PA5.1-6 | Hemodynamic Disorders — Practice Quiz

A 58-year-old woman with poorly controlled nephrotic syndrome presents with bilateral pitting pedal edema and ascites. Serum albumin is 1.8 g/dL. Which mechanism is MOST responsible for her edema?

Pleural fluid analysis from a patient with bacterial pneumonia yields: protein 5.2 g/dL, LDH 320 U/L (serum LDH 180 U/L), fluid/serum protein ratio 0.72, glucose 42 mg/dL, and cloudy appearance. These findings BEST characterise this fluid as:

At autopsy of a 72-year-old man who died of right-sided heart failure, the liver appears dark-red with a nutmeg-cut surface and yellowish zones between congested central areas. Microscopically, the central veins and surrounding sinusoids are distended with red cells. The hepatocytes at the centre are necrotic while periportal hepatocytes are preserved. This pattern is BEST explained by:

A 34-year-old woman, 3 weeks post-partum, presents with sudden onset breathlessness, pleuritic chest pain, and haemoptysis. D-dimer is markedly elevated and CT pulmonary angiogram shows a saddle embolus at the bifurcation of the main pulmonary artery. Which of the following BEST represents the Virchow's triad factor that contributed MOST to clot formation in this patient?

A venous thrombus removed during thrombectomy is examined histologically. The pathologist identifies alternating pale (platelet-fibrin) and red (erythrocyte-rich) laminations. These structures are BEST called:

A 55-year-old man undergoes emergency embolectomy for an acute limb-threatening arterial occlusion of the femoral artery. The embolus is described as grey-white, firm, and laminated. His ECG shows atrial fibrillation. This arterial thrombus most likely formed:

A 40-year-old woman develops sudden severe dyspnoea, hypoxia, and cardiovascular collapse 12 hours after delivering twins via a complicated vaginal delivery with perineal lacerations. She is afebrile. Chest X-ray shows bilateral diffuse infiltrates. Blood film shows fragmented red cells. The MOST likely diagnosis is:

A 68-year-old smoker with known coronary artery disease develops acute MI and is taken to the catheterisation lab. The artery supplying the infarcted territory is found to have a completely occlusive thrombus at the site of a ruptured plaque. 36 hours later, the infarcted area is reperfused but shows haemorrhagic discolouration on gross pathology. Which type of infarct is this, and WHY is it haemorrhagic?

A 25-year-old man sustains multiple long-bone fractures in a road traffic accident. 48 hours later he develops progressive confusion, petechial haemorrhages over the chest and axillae, and worsening hypoxia (PaO₂ 58 mmHg). CXR shows bilateral infiltrates. Blood lipase is normal. The MOST likely diagnosis is:

A 19-year-old medical student volunteers in a field hospital during a cholera outbreak. Three patients arrive simultaneously: Patient A has profuse watery diarrhoea and sunken eyes (cholera); Patient B survived a house fire with 40% TBSA burns; Patient C had a witnessed cardiac arrest and is in cardiogenic shock. All three are hypotensive with cold clammy peripheries. For Patient A, the PREDOMINANT mechanism of shock is:

A 62-year-old woman is admitted to the ICU with septic shock from a ruptured appendix. Despite aggressive IV fluids, her blood pressure remains 70/40 mmHg. Investigations show elevated serum lactate (8 mmol/L), white cell count 22,000/mm³, and fibrinogen 80 mg/dL. She develops petechiae and oozing from IV sites. The MOST likely explanation for her coagulopathy is:

A 48-year-old man with decompensated alcoholic cirrhosis presents with tense ascites, jaundice, and bilateral ankle oedema. His serum albumin is 2.1 g/dL and portal pressure is estimated to be markedly elevated. Which combination of mechanisms MOST accurately explains his fluid accumulation?