NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University
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Free NU570 Adv Physiology Pathophysiiology. Thomas Jeferson University Questions
A 72-year-old woman complains of shortness of breath on exertion. She becomes short of breath at night unless she uses three pillows to prop herself up (orthopnea). Physical examination reveals mild obesity, bilateral pitting leg edema, enlarged liver, and fine crackling sounds on inspiration (rales). A chest x-ray shows cardiomegaly. What is the most likely cause of orthopnea in this patient?
- Cardiac tamponade
- Cor pulmonale
- Hypovolemic shock
- Portal hypertension
- Pulmonary edema
Explanation
Correct Answer: E) Pulmonary edema.
This patient has classic signs of congestive heart failure — cardiomegaly, bilateral pitting edema, hepatomegaly, and pulmonary rales. Orthopnea (needing multiple pillows to breathe at night) occurs because lying flat causes redistribution of fluid from the legs and periphery into the pulmonary circulation, worsening pulmonary edema and making breathing difficult. Sitting upright uses gravity to reduce venous return and pulmonary congestion, relieving symptoms. Pulmonary edema from left-sided heart failure is the direct cause of orthopnea in this patient.
A 55-year-old stone worker presents with a 5-year history of increasing shortness of breath. Chronic inhalation of quartz (silicon dioxide) in this patient most likely caused which of the following lung diseases?
- Asthma
- Atelectasis
- Bronchiectasis
- Emphysema
- Pneumoconiosis
Explanation
Correct Answer: E) Pneumoconiosis.
Pneumoconiosis is a group of occupational lung diseases caused by chronic inhalation of inorganic dust particles. Silicosis, caused specifically by quartz (silicon dioxide) inhalation, is the most common form seen in stone workers, miners, and sandblasters. Inhaled silica particles are engulfed by alveolar macrophages, which die and release fibrogenic factors, leading to progressive pulmonary fibrosis and nodule formation. The gradual onset of dyspnea over years is characteristic. The other conditions listed are not caused by occupational dust inhalation.
A 50-year-old alcoholic man was brought to the Emergency Department in respiratory distress, complaining of stabbing chest pain on inspiration and sudden onset chills. He was running a high fever (104°F), coughing, and expectorating a thick yellow-green sputum. Which of the following is the most likely cause of his respiratory distress?
- Bacterial pneumonia
- Chronic bronchitis
- Emphysema
- Laryngitis
- Metastatic lung cancer
Explanation
Correct Answer: A) Bacterial pneumonia.
The combination of high fever, chills, productive cough with thick purulent (yellow-green) sputum, pleuritic chest pain (worsened by inspiration), and respiratory distress is classic for bacterial pneumonia. Alcoholism is a major risk factor because it impairs mucociliary clearance, suppresses immune defenses, and increases aspiration risk. Common causative organisms include Streptococcus pneumoniae and Klebsiella pneumoniae. None of the other listed conditions present with this acute infectious picture.
A neonate is rushed to the hospital in acute respiratory distress and expires. The lungs are examined at autopsy. This pulmonary condition is termed:
- Atelectasis
- Bronchiectasis
- Emphysema
- Pneumonia
- Pulmonary aplasia
Explanation
Correct Answer: A) Atelectasis.
The autopsy image shows collapsed, airless, dark red lungs that have failed to expand — consistent with neonatal atelectasis, most commonly caused by surfactant deficiency in premature infants (hyaline membrane disease/neonatal respiratory distress syndrome). Without adequate surfactant, alveolar surface tension remains high, causing alveoli to collapse after each breath. The lungs appear dark and liver-like rather than the expected spongy, air-filled appearance. This is a leading cause of respiratory failure and death in premature neonates.
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.
A 69-year-old man is brought to the Emergency Department because of the sudden onset of left-sided chest pain that is exacerbated upon inspiration. Physical examination reveals dyspnea and hemoptysis. His temperature is 38°C (101°F), pulse is 110/min, respirations are 35/min, and blood pressure is 158/100 mm Hg. A lateral chest wall friction rub is present on auscultation. The left leg is markedly edematous. A chest x-ray reveals a left pleural effusion. What is the most likely cause of this patient's left-sided chest pain, pleural effusion, dyspnea, and hemoptysis?
