JCU MB4 Term 1 Week 3 (PVD)

1

A 74-year-old man has diminished right femoral, popliteal, and dorsalis pedis pulses. A CT image of his pelvis below the aortic bifurcation is shown. Describe the findings.

Contrast CT of iliac arteries

2

Picture shows opened aorta at autopsy. What is the arrow showing?

Soft plaque

3

A 25-year-old man has a 2-year history of worsening right leg pain, exacerbated by walking even short distances. On examination, his right femoral popliteal, and posterior tibial arterial pulses are absent. His total cholesterol is 430 mg/dL (desirable ≤ 200 mg/dL), and his HDL cholesterol is 22 mg/dL (normal ≥ 35 mg/dL). His CT angiogram is shown. What is the diagnosis?

CT Angiogram - RIA aneurysm

4

Microscopy of a coronary artery is shown. What clinical feature would be associated?

Coronary Artery - Stable plaque

5

Microscopy of a coronary artery is shown. What clinical feature would be associated?

Coronary Artery - Complete occlusion

6

A 25-year-old man has a 2-year history of worsening right leg pain, exacerbated by walking even short distances. On examination, his right femoral popliteal, and posterior tibial arterial pulses are absent. His total cholesterol is 430 mg/dL (desirable ≤ 200 mg/dL), and his HDL cholesterol is 22 mg/dL (normal ≥ 35 mg/dL). His CT angiogram is shown. What is the most likely underlying disease in this man?

CT Angiogram - RIA aneurysm

7

An autopsy specimen of a coronary artery is shown. What is the best description of the morphology?

Coronary artery - soft plaque

8

A 65-year-old man has a 5-year history of post-prandial pain and intermittent claudication. His BMI is 35 (normal 18.5-25), fasting glucose 209 mg/dL (normal < 110 mg/dL) and creatinine 2.3 mg/dL (normal = 1.2 mg/dL). His abdominal CT scan is shown. What does his aorta show?

Abdominal CT - Aortic calcification and thrombus

9

52-year-old male, sudden severe chest pain. Picture shows aorta at autopsy. What is the diagnosis?

Aortic dissection

10

58-year-old male, severe chest pain. Example gross specimen of his aorta is shown. What is the diagnosis?

Fusiform aortic aneurysm

11

A 65-year-old man has a 5-year history of post-prandial pain and intermittent claudication. His BMI is 35 (normal 18.5-25), fasting glucose 209 mg/dL (normal < 110 mg/dL) and creatinine 2.3 mg/dL (normal = 1.2 mg/dL). His abdominal CT scan is shown. What is the likely underlying condition?

Abdominal CT - Aortic calcification and thrombus

12

Microscopy of a coronary artery is shown. What is the feature shown my arrow C?

Labelled Coronary Artery Microscopy

13

A 74-year-old man has diminished right femoral, popliteal, and dorsalis pedis pulses. A CT image of his pelvis below the aortic bifurcation is shown. What is the pathogenesis of his disease?

Contrast CT of iliac arteries

14

A 69-year-old man has sudden sever abdominal pain. On exam his abdomen is distended and no bowel sounds are auscultated. Doppler ultrasonography shows absent superior mesenteric artery flow. An exploratory laparotomy is performed, and the results are shown in the picture. What has happened here?

Intestinal gangrene

15

A 65-year-old man reliably gets chest pain after climbing a single flight of stairs; the pain is promptly relieved by nitroglycerin. If we sampled his left anterior descending artery at this point, it would have the appearance shown. What term describes his symptoms.

Coronary artery - stable plaque

16

A 47-year-old woman has sudden chest pain radiating to her neck. An ECG shows Q waves and ST-segment elevation in two anatomically contiguous leads. She has a sudden arrhythmic even and, despite intervention, dis. The microscopic appearance of her left circumflex artery is shown. What cells contribute to this lesion?

Coronary artery - thrombotic occlusion

17

The coronary artery shown is from a 22-year-old man who died in a motor vehicle accident. What laboratory test findings indicate increased risk of progression to myocardial infarction or cardiac-related death?

Aorta with fatty streaks

18

A 61-year-old woman with lower extremity claudication, abdominal angina, and hypertension dies as a result of bowel infarction and resulting sepsis. The gross appearance of her aorta at autopsy is shown. How can these problems be treated?

Severe aortic atherosclerosis

19

A 63-year-old man has severe substernal chest pain radiating to his left jaw. He is hypotensive and tachycardic. He has elevated creatine phosphokinase and troponin I, and is admitted to the cardiac intensive care unit. He dies 24 hours later of intractable tachycardia. His myocardium at autopsy is shown. What is the diagnosis?

MI - less than 24 hours

20

A 54-year-old man with hypertension and a 60-pack-year smoking history has prolonged chest pain radiating to his neck. He abruptly develops severe dyspnoea 3 days later. Examination reveals hypotension and tachycardia, with diffuse rales and a high-pitched holosystolic murmur radiating to the axilla. He dies in florid pulmonary oedema. His heart is shown at autopsy.

Mitral valve papillary muscle rupture

21

A 56-year-old male smoker with hypertension and type 2 diabetes has a 3-hour episode of chest discomfort attributed to heartburn from shovelling snow too soon after a large beer and pizza repast. The discomfort abates, but he dies suddenly 5 days later while watching television. His myocardium at autopsy is shown. What life-threatening complication of this disease may now have happened?

MI - 1 to 3 weeks

22

One year after a myocardial infarction, a 65-year-old woman has congestive heart failure with an ejection fraction of 25% (normal 50% to 75%). She has a sudden embolic stroke and dies; her heart is shown at autopsy. What is the cause of her death?

Healed MI with aneurysm and fibrosis