HEMODYNAMIC DISORDERS REVIEW
OF PATHOLOGY CH4 ILLUSTRATED
PATHOLOGY QUESTION WITH
CORRECT ANSWERS
B) Alveolar transudate
Acute left ventricular failure after a myocardial infarction causes venous congestion in
the pulmonary capillary bed and increased hydrostatic pressure, which leads to
pulmonary edema by transudation in the alveolar space. Neutrophils and fibrin would be
found in cases of acute inflammation of the lung (i.e., pneumonia). Fibrosis and
hemosiderin-filled macrophages (heart failure cells) would be found in long-standing,
not acute, left ventricular failure. Purulent exudate - Answer-A 50-year-old man suffers
an infarction of the anterior left ventricular wall. He receives therapy with anti-arrhythmic
and pressor agents. He is in stable condition until he develops severe breathlessness 3
days later. An echocardiogram shows a markedly decreased ejection fraction.
Representative chest radiographic findings are shown in the figure above. Which of the
following microscopic changes is most likely to be present in his lungs?
A Alveolar neutrophilic exudate
B Alveolar transudate
C Alveolar wall fibrosis
D Pleural fibrosis
E Pleural space neutrophilic exudate
F Pleural space transudate
C) Congestive heart failure
The figure shows a so-called nutmeg liver caused by chronic passive congestion from
congestive heart failure. The elevated enzyme levels suggest that the process is so
severe that hepatic centrilobular necrosis has also occurred. The physical findings
suggest right-sided heart failure that can occur with pulmonary emphysema and
pulmonary arterial hypertension. Biliary tract obstruction would produce bile stasis
(cholestasis) with icterus. Hepatic congestion is not di - Answer-A 58-year-old man with
pulmonary emphysema has a 10-year history of congestive heart failure. On physical
examination, he has lower leg swelling with grade 2 pitting edema to the knees and
prominent jugular venous distention to the level of the mandible. His serum levels of
AST and ALT are increased. The representative gross appearance of his liver is shown
in the figure. Which of the following underlying conditions is most likely to be present in
this man?
A Chronic renal failure
,B Common bile duct obstruction
C Congestive heart failure
D Portal vein thrombosis
E Thrombocytopenia
C) Hematoma
He has a subdural hematoma from this traumatic injury causing tearing of cerebral
veins. A hematoma is a collection of blood in a potential space or within tissue.
Congestion occurs when there is vascular dilation with pooling of venous blood within
an organ. Ecchymoses are blotchy areas of hemorrhage beneath skin, serosal surfaces,
or mucous membrane surfaces from a contusion (bruise), which he likely has on the
back of his head. Petechiae are 1- to 2-mm pinpoint areas of hemorrha - Answer-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
D) Petechiae
Note the small punctate 1- to 2-mm petechial hemorrhages on the epicardial surface
shown in the figure. Such hemorrhages most often result from reduced numbers of
platelets or reduced platelet function. It is platelets that plug small vascular defects.
Congestion occurs when there is vascular dilation with pooling of blood within an organ.
A hematoma is a collection of blood in a potential space or within tissue. Purpura
denotes blotchy hemorrhage on skin, serosal surfaces, or muco - Answer-An autopsy
study is performed to correlate patterns of hemorrhage with underlying causes. Patients
with the gross appearance of hemorrhage shown in the figure had minimal blood
volume loss, but an appearance similar to this in many other organs. Which of the
following terms best describes this pattern?
A Congestion
B Ecchymosis
C Hematoma
D Petechiae
E Purpura
E) Vasoconstriction
,The initial response to arteriolar injury is vasoconstriction, since there is smooth muscle
in the vessel wall. But this is transient, and the coagulation mechanism must be initiated
to maintain hemostasis. Fibrin polymerization is part of secondary hemostasis after the
vascular injury is initially closed. Neutrophils are not essential to hemostasis. Platelet
aggregation occurs with release of factors such as ADP, but this takes several minutes.
Protein C is involved in anti - Answer-A superficial puncture wound from a needlestick
injury leads to a small amount of bleeding in a healthy person. Sec- onds 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
C) Prostacyclin
Endothelial injury releases glycoprotein tissue factor (factor III) that drives the
coagulation process and activates platelets. Adjacent intact endothelium generates
prostacyclin (PGI2) via arachidonic acid metabolism to inhibit clot propagation beyond
where it is needed. PGI2 and nitric oxide are powerful vasodilators and inhibitors of
plate- let aggregation. This limits thrombus formation just to the area of injury.
