hydrostatic pressure in the venous system.

Explanation

The increased hydrostatic pressure best describes the pathophysiology involved in the production of the changes found in his lungs. The patient's symptoms of difficulty breathing, bibasilar crackles, and pitting edema are consistent with congestive heart failure (CHF). In CHF, the heart is unable to pump blood effectively, leading to increased pressure in the pulmonary circulation. This increased pressure causes fluid to leak out into the alveoli, resulting in bibasilar crackles and difficulty breathing. The pitting edema in the lower extremities is also a consequence of increased hydrostatic pressure in the venous system.

8. A 62 year old woman attends to clinic with a longstanding history of systemic hypertension complaining of breathlessness on exertion. On physical examination her physician finds bibasilar crackles. An ECG reveals left ventricular hypertrophy by voltage criteria but not ST segment elevation or depression. Serum cardiac enzymes levels are within normal limits. An echocardiogram reveals dilatation of the left ventricle. Her breathlessness is most likely due to:

Right sided CHF due to systolic dysfunction

Left sided CHF due to diastolic dysfunction

High output Cardiac Failure

Pleural effusion due to Right Heart Failure

ARDS due to hypertension

The correct answer is left sided CHF due to diastolic dysfunction. This is indicated by the patient's history of systemic hypertension, physical examination findings of bibasilar crackles, ECG findings of left ventricular hypertrophy, and echocardiogram findings of left ventricular dilatation. These findings suggest that the patient has diastolic dysfunction, which is characterized by impaired relaxation and filling of the left ventricle. This can lead to increased pressure in the left atrium and pulmonary congestion, resulting in breathlessness on exertion.

Explanation

The correct answer is left sided CHF due to diastolic dysfunction. This is indicated by the patient's history of systemic hypertension, physical examination findings of bibasilar crackles, ECG findings of left ventricular hypertrophy, and echocardiogram findings of left ventricular dilatation. These findings suggest that the patient has diastolic dysfunction, which is characterized by impaired relaxation and filling of the left ventricle. This can lead to increased pressure in the left atrium and pulmonary congestion, resulting in breathlessness on exertion.

9. A 68 year-old female suffered a fracture to her right femoral trochanter. Two weeks later her right leg below the knee is markedly swollen and there is tenderness to palpation. She experiences pain on movement of this leg. Which of the following is most likely to occur?

Gangrenous necrosis of the foot

Hematoma of the thigh

Disseminated intravascular coagulation (DIC)

Pulmonary thromboembolism

Fat embolism

After suffering a fracture to her right femoral trochanter, the patient is now experiencing marked swelling and tenderness in her right leg below the knee, along with pain on movement. These symptoms are indicative of deep vein thrombosis (DVT), which is a blood clot that forms in the deep veins of the leg. If left untreated, DVT can lead to the formation of a pulmonary embolism, where the blood clot travels to the lungs and blocks blood flow. Therefore, the most likely occurrence in this case is a pulmonary thromboembolism.

Explanation

After suffering a fracture to her right femoral trochanter, the patient is now experiencing marked swelling and tenderness in her right leg below the knee, along with pain on movement. These symptoms are indicative of deep vein thrombosis (DVT), which is a blood clot that forms in the deep veins of the leg. If left untreated, DVT can lead to the formation of a pulmonary embolism, where the blood clot travels to the lungs and blocks blood flow. Therefore, the most likely occurrence in this case is a pulmonary thromboembolism.

10. Generalized Edema is not a common clinical presentation in one of the following conditions associated to hypoproteinemia (reduced plasma osmotic pressure):

Crohn´s disease

Neoplasia

Malnutrition

Liver cirrhosis

Nephrotic syndrome

Liver cirrhosis is not commonly associated with generalized edema. Generalized edema is a clinical presentation commonly seen in conditions such as nephrotic syndrome, malnutrition, neoplasia, and Crohn's disease, which are all associated with hypoproteinemia and reduced plasma osmotic pressure. In liver cirrhosis, the primary cause of edema is portal hypertension, which leads to fluid accumulation in the abdomen (ascites) rather than generalized edema.

Explanation

Liver cirrhosis is not commonly associated with generalized edema. Generalized edema is a clinical presentation commonly seen in conditions such as nephrotic syndrome, malnutrition, neoplasia, and Crohn's disease, which are all associated with hypoproteinemia and reduced plasma osmotic pressure. In liver cirrhosis, the primary cause of edema is portal hypertension, which leads to fluid accumulation in the abdomen (ascites) rather than generalized edema.