NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University
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Free NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University Questions
A 39-year-old man with AIDS is admitted to the hospital with a 3-week history of chest pain and shortness of breath. An x-ray film of the chest shows bilateral nodularities of the lungs. A CT-guided lung biopsy reveals granulomatous inflammation with scattered multinucleated giant cells. Giant cells in these pulmonary lesions are derived from which of the following inflammatory cells?
- Basophils
- Endothelial cells
- Eosinophils
- Macrophages
- Neutrophils
Explanation
Correct Answer: D) Macrophages.
Multinucleated giant cells in granulomatous inflammation are formed by the fusion of activated macrophages (specifically epithelioid macrophages). In an immunocompromised AIDS patient with bilateral pulmonary nodules, opportunistic granulomatous infections such as Mycobacterium avium complex or fungi are common triggers. Macrophages fuse in response to persistent antigens they cannot destroy, forming Langhans or foreign-body giant cells. No other listed cell type forms giant cells.
A 75-year-old woman with a recent history of myocardial infarction develops hemopericardium and expires. At autopsy, multiple wedge-shaped lesions are observed on the surface of the patient's spleen. These pale infarcts were most likely caused by thromboemboli originating in which of the following anatomic locations?
[IMAGE_1]
- Brain
- Heart
- Lungs
- Liver
- Spleen
Explanation
Correct Answer: B) Heart.
Following a myocardial infarction, the damaged and poorly contracting left ventricle can develop mural thrombi (blood clots forming on the inner wall). These thrombi can dislodge and travel through the systemic circulation as emboli, lodging in end-arterial vessels of organs such as the spleen, kidneys, and brain, causing pale (ischemic) wedge-shaped infarcts. The wedge shape is characteristic of embolic occlusion of end-arteries. The heart is the origin of these systemic emboli given the patient's recent MI history.
A sputum sample obtained from a 68-year-old former construction worker reveals needle-like inert minerals (shown).
- B cell lymphoma
- Carcinoid tumor
- Mesothelioma
- Teratocarcinoma
- Transitional cell carcinoma
Explanation
Correct Answer: C) Mesothelioma.
The needle-like inert minerals visible in the sputum sample are asbestos fibers, specifically asbestos bodies (also called ferruginous bodies), which appear as golden-brown, dumbbell-shaped or beaded rods with a protein-iron coat around a central fiber.
Their presence in a former construction worker is consistent with occupational asbestos exposure, which was extremely common in construction, shipbuilding, insulation, and manufacturing industries before the widespread recognition of its dangers. Asbestos exposure is the leading cause of malignant mesothelioma, a rare and aggressive cancer of the pleural, peritoneal, or pericardial mesothelium.
The latency period between asbestos exposure and mesothelioma development is characteristically very long — often 20 to 40 years — which explains the presentation in a 68-year-old former worker. Asbestos also significantly increases the risk of lung adenocarcinoma, especially in smokers (synergistic effect). B cell lymphoma, carcinoid tumors, teratocarcinomas, and transitional cell carcinomas are not associated with asbestos exposure.
A 70-year-old male is admitted after a massive anterior myocardial infarction and initially stabilizes with medical management. Several days later, he suddenly develops ventricular tachycardia followed by cardiac arrest. Histologic remodeling of the infarcted myocardium reveals fibroblast infiltration with deposition of type I collagen, replacing large numbers of necrotic cardiac myocytes. Which of the following best explains the principal cause of death in patients following a massive myocardial infarction?
- Progressive systolic heart failure from reduced ejection fraction
- Acute papillary muscle rupture leading to severe mitral regurgitation
- Life-threatening ventricular arrhythmias due to disruption of normal electrical conduction by collagen scar tissue
- Recurrent coronary artery thrombosis from endothelial injury
Explanation
Correct Answer: C) Life-threatening ventricular arrhythmias due to disruption of normal electrical conduction by collagen scar tissue.
The most common cause of death following MI is ventricular arrhythmia. As necrotic myocytes are replaced by non-conducting collagen scar tissue, the normal electrical conduction pathways are disrupted, creating re-entry circuits that trigger fatal arrhythmias such as ventricular tachycardia and fibrillation. This explains the patient's sudden cardiac arrest days after initial stabilization.
A 56-year-old man who has been at home recovering following an appendectomy, collapses after rushing out of bed to answer the telephone. Autopsy findings are shown (see image). This thromboembolus most likely originated in which of the following anatomic sites?
- Left ventricle of heart
- Leg vein
- Pulmonary artery
- Right ventricle of heart
- Thoracic aorta
Explanation
Correct Answer: B) Leg vein
The autopsy image shows a saddle pulmonary embolism straddling the bifurcation of the pulmonary trunk. Following surgery, prolonged immobility promotes venous stasis in the deep veins of the legs, leading to deep vein thrombosis (DVT). When the patient suddenly stood up and rushed to the phone, the thrombus dislodged and traveled through the venous system to the pulmonary circulation. Post-surgical patients are among the highest-risk groups for DVT and fatal pulmonary embolism, which is why early ambulation and prophylactic anticoagulation are standard of care.