Glycoprotein IIb/IIIa, which induces shape change; phospholi - Answer-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 Glycoprotein IIb/IIIa
B Platelet-activating factor
C Prostacyclin
D Tissue-type plasminogen activator
E Thrombomodulin
F Thromboxane
E) Thrombomodulin
Thrombomodulin is present on intact endothelium and binds thrombin, which then
inhibits coagulation by activating protein C. Normally, thrombin activates factors V, VIII,
and IX, and also stabilizes the secondary hemostatic plug by activating factor XIII, which
cross-links fibrin. Thrombin helps activate platelets. Calcium is a cofactor that assists
clotting in the coagulation cascade (ethylene-diaminetetraacetic acid [EDTA] in some
blood collection tubes binds calcium to prev - Answer-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)
B) Platelet adhesion
Von Willebrand factor (vWF) acts like a "glue" between platelets and the exposed
extracellular matrix of the vessel wall after vascular injury. None of the other steps listed
depends upon vWF. Because the patient's prothrombin time (PT) is normal, a lack of
prothrombin or the presence of an inhibitor is unlikely. Because vWF stabilizes factor
VIII, a deficiency of vWF may prolong the partial thromboplastin time (PTT). - Answer-A
26-year-old woman has a history of frequent nose- bleeds and increased menstrual
blood flow. On physical examination, petechiae and purpura are present on the skin of
her extremities. Laboratory studies show normal partial thromboplastin 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 Aggregation of platelets
Aspirin blocks the cyclooxygenase pathway of arachidonic acid metabolism and
generation of eicosanoids in platelets, including thromboxane A2, to block
vasoconstriction and inhibit platelet aggregation. Platelet adhesion to extracellular
matrix is mediated by interactions with von Willebrand factor. Tissue factor (factor III),
produced by injured endothelium as well as subendothelial smooth muscle and
fibroblasts, is released with tissue injury and is not platelet dep - Answer-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 recur- rent
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
OF PATHOLOGY CH4 ILLUSTRATED
PATHOLOGY QUESTION WITH
CORRECT ANSWERS
B) Alveolar transudate
Acute left ventricular failure after a myocardial infarction causes venous congestion in
the pulmonary capillary bed and increased hydrostatic pressure, which leads to
pulmonary edema by transudation in the alveolar space. Neutrophils and fibrin would be
found in cases of acute inflammation of the lung (i.e., pneumonia). Fibrosis and
hemosiderin-filled macrophages (heart failure cells) would be found in long-standing,
not acute, left ventricular failure. Purulent exudate - Answer-A 50-year-old man suffers
an infarction of the anterior left ventricular wall. He receives therapy with anti-arrhythmic
and pressor agents. He is in stable condition until he develops severe breathlessness 3
days later. An echocardiogram shows a markedly decreased ejection fraction.
Representative chest radiographic findings are shown in the figure above. Which of the
following microscopic changes is most likely to be present in his lungs?
A Alveolar neutrophilic exudate
B Alveolar transudate
C Alveolar wall fibrosis
D Pleural fibrosis
E Pleural space neutrophilic exudate
F Pleural space transudate
C) Congestive heart failure
The figure shows a so-called nutmeg liver caused by chronic passive congestion from
congestive heart failure. The elevated enzyme levels suggest that the process is so
severe that hepatic centrilobular necrosis has also occurred. The physical findings
suggest right-sided heart failure that can occur with pulmonary emphysema and
pulmonary arterial hypertension. Biliary tract obstruction would produce bile stasis
(cholestasis) with icterus. Hepatic congestion is not di - Answer-A 58-year-old man with
pulmonary emphysema has a 10-year history of congestive heart failure. On physical
examination, he has lower leg swelling with grade 2 pitting edema to the knees and
prominent jugular venous distention to the level of the mandible. His serum levels of
AST and ALT are increased. The representative gross appearance of his liver is shown
in the figure. Which of the following underlying conditions is most likely to be present in
this man?
