Question 241
A 53-year-old male with a past medical history of hypertension is working with his wife in the garage when he complains of a sharp pain in his chest. He says that he thinks he pulled a muscle and goes inside the house to lie down. Three hours later, she finishes her work in the garage and goes inside to check on him and finds him dead. The county coroner orders an autopsy, which identifies the pathologic condition pictured in the image. Of the following, what was the most likely cause for its development?
A. Ruptured myocardial infarct
B. Coronary artery dissection
C. Aortic dissection
D. Inflammation of the pericardium
E. Hemorrhage into a pericardial tumor
Answer For Question 241
Answer: C (Aortic dissection)
Explanation: Given his medical history of hypertension and the symptoms of sharp chest pain, of the choices, the most likely cause is an aortic dissection. A ruptured myocardial infarct would not present so quickly after the onset of symptoms, and the chest pain associated with an acute myocardial infarct would not typically be described as sharp. A coronary artery dissection would be a rare cause of a hemopericardium. Inflammation of the pericardium and rupture of a pericardial tumor could also be possible causes, but would be very rare compared to an aortic dissection. At the white arrow, a blue discoloration is apparent–this is blood within the pericardial sac.
Question 242
A 57-year-old male with a history of hypertension and hyperlipidemia often has a relatively brief pressure sensation in his chest after climbing four flights of stairs; however, today, he has much more severe pressure in his chest while at rest and the sensation lasts 30 minutes. His wife calls an ambulance. The pathologic lesion causing his symptoms is pictured below. What histologic change is identified by the arrow?
A. Coagulative necrosis
B. Liquefactive necrosis
C. Metastatic calcification
D. Dystrophic calcification
E. Caseous necrosis
F. Hemosiderin
Answer for Question 242
Answer D (Dystrophic calcification)
Explanation: Calcification appears as irregular, chunky blue to purple, and variably sized pigment-like material. Dystrophic calcification affects damaged tissue (such as coronary artery atherosclerosis) and occurs in people with normal calcium blood concentrations; metastatic calcification can affect normal or abnormal tissue and occurs in people with higher blood calcium concentrations–the histologic appearance would be similar, but dystrophic calcification is far more common.
Question 243
A forensic pathologist is examining histologic sections in her office one afternoon and identifies the histologic feature illustrated below. Of the following, what is the most likely cause of the individual’s death?
A. Viral infection of myocardium
B. Multiple myeloma
C. Delayed death after untreated chest trauma
D. Dysrhythmia after resuscitated myocardial infarct
E. Parathyroid gland hyperplasia
Answer for Question 243
Answer: D (Dysrhythmia after resuscitated myocardial infarct)
Explanation: The histologic finding is contraction band necrosis (examples are at the black arrows), which are a feature of reperfusion injury, such as could occur with a resuscitated infarct. They may be due to calcium influx into the cell; however, they are not associated with parathyroid gland hyperplasia. There are no lymphocytes present as would be seen with viral myocarditis.
Question 244
A 25-year-old male collapses while playing basketball with friends. He is taken to the emergency room, but despite aggressive resuscitation, he does not survive. An autopsy is performed. Histologic examination of the heart reveals the pathologic change illustrated below. Of the following, which would have been found on gross examination of the heart?
A. An atrial septal defect
B. Fatty infiltration of wall of right ventricle
C. Thick interventricular septum
D. Anomalous origin of a coronary artery
E. Severe coronary artery atherosclerosis
Of the following, a mutation of which protein is most commonly associated with this disease entity?
A. Plakoglobin
B. LDL receptor
C. IL-7
D. CD31
E. β-myosin heavy chain gene
Answer for Question 244
Answer: C (Thick interventricular septum) and E (β-myosin heavy chain gene)
Explanation: The pathologic change illustrated in the image is myofiber disarray, which is characteristic of hypertrophic cardiomyopathy, which is associated with sudden cardiac death. Gross features of this disease process include a thick interventricular septum and fibrosis of the left ventricular outflow tract corresponding to the anterior leaflet of the mitral valve. The most common mutation causing this disorder is a mutation of the β-myosin heavy chain gene. Fat in the right ventricle and mutations of plakoglobin are associated with arrhythmogenic right ventricular dysplasia.
Question 245
A 62-year-old male presents to his family physician complaining of chest pain, which he describes as occurring after a consistent amount of physical exertion for the last three months and which lasts about 10 minutes. He has had no other symptoms associated with his chest pain. If the image illustrates the lesion causing his symptoms, of the following combinations, which best describes his symptoms and his underlying pathology?
A. Stable angina; vulnerable plaque
B. Stable angina; complicated plaque
C. Unstable angina; vulnerable plaque
D. Unstable angina; complicated plaque
E. Variant angina; vulnerable plaque
F. Variant angina; complicated plaque
Answer for Question 245
Answer: A (Stable angina; vulnerable plaque)
Explanation: Given the history, the patient has stable angina (recurring chest pain with exertion that has been occurring for some period of time and after a set amount of exertion). The plaque has a thin fibrous cap (white arrow), and thus, could be consider vulnerable to rupture or another acute change. The material at the blue arrow is calcification.
