- CORRECT ANSWER: Recognize epitheloid macrophages & *multinucleated giant
cells*
= predominant cells found in granulomas
concomitant macrophage induces T helper cells to differentiate into TH1 --> produce
*interferon-gamma* --> activates macrophages = killing mycobacteria ability
- absence of any aortic valve pathology = pressure in aorta similar to LV pressure during
systole
Aortic stenosis
- abnormal pressure gradient between left ventricular & aortic pressure tracings during
systole
- intensity directly related to magnitude of left ventricle to aorta pressure gradient
= systolic ejection-type, crescendo-decrescendo murmur
,- starts after first heart sound & typically ends before A2 component of 2nd heart sound
- CORRECT ANSWER: A 73-year-old man is evaluated for exertional dyspnea. His
exercise tolerance has decreased over the last year, & he can barely walk 2-3 blocks
without stopping. The patient also reports occasional episodes of lightheadedness &
palpitations. He has had no chest pain or syncope. He was diagnosed with HT in the
past but does not taken any meds. Physical exam reveals a cardiac murmur. The
patient is referred to a cardiologist for further evaluation. Cardiac catheterization is
performed, & the findings are show in the image. What points most likely corresponds to
the peak murmur intensity in this patient?
- consolidation involving the right middle lobe (acute lobar pneumonia) can obscure this
- right middle lobe = immediately adjacent to right border of heart
- on posteroanterior (PA) chest x-ray projections, right atrium = most of right side of
cardiac silhouette - CORRECT ANSWER: Recognize *right atrium* on chest x-ray
- ACEI blocks synthesis of AII & Aldosterone
- AI & renin increase because they are both before the block
- bradykinin increase because ACE is inolved in kinase system --> cough, angioedema -
CORRECT ANSWER: An asymptomatic 42-year-old man with essential hypertension is
started on an angiotensin-converting enzyme inhibitor. What shows the most likely
effect of treatment on circulating levels of aldosterone, renin, & bradykinin?
- Aldosterone
- Renin
- Bradykinin
- decreased atmosphere oxygen (PO2) --> decreased PaO2 --> increased ventilation --
> decreased PaCO2 --> respiratory alkalosis --> altitude sickness
- increased 2,3-BPG --> binds Hb = Hb releases more O2
- increased renal excretion of HCO3- = compensates for respiratory alkalosis
- chronic hypoxic pulmonary vasoconstriction --> pulmonary HT & RVH - CORRECT
ANSWER: A healthy 5-year-old man who resides at sea level takes a 45-minute ride in
a cable car from near sea level to a skin resort (altitude 3050 m [10,000 ft]). What
labeled points on the diagram best represents this patient 30 minutes after arrival at the
resort?
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