Image questions Flashcards
50 yom with chest pain for 24 hours: (a fib/ventricular tachycardia/ventricular bigeminy)
ventricular bigeminy: a ventricular premature beat follows each normal beat
55 yom with 4 hours of crushing chest pain. (anterior wall MI/inferior wall MI/anteroseptal MI/RV MI/L lateral wall MI)
inferior wall MI.
The electrocardiogram shows the early hyperacute injury phase of inferior wall myocardial infarction. This is reflected by the marked slope elevation of the ST segments, and the increased amplitude of the T waves in Standard leads II and III, and lead aVF. Reciprocal ST segment depression occurs in Standard leads I, lead AVL and leads V 4 to V6.
lipid deposition and smooth muscle cell hyperplasia (accumulation in intima)
atherosclerosis
two findings
atherosclerosis and thrombus
dissecting aorta
medium sized arteries, smoking history
Buerger disease (thromboangiitis obliterans)
what vessel does syphilitic aneurysm typically affect
ascending aorta (vasa vasorum)
xanthomas in which disease
familial cholesterolemia (foamy macrophages, ApoE involved, lacks LDL receptor)
filarial worm infestation causing obstruction of what
lymph nodes (elephantiasis)
biopsy of skin lesion in 25yow patient with proteinuria, recent hx of Hep B infection, P-ANCA, elevated erythrocyte sed rate
polyaderitis nodosa (medium sized and smaller muscular arteries, fibrinoid necrosis)
AIDS patient with multiple purple-colored skin nodules on hands and feet. What virus is implicated
HHV 8 (Kaposi sarcoma)
70yow with throbbing unilateral headache and vision problems, mandibular pain
Giant cell arteritis
cavernous hemangioma
thoracic aorta with aldehyde fuchsin stain
cystic medial necrosis (dissecting aneurysm). focal loss of elastic and muscle fibers in the aortic media leads to cystic spaces filled with pools of metachromatic myxoid material
aneurysm
coronary artery section in pt with familial hypercholesterolemia. what’s in it?
platelets and RBCs + fibrin = thrombus (at an early age)
fever, skin rash, mucosal inflammation, lymph node enlargement. usually self limited but may involve coronary arteries and lead to aneurysm
Kawasaki
renal biopsy. (papillary necrosis/polyarteritis nodosa/monckeberg medial sclerosis/hyaline ateriolosclerosis)
hyaline ateriolosclerosis
varicose veins
excessive collagen deposition in the skin, subintimal fibromuscular thickening, renal biopsy. what is the disease
scleroderma
infant heart. (cardiac amyloidosis/endocardial fibroelastosis/hypoplastic left heart syndrome)
endocardial fibroelastosis (fibroelastotic thickening of the endocardium of the left ventricle, may also affect valves)
left main coronary artery 2 days after an MI. what histologic changes are present?
two days after MI: heart muscle will show myofiber necrosis, edema, and focal hemorrhage. this artery shows necrosis of cardiac myocytes and infiltrates of neutrophils
35 yom with MI, L main coronary artery two days later. what underlying disease does the patient have?
familial hypercholesterolemia
ruptured myocardial wall causes what
cardiac tamponade
this infarct was caused by thrombotic occlusion of which coronary artery
LAD (most common) supplies anterior wall and anterior septum of LV
image shows hemopericardium. myocardial rupture and hemorrhage into the pericardial sac is most commonly seen when after an MI
between 1 to 4 days after MI
this heart shows mural thrombosis in the aneursym. what is a likely complication?
stroke
RV hypertrophy and dilation secondary to pulmonary HTN
cor pulmonale (MCC is COPD)
presence of sterile vegetations on apparently normal cardiac valves in assoc with cancer or some other wasting disease
nonbacterial thrombotic endocarditis/marantic endocarditis
78yom with hx of recurrent syncope. aortic valve disease (bacterial endocarditis/calcific aortic stenosis/hypertrophic subaortic stenosis/marantic endocarditis)
calcific aortic stenosis
the boxcar nuclei in the myocardium on the right indicate what?
