Chapter 8

Question 1

1. 65 yo woman with history of smoking has 3 wk history of chest pain and bloody sputum; CXR shows hilar lung mass; also squamous cell carcinoma growing within lumen of bronchus; what chemical agent could be causing cancer?

Answer 1

Aromatic hydrocarbons (potent experimental carcinogens)

Question 2

2. 75 yo man in a shipyard for 25 years dies of thoracic tumor; autopsy shows pleural tumor; interstitial pulmonary fibrosis and multiple pleural plaques; we see brown beaded ferruginous bodies in lungs; what caused this?

Answer 2

Asbestos, leading to development of pleural tumor termed malignant mesothelioma. We see interstitial fibrosis of lungs and pleural plaques with dense CT; asbestos bodies with fibers are coated with protein and iron

Question 3

3. 47 yo man with 6 week history of increasing fatigue and drak-colored stools; CBC with Hg of 8.6 g/dL and microcytic, hypochromic RBC’s; peptic ulcer along lesser curvature of stomach; why the anemia?

Answer 3

Iron

Question 4

4. 49 yo woman with 2-mo history of yellow discoloration of eyes, abdo pain, weight loss, low-grade fever; PE with distended abdo, RUQ tenderness, palpable liver below costal margin; alcoholic hepatitis; with antifreeze and ethylene glycol present, which organ fails?

Answer 4

Kidney; acute tubular necrosis of kidney, leading to renal failure

Question 5

5. Neonate noted to have mild growth retardation and facial dysmorphology; mother an abuser of several substances. Why?

Answer 5

Alcohol; fetal alcohol syndrome with the listed symptoms, neurologic impairment, other congenital anomalies

Question 6

6. 10 yo boy with irritability and ataxia; has anemia, basophilic stippling of erythrocytes, dark-gray pigmentation of gums

Answer 6

Chronic lead poisoning; inhibits delta-aminolevulinic acid dehydratase and ferrochelatase, leading to to microcytic hypochroic anemia; we inhibit heme synthesis

Question 7

7. 50 yo man has enlarged liver; getting chronic exposure to vinyl chloride; what is he at risk for with respect to cancer of liver?

Answer 7

Angiosarcoma; malignant tumor of endothelial cells in liver; it’s associated with exposure to arsenic and Thorotrast

Question 8

8. Severely depressed 32-yo man commits suicide by running his car motor in his closed garage for several hours; CO poisoning happens how?

Answer 8

Displacement of O2 on Hg by CO

Question 9

9. Japanese fisherman lives in vicinity of plastics factory; has constriction of visual fields, paresthesias, ataxia, dysarthira, hearing loss; why the neurologic disease?

Answer 9

Mercury; organic mercurials can damage the brain, whereas inorganic mercury toxic to kidneys

Question 10

10. 12 yo boy has gangrene of fingers and toes; what mediates necrosis in fingers and toes of the patient after being stuck in the woods?

Answer 10

Membrane disruption by water crystals; crystallization of tissue water, causes cellular disruption and vascular changes resulting in frostbite; mech disruption of cellular membranes by ice crystasl occurs during both freezing and thawing

Question 11

11. 35 yo man hospitalized with 3-degree burns after being rescued from house fire. Suffers from shock and oligura, but renal function returns to normal; most likely cause of death?

Answer 11

Sepsis; the burned skin

Question 12

12. Adult running marathon in summer has hot dry skin, cessation of sweating, lactic acidosis, hypocalcemia, muscle necrosis (rhabdomyolysis); diagnosis?

Answer 12

Heat stroke; happens during unusually vigorous exercise; done on exertion espeically with ambient temp is high

Question 13

13. 26 yo electrician found unconscious in backyard beside metal ladder and exposed electrical wire and deep burn on right hand; what was cause of death?

Answer 13

Cardiac arrhythmia; electrical energy disrupts system within heart and causes death through v fib

Question 14

14. Sailor seen after breach in reactor containment system of sub; has pancytopenia, Hg 7.8 g/dL, WBC count 900/uL, platelets low; how many rads of acute total-body radiation?

Answer 14

300 rads: depression of bone marrow, symptoms related to granulocytopenia and thrombocytopenia within two weeks; anemia comes more slowly

Question 15

15. Sailor on that same sub dies 10 days after accident with severe diarrhea and dehydration; how many rads?

Answer 15

1000; destruction of tissues composed of proliferating cells; damage to GI tract most serious consequence

Question 16

16. 66 yo woman with 6-mo history of scaling and abnormal pigmentation of skin; treated for thyroid cancer 1 yr ago; atrophy of epidermis and dense fibrosis of dermis, and dilated superficial bv’s; what was the exposure?

Answer 16

Radiation therapy; consider that the treatment of cancer traverses first the skin and you get radiation dermatitis

Question 17

17. 28 yo radar technician on aircraft carrier subjected to intense microwave radiation for 7 years; elevated risk for developing what?

Answer 17

Not associated with ANY health risks!

Question 18

18. 15 yo African boy with history of tooth loss, gingivitis, skin heorrhages, multiple infections, poor wound healing; also bad height and weight; why?

Answer 18

Scurvy; need Vit C for collagen syntehsis; deficiency is poor wound healing; perifollicular hemorrhages, also gingivitis, alveolar bone resorption

Question 19

19. 24 yo woman has dermatitis, diarrhea, dementia; condition?

Answer 19

Pellagra

Question 20

20. 45 yo woman with longstanding Crohn disease and fat malabsorption has fracture of femoral neck after contusion; what vit is deficient?

