Pathology I Review 1

8/9/2019 Pathology I Review 1

1/45


2/45

Case 1

A 68 year old patient comes to theER with severe pain on left arm, leftneck, and chest. Patient states that

he has had angina pectoris in thepast but it resolved withNitroglycerine treatment. Vital

Signs = BP: is 150/95, RR: 25, P:85, Temp: 99F.


3/45

Case 1

What do you expect will happen withLactate, K+, Ca2+? (at the cellularlevel)

How will ATP be affected and why?

What is the likely diagnosis? Type ofNecrosis? Why?

Which test would you order to confirmdiagnosis?

How far ago did this patient actually

experience complete blockage of thecoronar arter ?


4/45

Case 1


5/45

Case 1

molATP&

LACTATEperG

ram

Dry


6/45

Case 1


7/45

Case 1


8/45

Case 1

After 95 minutes this patient is taken tothe Cath Lab. and was found to havea atherosclerotic plaque that occluded

96% of the Left Anterior DescendingCoronary Artery. A balloon angioplastywas performed and the perfusion wasimproved. When the patient woke up

from the anesthesia he complains ofsevere chest pain. The reason for thissymptom would be?, What causes thiseffect?, What would happen to the

Troponin and CKMB levels?


9/45


10/45


11/45

Case 2

A 53 year old female underwentsurgical repair of an Abdominal AorticAneurism a week ago. The surgeon

reported that during the procedure aclot found in the aneurism rupturedand therefore close observationshould be implemented. The patient

now presents with a BP of 210/110,hematuria, and proteinuria.

ANY THOUGHTS??

The patient has some evidence of

electrolyte imbalance.


12/45

Case 2

Evidence of Renal Infarction wascollected.

What accounts for the increase inBP?

What type of necrosis would youexpect to see in a tissue biopsy?

How would you describe this type oflesion in lung tissue and intestine?Why?


13/45

Case 2


14/45

Case 2


15/45

Case 2


16/45

Case 2


17/45

Case 3

A 35 year old male with history ofAtrial Fibrillation is brought to theEmergency Department after a

syncopalepisode. When examiningthe patient you notice slurredspeech, weakness on the left face

and left extremities, and numbnesson the same areas.

You immediately start a protocol to

manage which acute condition?


18/45

Case 3


19/45

Case 3

The patient was in fact diagnosed witha middle cerebral artery occlusionthat caused an ischemic infarct and

three years later he was pronounceddead due to a fulminant myocardialinfarction. What kind of brain tissueinjury would you expect to find during

the autopsy? Why?

What cells would you expect to see atthe site of the infarct if a tissue

sample was biopsied right after the


20/45

Case 3


21/45

Case 3


22/45

Case 4

A 64 year old patient presents to theER with a history of fever for thepast two days. You perform a CBC

which shows elevated PMN countand a glucose of 210mg/dl. Thepatient states that the sugar is high

because he forgot to take hisinsulin this morning. You then ordera chest X-ray.


23/45

Case 4


24/45

Case 4

After reviewing the radiograph youdetermine that this patients lesionis?

If this is a necrotic lesion, what typeof necrosis would it be?

You are not very sure about the

diagnosis so you order a CT scan.


25/45

Case 4


26/45

Case 4

You also decide to take a biopsywhich shows the following


27/45

Case 5

You are taking a pathology test andare given the following images.


28/45

Case 5

You are then asked to Identify:

1.Location of the lesion.

2.Type of lesion.

3.Cellular composition of the lesion(early and late).

4.Patients at risk for this type of lesion.


29/45

Case 6

A 25 year old female patient comes toyou due to severe abdominal pain.Upon first contact with the patient

you notice severe jaundice. Yoususpect a viral process and test forHepatitis viruses which comes backpositive for HBV.

The most likely cause for the jaundicewould be?

Which major players are involved in thisresponse?

What are the two pathways by which


30/45

Case 6

Name the initiator and executercaspases.

Name a couple of physiological

processes that involve Apoptosis.


31/45

Case 6


32/45

Case 6

You decide to take a biopsy of theliver tissue which is shows below.


33/45

Case 6


34/45

Case 6


35/45

Case 7

A patient that has been diagnosed withsevere cholecystitis and cholelythiasispresents to you with extreme abdominaland mid-back pain. She states that her

stools are clay colored and alsodescribes what you know is steatorrhea.

You immediately think that it is imperativeto order a series of blood tests which

should include serum calcium. What is the reasoning behind your

rationale?

What is your strongest differential

diagnosis?


36/45

Case 7

The patient was taken to the OR andthe surgeon had to remove thepancreas which looked as follow:


37/45

Case 7

Pathological biopsies were taken andshowed the following:


38/45

Case 7

What is the type of Necrosis?

Explain the series of events that leadto the previous injury.

Explain the role of Calcium.

Name a scenario in which fatnecrosis is NOT related to

Enzymatic damage.


39/45

Case 7


40/45

Case 8

A 45-year-old man is referred to clinicfrom a nearby shelter for homelessmen due to a cough that has beengoing on for about 7 months. Patient

reports that he has stayed at fourdifferent shelters and with a friendduring the past year, but would like tofind more permanent housing. Patient

returns to clinic with several newshelter residents that have beenreferred for screening. Tuberculin skintest is 15 mm in diameter. A chestradiograph was obtained and showed

the following:


41/45

Case 8


42/45

Case 8

The patient underwent surgery andthe following mass was removedfrom the apex of the lung:


43/45


44/45

Case 8


45/45

Documents

Pathology I Review 1