hypertension
sudden death in young athletes
hypertrophic cardiomyopathy–cardiac hypertrophy is out of proportion to the hemodynamic load placed on the heart, autosomal dominant
most common type of cardiomyopathy
dilated cardiomyopathy
heart with CHF shows biventricular dilation and hypokinesis, patchy interstitial mononuclear inflam infiltrate composed of T lymphocytes and macrophages
viral myocarditis
most common primary tumor of the heart
cardiac myxoma, most arise in LA
chronic fibrosing disease of the pericardium that compresses heart and restricts inflow (results from an exuberant healing response)
constrictive pericarditis
higher risk for cerebral embolism
mitral valve prolapse
mitral valve. (bacterial endocarditis/carcinoid heart disease/Libman-Sacks endocarditis/marantic endocarditis/mitral valve prolapse)
bacterial endocarditis
72 yow dies of CHF. aortic valve at autopsy
chronic rheumatic valvulitis (fusion of commissures!)
alcoholic patient, 40yom currant jelly sputum, diffuse pulmonary consolidation. (atypical/broncho/interstitial/lobar) PNA
lobar PNA
interstitial PNA in infants and immunocompromised pts. alveolar cells are large, show basophilic nuclear inclusions, peripheral halo and multiple cytoplasmic basophilic inclusions
CMV
pt undergoing chemo. cough, fever, multiple areas of consolidation and a large cavity in the RUL
invasive aspergillosis
38 yow with SLE being treated with corticosteroids who breeds pigeons. granulomas and budding yeast forms, stain positively for polysaccharides (actinomycosis/coccidiomycosis/cryptococcosis/histoplasmosis)
cryptococcosis–pigeon droppings
pt with AIDS, CXR shows bilat and diffuse infiltrates
pneumocystis jiroveci
(atelectasis/bronchiectasis/bronchoPNA/lobar PNA/pulmonary fibrosis)
pulmonary fibrosis
alveoli are filled with granular, proteinaceous, eosinophilic material, PAS positive, assoc with compromised immunity, leukemia, lymphoma
alveolar proteinosis aka lipoproteinosis
COPD in a young woman, long history of SOB, chronic cough, sputum production, wheezing
alpha 1 AT deficiency
status asthmaticus. what histo is present
smooth muscle hyperplasia and basement membrane thickening
numerous small, fibrotic nodules in both lungs
silicosis
worked on ships. pulmonary fibrosis and iron stains of lung tissue show numerous ferruginous bodies
asbestosis (diffuse interstitial fibrosis)
25 yo black woman with 3 month hx of cough and SOB on exertion. elevated ACE
sarcoidosis
rare pneumonitis that occurs in Sjogren and HIV
lymphocytic interstitial PNA (LIP)
23yom with nasal obstruction, serosanguinous discharge, cough, bloody sputum. CXR shows cavitated lesions and multiple nodules over both lung fields. Obliteration of maxillary sinuses. Hematuria, C-ANCA
Wegener granulomatosis–aseptic necrotizing granulomatous inflammation and vasculitis
pulmonary eosinophilic granuloma due to what disease
langerhans cell histiocytosis
patient responds favorably to antiestrogen and antiprogesterone tx. rare interstitial lung disease that occurs in women of childbearing disease
lymphangioleiomyomatosis
22yom with 6 months of increasing SOB and rusty sputum. linear deposits of IgG and C3 are detected in the alveolar basement membrane by immunofluorescence
Goodpasture
28 yom with 6 days of fever and SOB. pt does not respond to standard antibiotics. (lipid/pneumococcal/pneumocystis/eosinophilic/usual interstitial) PNA
eosinophilic PNA
53yom with increasing SOB on exertion, dry cough that has developed over a period of a few years. patchy scarring with extensive areas of honeycomb cystic change
usual interstitial PNA
55yow with sudden onset fever, dry cough, SOB. seen for flu like symptoms 6 weeks ago. biopsy shows inflamed airways with plugs of fibrous tissue
cryptogenic organizing PNA (bronchiolitis obliterans organizing PNA)
45yow with severe kyphoscoliosis with fatigue, SOB on exertion, fainting, bloody sputum. CXR shows enlargement of the central pulmonary arteries
pulmonary HTN
popcorn pattern of calcification
pulmonary hamartoma
what type of cancer in the lung
squamous cell carcinoma
history of smoking, peripheral subpleural mass
adenocarcinoma
lung cancer, stains for keratin and chromogranin are negative
large cell undifferentiated
primary pulmonary adenocarcinoma originating from stem cells in the terminal bonchioles
bronchioalverolar carcinoma
“oat cell” carcinoma, exhibits neuroendocrine features, Cushing Syndrome
small cell carcinoma (carcinoid tumor is also neuroendocrine BUT no Cushing syndrome)
neuroendocrine granules within tumor cells in the lung
carcinoid tumor
the heart of a patient who died in uremia displays what type of pericarditis
fibrinous pericarditis