A Chronic renal failure
,B Common bile duct obstruction
C Congestive heart failure
D Portal vein thrombosis
E Thrombocytopenia
C) Hematoma
He has a subdural hematoma from this traumatic injury causing tearing of cerebral
veins. A hematoma is a collection of blood in a potential space or within tissue.
Congestion occurs when there is vascular dilation with pooling of venous blood within
an organ. Ecchymoses are blotchy areas of hemorrhage beneath skin, serosal surfaces,
or mucous membrane surfaces from a contusion (bruise), which he likely has on the
back of his head. Petechiae are 1- to 2-mm pinpoint areas of hemorrha - Answer-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
D) Petechiae
Note the small punctate 1- to 2-mm petechial hemorrhages on the epicardial surface
shown in the figure. Such hemorrhages most often result from reduced numbers of
platelets or reduced platelet function. It is platelets that plug small vascular defects.
Congestion occurs when there is vascular dilation with pooling of blood within an organ.
A hematoma is a collection of blood in a potential space or within tissue. Purpura
denotes blotchy hemorrhage on skin, serosal surfaces, or muco - Answer-An autopsy
study is performed to correlate patterns of hemorrhage with underlying causes. Patients
with the gross appearance of hemorrhage shown in the figure had minimal blood
volume loss, but an appearance similar to this in many other organs. Which of the
following terms best describes this pattern?
A Congestion
B Ecchymosis
C Hematoma
D Petechiae
E Purpura
E) Vasoconstriction
,The initial response to arteriolar injury is vasoconstriction, since there is smooth muscle
in the vessel wall. But this is transient, and the coagulation mechanism must be initiated
to maintain hemostasis. Fibrin polymerization is part of secondary hemostasis after the
vascular injury is initially closed. Neutrophils are not essential to hemostasis. Platelet
aggregation occurs with release of factors such as ADP, but this takes several minutes.
Protein C is involved in anti - Answer-A superficial puncture wound from a needlestick
injury leads to a small amount of bleeding in a healthy person. Sec- onds 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
C) Prostacyclin
Endothelial injury releases glycoprotein tissue factor (factor III) that drives the
coagulation process and activates platelets. Adjacent intact endothelium generates
prostacyclin (PGI2) via arachidonic acid metabolism to inhibit clot propagation beyond
where it is needed. PGI2 and nitric oxide are powerful vasodilators and inhibitors of
plate- let aggregation. This limits thrombus formation just to the area of injury.
Glycoprotein IIb/IIIa, which induces shape change; phospholi - Answer-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 Glycoprotein IIb/IIIa
B Platelet-activating factor
C Prostacyclin
D Tissue-type plasminogen activator
E Thrombomodulin
F Thromboxane
E) Thrombomodulin
Thrombomodulin is present on intact endothelium and binds thrombin, which then
inhibits coagulation by activating protein C. Normally, thrombin activates factors V, VIII,
and IX, and also stabilizes the secondary hemostatic plug by activating factor XIII, which
cross-links fibrin. Thrombin helps activate platelets. Calcium is a cofactor that assists
clotting in the coagulation cascade (ethylene-diaminetetraacetic acid [EDTA] in some
blood collection tubes binds calcium to prev - Answer-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)
B) Platelet adhesion
Von Willebrand factor (vWF) acts like a "glue" between platelets and the exposed
extracellular matrix of the vessel wall after vascular injury. None of the other steps listed
depends upon vWF. Because the patient's prothrombin time (PT) is normal, a lack of
prothrombin or the presence of an inhibitor is unlikely. Because vWF stabilizes factor
VIII, a deficiency of vWF may prolong the partial thromboplastin time (PTT). - Answer-A
26-year-old woman has a history of frequent nose- bleeds and increased menstrual
blood flow. On physical examination, petechiae and purpura are present on the skin of
her extremities. Laboratory studies show normal partial thromboplastin 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 Aggregation of platelets
Aspirin blocks the cyclooxygenase pathway of arachidonic acid metabolism and
generation of eicosanoids in platelets, including thromboxane A2, to block
vasoconstriction and inhibit platelet aggregation. Platelet adhesion to extracellular
matrix is mediated by interactions with von Willebrand factor. Tissue factor (factor III),
produced by injured endothelium as well as subendothelial smooth muscle and
fibroblasts, is released with tissue injury and is not platelet dep - Answer-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 recur- rent
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
