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Hemodynamic Disorders Review of Pathology CH4 Illustrated Pathology Review Question bank with Correct Answers
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C) Increased hydrostatic pressure The hydrostatic pressure exerted from standing upright leads to edema in dependent parts of the body. In a healthy patient, normal renal function would be sufficient to clear free water ingested orally. Hypoalbuminemia leads to more generalized edema, although ...

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  • August 15, 2024
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  • the hydrostatic pressure exerted from standing up

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Hemodynamic Disorders Review of
Pathology CH4 Illustrated Pathology
Review Question bank with Correct
Answers
C) Increased hydrostatic pressure

The hydrostatic pressure exerted from standing upright leads to edema in dependent
parts of the body. In a healthy patient, normal renal function would be sufficient to clear
free water ingested orally. Hypoalbuminemia leads to more generalized edema,
although the effect is more pronounced in dependent areas. Lymphatic obstruction from
infection or tumor can lead to lymphedema, but this is a chronic process. Secondary
aldosteronism results from congestive - Answer-A 45-year-old woman who works while
standing for long periods notices at the end of her 8-hour shift that her lower legs and
feet are swollen, although there was no swelling at the beginning of the day. There is no
pain or erythema associated with this swelling. She is otherwise healthy and takes 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

D) Lymphedema

The surgery disrupted lymphatic return, resulting in functional lymphatic obstruction and
lymphedema of the arm. The lymphatic channels are important in scavenging fluid and
protein that have leaked into the extravascular tissues from the intravascular
compartment. Although the amount of fluid that is drained through the lymphatics is not
great, it can build up gradually. Cellulitis is caused by an infection of the skin and
subcutaneous tissue, and displays erythema, warmth, and t - Answer-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°
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) Lymphatic obstruction

Spread of the cancer to the dermal lymphatics produces a peau d'orange appearance of
the breast. Because the breast has an extensive venous drainage, cancer or other focal
mass lesions are unlikely to cause significant congestion and edema of the breast.
Chronic inflammation is rare in breast tissue and is not associated with cancer. Passive
congestion does not involve the breast. Ischemia is rare in the breast because of the
abundant arterial supply. - Answer-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

F) Increased salt retention

This child has nephrotic syndrome with loss of albu- min into the urine and
hypoalbuminemia that decreases plasma oncotic pressure, leading to movement of
intravascular water into the extravascular compartment to produce edema. In response,
hypovolemia with renal hypoperfusion induces increased production of renin,
angiotensin, and aldosterone, which all promote sodium and water retention, further
exacerbating his edema. Thiazide diuretics increase renal excretion of - Answer-A 7-
year-old boy has had increasing lethargy for a week. On physical examination, he has
periorbital edema and pit- ting edema at the ankles, but is normotensive and afebrile.
Laboratory studies show marked albuminuria. He is given a thiazide diuretic and his
urine output increases and his edema resolves. Which of the following changes most
likely potenti- ated his edema?

A Decreased aldosterone
B Decreased renin
C Increased albumin
D Increased cortisol
E Decreased antidiuretic hormone
F Increased salt retention

,C) Increased hydrostatic pressure

She has congestive heart failure, with bilateral diffuse pulmonary infiltrates due to
edema. The left side of her heart has failed, which increases hydrostatic pressure in the
pulmonary vasculature. The higher pressure forces fluid to leak into the alveoli, and it is
then coughed up. Note the enlarged heart with prominent border of the left atrium in the
figure. This fluid is a transudate because there is little protein or cells present. The
kidneys can general - Answer-A 94-year-old woman has dyspnea and an increasing
cough with frothy sputum production for the past month. She is afebrile. A chest
radiograph shows the findings in the figure. Which of the following is the most likely
mechanism for development of her pulmonary infiltrates?

A Decreased sodium intake
B Hypoalbuminemia
C Increased hydrostatic pressure
D Inflammation
E Pulmonary venous obstruction

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?

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