02 GRAT - Hemodynamics

1.
A 65-year-old woman with history of chronic ischemic heart disease, presents to the
physician’s office with chief complaints of breathlessness for the past one week. Vitals are
stable. General physical examination reveals findings shown in the attached image.
Physical findings include bibasilar inspiratory crackles, distention of the neck veins, and
tender hepatomegaly. Which of the following chemical alterations is most likely operative
in this patient? –
A. Decreased plasma renin activity

B. Decreased serum concentration of
antidiuretic hormone (ADH)
C. Decreased serum concentration of atrial
natriuretic peptide (ANP) (attempts to
counter RAAS system)
D. Increased serum sodium concentration
(Normal sodium maintained by ANP)
E. Increased serum concentration of
aldosterone
2. A 32-year-old man driving cross-country with his buddies is brought to the ER after he
suddenly develops shortness of breath, hemoptysis, and chest pain. He has had no recent
trauma or surgeries but was successfully treated for acute promyelocytic leukemia three
years ago. His mother has a history of deep venous thrombosis (DVT). EKG reveals sinus
tachycardia. Imaging findings are shown in the attached image. Which of the following
options best rules in the possibility of an inherited thrombophilia in this patient?
A. Male sex
B. Immobilization
C. Malignancy
D. Age less than 40 years
Immobilization would contribute to the

formation, but it would be more indicative of
acquired thrombophilia rather than inherited
(from the mother). PML can cause DIC.
3. A 75-year-old male suffers a massive stroke and passes away. At autopsy, examination
of the wall of the left ventricle reveals a dry, friable, hemorrhagic mass adherent to the
wall with gross laminations. Histopathologic examination of the mass shows extensive
growth of smooth muscle cells, fibroblasts and endothelial cells. Which of the following
best describes the findings obtained?
A. Canalization
B. Propagation
C. Hyalinization
D. Organization
E. Dissolution
4. A 9-month-old infant is brought to the emergency room with a 3-hour history of intense
abdominal pain and bloody diarrhea. Physical examination reveals a tender abdomen
without ascites. The child dies 24 hours later, and torsion (volvulus) of the small bowel is
discovered at autopsy. Autopsy findings are shown in the attached image. Which of the
following best describes the underlying mechanism for the likely histopathologic finding
associated with the small bowel, in this case? (red infarct)
red arrow: normal bowel
black arrow: ischemic bowel
white arrow: adhesions
A. Release of hydrolytic enzymes by

neutrophils causing the tissue to liquefy
(liquefactive)
B. Denaturation of structural enzymes
and proteins (coagulative)
C. Lipid release from cell walls of
tuberculous bacteria (caseous)
D. Vascular acellular necrosis in immune
mediated disease producing fibrinoid
deposits. (fibrinoid)
E. Enzyme mediated necrosis causing saponification (fat necrosis)
5. An 88-year-old woman with chronic ischemic heart disease and a history of smoking
complains of increasing shortness of breath. Past history is significant for recurrent
hospital admissions for breathlessness and fatigue. On physical examination, the patient
has swollen legs, an enlarged liver, and fluid in the pleural spaces. Crepitations are heard
on auscultation. She suffers a massive heart attack and expires. Microscopic examination
of the liver at autopsy would most likely reveal which of the following findings?
(A) PAS positive globules within hepatocytes – alpha-1-antitrypsin
(B) Large iron deposits within hepatocytes - hemochromtosis
(C) Massive hepatic necrosis - Cirrhosis
(D) Regenerating hepatic nodules surrounded by fibrous bands - Cirrhosis
(E) Centrilobular hemorrhage with hemosiderin laden macrophages (heart failure cells)
6. A 32-year-old man is admitted to the ICU after an automobile accident. He suffered a

compound fracture of the femur and had internal bleeding from a ruptured spleen and
liver hematoma. Mean arterial pressure is 55mmHg (Normal 70-100mmHg).
His oxygen saturation is 92%, and his PaO2 is 72 mmHg on FiO2 of 0.6. A pulmonary artery
catheter was placed during surgery. His cardiac output is 7.8 L/min. A lactate level is 4.8
mmol/L. Which of the following would be elevated above normal levels in the
compensatory stage of this shock? – Hypovolemic Shock
a. Cardiopulmonary receptor activity

b. Carotid baroreceptor activity
c. Right ventricular end-diastolic volume (decreased – blood loss)
d. Splanchnic blood flow (decreased)
e. Heart rate (reflex tachycardia)
7. A 45-year-old female is admitted unconscious, to the neurologic ICU with a C2-3 spinal
cord transection, following an automobile accident. The patient is in shock with a blood
pressure of 72/40 mmHg. What would the expected findings be on a pulmonary artery
catheter? – Neurogenic (Distributive)
CVP PCWP CO SVR
A Decreased Decreased Increased Decreased
B Increased Increased Decreased Increased
C Increased Increased/ Decreased Increased
decreased
D Decreased Decreased Decreased Increased
E Decreased Decreased Decreased Decreased
A. A
B. B
C. C
D. D
E. E
8. A 69-year-old woman with a history of atrial fibrillation is started on an oral

anticoagulant. Her prothrombin time is monitored on a regular basis. A few months into
her therapy, she begins treatment for a duodenal ulcer and she develops symptoms of a
bleeding diathesis. Which of the following ulcer medications is most likely responsible for
this change in her hemostatic status? – warfarin toxicity
A. Cimetidine (cytP450 inhibitor)

B. Famotidine
C. Misoprostol
D. Omeprazole
E. Ranitidine
9. A 65-year-old woman with a history of coronary artery disease has several episodes of
transient ischemic attacks (TIA). Her past medical records show a history of severe aspirin
sensitivity. Which of the following would you consider to be the best alternative to
aspirin?
A. Abciximab
B. Cilostazol
C. Dipyridamole
D. Ticlopidine (alternate to aspirin with Incr. Side effects)
E. Tirofiban
10. An 81-year-old male nursing home resident with severe dementia is brought to the
emergency department due to a one-day history of lethargy fever and vomiting. His
caregivers report that he has had poor oral intake over the last week. His past medical
history is significant for emphysema, congestive heart failure with reduced left ventricular
systolic function, hypertension, and type 2 diabetes mellitus. On physical examination, he
is lethargic but arousable. His blood pressure is 71/45 mmHg, and his heart rate is
122/min and regular. His extremities are warm. Coarse rhonchi are heard over the right
lower lung field. After receiving several intravenous fluid boluses, he is given an
intravenous infusion of an agent that increases peripheral vascular resistance, increases
systolic blood pressure, decreases pulse pressure, and decreases heart rate. Which of the
following agents is being described?
A. Atenolol
B. Dobutamine
C. Isoproterenol
D. Epinephrine
E. Phenylephrine (alpha agonist)

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1.

A. Decreased plasma renin activity

Immobilization would contribute to the

A. Release of hydrolytic enzymes by

6. A 32-year-old man is admitted to the ICU after an automobile accident. He suffered a

a. Cardiopulmonary receptor activity

8. A 69-year-old woman with a history of atrial fibrillation is started on an oral

A. Cimetidine (cytP450 inhibitor)

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