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A 66-year-old woman comes to the emergency department 3 hours after the onset of chest pain that radiates to her neck and left arm. She is diaphoretic and hypotensive; the serum troponin I level is elevated. Thrombolytic therapy is begun. Which of the following drugs is most likely to be administered _ _

A. Tissue plasminogen activator
B. Aspirin
C. Heparin
D. Nitric oxide
E. Vitamin K

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A 49-year-old man is in stable condition after an infarction of the anterior left ventricular wall. He receives therapy with antiarrhythmic and pressor agents. Three days later, he develops severe breathlessness, and an echocardiogram shows markedly decreased ejection fraction. He dies 2 hours later. At autopsy, which of the following microscopic changes is most likely to be present in the lungs _ _

A. Congestion of alveolar capillaries with fibrin and neutrophils in alveoli
B. Congestion of alveolar capillaries with transudate in alveoli
C. Fibrosis of alveolar walls with hemosiderin-laden macrophages in alveoli
D. Multiple areas of subpleural hemorrhagic necrosis
E. Purulent exudate in the pleural space
F. Purulent exudate in the mainstem bronchi

A 27-year-old man is on a scuba diving trip to the Caribbean and descends to a depth of 50 m in the Blue Hole off the coast of Belize. After 30 minutes, he has a malfunction in his equipment and quickly returns to the boat on the surface. He soon experiences difficulty breathing, with dyspnea and substernal chest pain, followed by a severe headache and vertigo. About 1 hour later, he develops severe, painful myalgias and arthralgias. These symptoms abate within 24 hours. Which of the following mechanisms is the most likely cause of these symptoms_ _

A. Disseminated intravascular coagulation
B. Systemic vasodilation
C. Venous thrombosis
D. Tissue nitrogen emboli
E. Fat globules in arterioles

A 39-year-old woman comes to the physician because she has noticed a lump in her breast. Over the past 2 months, the left breast has become slightly enlarged compared with the right breast. On physical examination, the skin overlying the left breast is thickened, reddish-orange, and pitted. Mammography shows a 3-cm underlying density, and a fine-needle aspirate of the density indicates carcinoma. Which of the following mechanisms best explains the gross appearance of the left breast _ _

A. Venous thrombosis
B. Lymphatic obstruction
C. Ischemia
D. Chronic passive congestion
E. Chronic inflammation

A 73-year-old man was diagnosed l year ago with pancreatic adenocarcinoma. He now sees his physician because of a transient ischemic attack. On auscultation of the chest, a heart murmur is heard. Echocardiography shows a l-cm nodular lesion on the superior aspect of the anterior mitral valve leaflet. The valve leaflet appears to be intact. The blood culture is negative. Which of the following terms best describes this mitral valve lesion _ _

Adenocarcinoma
B. Atheroma
Chronic passive congestion
D. Mural thrombus
E. Vegetation

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