Answer 20

Vit D (see problem with vit D absorption with lipid malabsorption, and also osteomalacia)

Question 21

21. Alcoholic with peripheral neuropathy, difficulty balancing and dementia; has arrhythmia and lesions in mamillary bodies; what is the deficiency?

Answer 21

Vit B1

Question 22

22. 40 yo malnourished woman with 6 mo history of night blindness; keratomalacia and corneal ulceration; what to suspect?

Answer 22

Vit A

Question 23

23. 26 yo woman with fever and shaking chills; pulse 120/min, BP 140/80; PE with harsh systolic murmur; then headache and coma; what leads to the bloody aortic valve?

Answer 23

IV drug abuse; introducing bacteria that leads to bacterial endocarditis, like with Staph aureus; the photo shows adherent vegetations on aortic valve, and vegetations with platelets, fibrin, cell debris, masses of organisms

Question 24

24. 50 yo woman with easy fatigability, smooth sore tongue, numbness and tingling of feet, weakness of legs; CBS with megaloblastic anemia not reversed by folate theraphy; Hg is low, WBC count low, platelets lows; deficiency?

Answer 24

Vit B12

Question 25

25. Starving 4 yo African boy with apathy, generalized emea, fatty liver; despite generalized growth failure, subcutaneous fat is preserved; deficiency?

Answer 25

Kwashiorkor; deficiency of protein in diet; features edema, large fatty liver, depigmentation of skin; apathy notable, diarrhea common, anemia IS THE RULE!!!

Question 26

26. Petechial hemorrhages on upper and lower extremities of 5-day old infant; what deficiency?

Answer 26

Vit K (no klebsiella made by newborn)

Question 27

27. 6 yo girl in Africa has wasting of muscle and fat, protuberant abdomen; pulse, BP, temp are low, face wrinkled, NO EDEMA!! Diagnosis?

Answer 27

Marasmus

Question 28

28. 40 yo ill man from Vienamese village with painful sores around mouth; PE shows prominent fissures at angles of mouth; cheilosis of patient most likely caused by deficiency of which vitamins?

Answer 28

Vitamin B2

Question 29

29. 32 yo woman is a vegan, weak and pale, with macrocytic, normochromic anemia; what deficiency?

Answer 29

Vit B12

Question 30

30. 46 yo man with weakness, dyspnea on exertion, palpitations; pulse 95, RR 24, BP 120/80; PE with pulmonary rales and peripheral edema; normal serum cholesterol and elevated fasting blood sugar; cardiomegaly but no valvular abnormalities or old MIs; normal coronary arteries; cause?

Answer 30

Chronic alcoholism; alcoholic cardiomyopathy leads to dilation and hypertrophy of the heart; disorder could cause congestive heart failure

Question 31

31. 28 yo pregnant woman gives birth to small baby with no congenital abnormalities; why the low birth weight?

Answer 31

Smoking; fetal tobacco syndrome; small for gestational age, and not born preterm; incidence of abruptio placentae, placenta previa, uterine bleeding and premature rupture of the membranes are all increased in women who smoke

Question 32

32. 52 yo man with sudden crushing chest pain and tachy; cig smoker, alchol drinker, abuses illicit drugs; elevated serum levels of CK-MB and troponin I; why these problems?

Answer 32

Cig smoking; major independent risk factor for MI and acts with other risk factors like high BP and blood cholesterol levels (elevated in his case) to lead to MI

Question 33

33. 52 yo man with chronic cough and SOB; smokes two packs of cigs a day for 30 years; pulmonary function tests show COPD; increased risk of smoking-related cancer in what organ?

Answer 33

Pancreas; adenocarcinoma!!

Question 34

34. Homeless, poorly nourished man collapses on street, long history of abusing many illicit drugs; moderately enlarged heart; patent coronary arteries, no valvular abnoramlities; patchy fibrosis of myocardium; what caused cardiomyopathy?

Answer 34

Cocaine; leads to anxiety, delirium, occasionally seizures; can affect small intramyocardial, coronary arteries

Question 35

35. 52 yo obese man has hoarseness for 2 months; worked in chemical factory for 25 years; smoker, consumes 1-2 beers a day, uses illicit drugs; enlarged and firm cervical lymph nodes; squamous cell carcinoma; why the disease?

Answer 35

Cig smoking

Question 36

36. 48 yo man with weakness, easy fatigability for 6 weeks; 20 years in chem factory; CBC with low Hg, high WBC count, low platelet count; bone marrow aspirate shows malignant melobasts, with acute myeloid leukemia as diagnosis; what exposure lead to diagnosis?

Answer 36

Benzene; bone marrow is principal target of chronic benzene intoxication; we see hypoplasia or aplasia of bone marrow and pancytopenia

Question 37

37. 48 yo woman with weakness, fatigue, easy bruisability for 2 mos; tech in nuclear energy plant for 15 years and exposed to considerable radiation; PE shows enlarged liver and spleen; what do you suspect?

Answer 37

Chronic melogenous lekemia; whole body radiation ultimately leads to cancer

Question 38

38. 16 yo girl with severe celiac disease for years has continued steatorrhea; has abod pain in RLQ; CBC with high Hg, high WBC, high neutrophils, relatively normal platelets; appendicitis is diagnosis;

Answer 38

Vit K deficiency; common in severe fat malabsorption, like in celiac sprue and biliary tract obstruction

Question 39

39. 24 yo beating victim brough to ER with 4-cm tear of skin caused by blunt trauma. What describes the lesion?

Answer 39

Laceration; it is a linear tear of the skin produced by force casuing unidirectional displacement

Abrasion is skin defect caused by crushes or scrapes
Avultion is tearing away or forcible sepration
Contusion: localized mech injury with focal hemorrhage