A 67-year-old man presents with worsening cough, sputum production, and shortness of breath. He has been a cigarette smoker for the past 50 years, smoking approximately 1 pack a day. He has a chronic AM cough productive of some yellow sputum but generally feels okay during the day. He was in his usual state of health until two weeks ago when he developed a cold. Since then, he has had a hacking cough and increased thick sputum production. He also has had difficulty walking more than a block without stopping due to shortness of breath. Physical examination reveals prolonged expiration, audible wheezing, and diffuse rhonchi throughout both lung fields. Chest x-ray shows hyperinflation of both lungs with a flattened diaphragm. His most likely diagnosis is:
- Emphysema
- Chronic Bronchitis
- Small Cell Lung CA
- Pulmonary Fibrosis
Explanation
Correct Answer: B) Chronic Bronchitis
This patient's presentation is classic for chronic bronchitis — defined as a productive cough for at least 3 months per year for 2 consecutive years. Key features include a chronic morning productive cough, yellow sputum, rhonchi, and wheezing. While hyperinflation can appear in both emphysema and chronic bronchitis, the dominant feature of productive cough and rhonchi points to chronic bronchitis. Emphysema typically presents with a "pink puffer" profile — barrel chest, minimal sputum, and predominantly diminished breath sounds.
The left ventricle of the heart from a 70-year-old man is examined at autopsy (shown). What was the most likely cause of the patient's death?
- Cardiac tamponade
- Congestive heart failure
- Hypovolemic shock
- Mycardial infarction
- Pulmonary thromboembolism
Explanation
Correct Answer: B) Congestive heart failure
The autopsy image shows a markedly dilated left ventricle with thinned walls, which is the classic gross pathology of dilated cardiomyopathy leading to congestive heart failure. In CHF, the ventricle becomes enlarged and weakened, losing its ability to pump blood effectively. The cavity dilation with wall thinning distinguishes this from hypertrophic changes seen in hypertension or other conditions.
A 26-year-old woman who recently emigrated from Africa presents with swelling of her right leg (elephantiasis shown). What is the name for fluid accumulation in the soft tissue of this patient's right leg?
- Ascites
- Effusion
- Fibrinous exudate
- Lymphedema
- Purulent exudate
Explanation
Correct Answer: D) Lymphedema.
The image shows elephantiasis — massive limb enlargement caused by chronic lymphatic obstruction. In tropical regions of Africa, this is most commonly caused by Wuchereria bancrofti, a parasitic filarial worm that obstructs lymphatic vessels. The resulting impairment of lymphatic drainage causes protein-rich fluid to accumulate in the soft tissues, a condition called lymphedema. Over time, chronic inflammation and fibrosis lead to the extreme limb enlargement seen in elephantiasis. Ascites refers to abdominal fluid, and effusion refers to fluid in body cavities, not soft tissue.
A 62-year-old woman suffers internal injuries in an automobile accident and appears to be in a state of shock. Two days later, the patient develops rapidly progressive respiratory distress and a pattern of "interstitial pneumonia" on chest x-ray (shock lung). Which of the following pathologic findings would be expected in the lungs of this patient with diffuse alveolar damage?
- Clusters of epithelioid macrophages
- Hyaline membranes and interstitial edema
- Intra-alveolar purulent exudate
- Pulmonary abscess
- Sheets of bacilli-filled macrophages
Explanation
Correct Answer: B) Hyaline membranes and interstitial edema.
This patient has developed Acute Respiratory Distress Syndrome (ARDS), also known as diffuse alveolar damage (DAD) or "shock lung," following traumatic injury and shock. The hallmark pathologic findings of DAD are hyaline membrane formation (composed of plasma proteins and cellular debris lining the alveolar walls) and interstitial edema due to increased capillary permeability. Purulent exudate indicates bacterial pneumonia, epithelioid macrophage clusters suggest granulomatous disease, and bacilli-filled macrophages point to mycobacterial infection — none of which match this clinical scenario.
68-year-old man with a history of heavy smoking suffers a massive heart attack and expires. A whole-mount of the patient's lungs is examined at autopsy. This patient suffered from which of the following chronic pulmonary diseases?
[IMAGE_5]
- Atelectasis
- Bronchiectasis
- Chronic bronchitis
- Emphysema
- Pneumonia
Explanation
Correct Answer: D) Emphysema.
The autopsy image shows enlarged, hyperinflated air spaces with destruction of alveolar walls, which is the hallmark of emphysema. Heavy cigarette smoking causes chronic inflammation and release of proteases (particularly elastase) that destroy alveolar walls, leading to permanent enlargement of airspaces distal to the terminal bronchioles. This reduces the surface area for gas exchange and leads to progressive dyspnea. Smoking also causes cardiovascular disease, explaining the concurrent massive heart attack in this patient.
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