- Congestive heart failure
- Cor pulmonale
- Diffuse alveolar damage
- Pulmonary thromboembolism
- Subacute bacterial endocarditis
Explanation
Correct Answer: D) Pulmonary thromboembolism.
This presentation is classic for pulmonary thromboembolism (PE). The key findings are pleuritic chest pain (worsened by inspiration), hemoptysis, tachycardia, tachypnea, pleural friction rub, pleural effusion, and unilateral leg edema indicating deep vein thrombosis (DVT) as the source of the embolus. The clot travels from the leg veins to the pulmonary circulation, causing pulmonary infarction. Congestive heart failure would present with bilateral edema and would not cause a friction rub. The unilateral leg swelling is the critical clue pointing to DVT-related PE.
An adult who has never smoked or been around cigarette smoke is unlikely to have which of the following diseases?
- Adenocarcinoma of the lung
- Small cell carcinoma of the lung
- Mature carcinoid tumor
- Squamous cell carcinoma of the lung
Explanation
Correct Answer: B) Small cell carcinoma of the lung
Small cell carcinoma of the lung has the strongest association with cigarette smoking of all lung cancers — it is almost exclusively found in smokers and is exceedingly rare in non-smokers. It arises from neuroendocrine cells and is highly aggressive. Adenocarcinoma, by contrast, is the most common lung cancer in non-smokers and women. Squamous cell carcinoma is also strongly linked to smoking but can occasionally occur in non-smokers. Carcinoid tumors are unrelated to smoking.
A 68-year-old woman is admitted to the hospital with a chief complaint of substernal chest pain. Examination reveals an obese woman (BMI 32 kg/m2) with a long history of angina pectoris and intermittent claudication (leg cramps). Which of the following is the most likely underlying disease process in this patient?
- Atherosclerosis
- Deep venous thrombosis
- Diabetes mellitus
- Necrotizing vasculitis
- Systemic hypertension
Explanation
Correct Answer: A) Atherosclerosis
This patient presents with two classic manifestations of atherosclerosis affecting different vascular beds: angina pectoris (coronary artery atherosclerosis causing myocardial ischemia) and intermittent claudication (peripheral artery atherosclerosis causing lower limb ischemia with exertion). Obesity is a major risk factor for atherosclerosis. The combination of ischemic chest pain and exercise-induced leg pain in the same patient is a strong indicator of systemic atherosclerotic disease. Atherosclerosis is the single unifying pathologic process that best explains this entire clinical picture.
A 92-year-old woman is brought unconscious to the emergency room from a nursing home. Her blood pressure is 70/30 mmHg. She is febrile (102°F) and breathing rapidly. Laboratory studies demonstrate an elevated white blood cell count with 92% segmented neutrophils. Urinalysis reveals gram-negative organisms. Which of the following types of shock most likely accounts for this patient's signs and symptoms?
- Anaphylactic
- Cardiogenic
- Hypovolemic
- Neurogenic
- Septic
Explanation
Correct Answer: E) Septic.
This patient presents with the classic features of septic shock: hypotension, fever, tachypnea, leukocytosis with neutrophilia, and a confirmed source of gram-negative infection in the urinary tract (urosepsis). Gram-negative bacterial endotoxins trigger a massive systemic inflammatory response causing widespread vasodilation and vascular permeability, leading to distributive shock. In elderly nursing home patients, urinary tract infections are the most common source of gram-negative sepsis, making this the most fitting diagnosis.
The left ventricle of the heart from an 82-year-old man is examined at autopsy (shown). [IMAGE_11] Which of the following is the most likely cause of this pathologic finding?
- Alcoholism
- Atherosclerosis
- Cigarette smoking
- Rheumatic fever
- Systemic hypertension
Explanation
Correct Answer: E) Systemic hypertension
The autopsy image shows a markedly hypertrophied left ventricle with a thickened wall and reduced chamber size — the classic gross pathology of concentric left ventricular hypertrophy. This is the hallmark response of the heart to longstanding systemic hypertension, where the ventricle must work against increased afterload. Over time, this compensatory hypertrophy can lead to diastolic dysfunction and eventual heart failure.
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