Hemostasis and Hemodynamics MCQ questions with complete solutions

A 60-year-old man with a history of multiple myocardial infarcts is hospitalized for shortness of breath. Physical examination reveals marked jugular distension, hepatomegaly, ascites, and pitting edema. A chest X-ray reveals cardiomegaly. The patient subsequently dies of cardiorespiratory failure. Examination of the lungs at autopsy would most likely disclose which of the following pathologic changes? (A) Diffuse alveolar damage with hyaline membranes (B) Intra-alveolar purulent exudate (C) Lymphocytic interstitial pneumonitis (D) Pulmonary arteriopathy with plexiform lesions (E) Vascular congestion and hemosiderin-laden macrophages correct answer: *The answer is E.* Left ventricular failure leads to chronic passive congestion of the lungs. Blood leaks from the congested pulmonary capillaries into the alveoli. Alveolar macrophages degrade RBCs and accumulate hemosiderin. These hemosiderin-laden macrophages are called heart failure cells. Diffuse alveolar damage with hyaline membranes (choice A) is a feature of adult respiratory distress syndrome. Purulent exudate (choice B) is observed in bacterial pneumonia. Lymphocytic interstitial pneumonitis (choice C) is characteristic of viral pneumonitis. Plexiform lesions (choice D) are typically seen in patients with pulmonary hypertension. Diagnosis: Congestive heart failure, pulmonary edema A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mm Hg. She is febrile (38°C/100.5°F) and tachypneic. Laboratory studies demonstrate a WBC count of 22,000/μL with 92% neutrophils. Urinalysis reveals numerous Gram-negative organisms. Which of the following most likely accounts for this patient's signs and symptoms? (A) Anaphylactic shock (B) Cardiogenic shock (C) Hypovolemic shock (D) Neurogenic shock