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Rim Halaby (talk | contribs) Created page with "{{WBRQuestion |QuestionAuthor={{Rim}} |ExamType=USMLE Step 1 |MainCategory=Pathology |SubCategory=Cardiology |MainCategory=Pathology |SubCategory=Cardiology |MainCategory=Path..." |
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{{WBRQuestion | {{WBRQuestion | ||
|QuestionAuthor={{ | |QuestionAuthor= {{YD}} (Reviewed by {{YD}}) | ||
|ExamType=USMLE Step 1 | |ExamType=USMLE Step 1 | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
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|MainCategory=Pathology | |MainCategory=Pathology | ||
|SubCategory=Cardiology | |SubCategory=Cardiology | ||
|MainCategory=Pathology | |||
|MainCategory=Pathology | |MainCategory=Pathology | ||
|MainCategory=Pathology | |MainCategory=Pathology | ||
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|MainCategory=Pathology | |MainCategory=Pathology | ||
|SubCategory=Cardiology | |SubCategory=Cardiology | ||
|Prompt=A 57 year old man is brought to the emergency department with acute substernal chest pain that radiates to his left shoulder | |Prompt=A 57-year-old man is brought to the emergency department with acute-onset substernal chest pain for the past 2 hours. He explains that his pain radiates to his left shoulder and is associated with nausea and diaphoresis. Following appropriate work-up, he is diagnosed with ST-segment elevation myocardial infarction (STEMI). He undergoes coronary revascularization and is discharged from the hospital the next day. A histopathological analysis of this patient's myocardium will show which of the following findings on light microscopy 12 days following his STEMI? | ||
|Explanation=Following a myocardial infarction, the heart undergoes gross and microscopic changes that are collectively referred to as the evolutionary process of MI | |Explanation=Following a myocardial infarction, the heart undergoes gross and microscopic changes that are collectively referred to as the evolutionary process of MI:<br> | ||
*0 to 4 hours post-MI: Very early following MI, the heart undergoes no gross or microscopic changes.<br> | |||
*4 to 12 hours post-MI: The infarcted area starts to demonstrate dark mottling. During that period also, there is edema, coagulative necrosis, and hemorrhage. Wavy fibers are observed microscopically.<br> | |||
|AnswerA= | *12 hours post-MI: Neutrophilic infiltration begins and contraction bands appear, signaling reperfusion injury. Necrotic changes are also observed during that time because cells release their necrotic material.<br> | ||
|AnswerAExp=Contraction bands, necrotic changes, and neutrophil migration starts 12 hours | *1 day post-MI: The infarcted area becomes hyperemic, and coagulative necrosis becomes more extensive with more inflammatory changes and neutrophilic migration. These changes persist for 3 days.<br> | ||
|AnswerB=Normal pathological specimen | *3 to 15 days post-MI: The border of the infarcted area becomes hyperemic and shows a soft yellowish infarcted region on gross pathology, and macrophage infiltration followed by granulation tissue is evident on light microscopy.<br> | ||
|AnswerBExp=A normal pathological specimen may be | *2 weeks post-MI: The infarcted area turns grayish and a contracted scar is formed. These changes persist for several months post-MI. | ||
|AnswerA=Formation of contraction bands | |||
|AnswerAExp=Contraction bands, necrotic changes, and neutrophil migration starts 12 hours following the onset of myocardial infarction. Neutrophilic migration persists for a few days. | |||
|AnswerB=Normal pathological specimen | |||
|AnswerBExp=A normal pathological specimen may be observed in 2 cases: Either in a normally perfused myocardium or within very early stages (0 to 4 hours) post-MI. | |||
|AnswerC=Necrotic cells and neutrophil migration | |AnswerC=Necrotic cells and neutrophil migration | ||
|AnswerCExp=Contraction bands, necrotic changes, and neutrophil migration starts 12 hours | |AnswerCExp=Contraction bands, necrotic changes, and neutrophil migration starts 12 hours following the onset of myocardial infarction. Neutrophilic migration persists for a few days. | ||
|AnswerD=Edema, hemorrhage, and wavy fibers | |AnswerD=Edema, hemorrhage, and formation of wavy fibers | ||
|AnswerDExp=Edema, hemorrhage, and wavy fibers are | |AnswerDExp=Edema, hemorrhage, and presence of wavy fibers on microscopy are all observed in early coagulative myocardial necrosis during the early stages (4 to 12 hours) post-MI | ||
|AnswerE=Macrophage infiltration and granulation tissue | |AnswerE=Macrophage infiltration and formation of granulation tissue | ||
|AnswerEExp=Macrophage infiltration and granulation tissue are | |AnswerEExp=Macrophage infiltration and granulation tissue are observed starting 3 days post-MI. These findings persist to approximately 15 days post-MI. | ||
|EducationalObjectives=At 3 to 15 days post-MI, light microscopy of the heart typically shows infiltration of macrophages and formation of granulation tissue. | |||
|RightAnswer=E | |RightAnswer=E | ||
|WBRKeyword= | |WBRKeyword=Myocardial infarction, STEMI, Chest pain, Inflammation, Neutrophilic infiltration, Granulation tissue, Light microscopy, Post-MI | ||
|Approved= | |Approved=Yes | ||
}} | }} |
Latest revision as of 01:39, 28 October 2020
Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]] |
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Exam Type | ExamType::USMLE Step 1 |
Main Category | MainCategory::Pathology |
Sub Category | SubCategory::Cardiology |
Prompt | [[Prompt::A 57-year-old man is brought to the emergency department with acute-onset substernal chest pain for the past 2 hours. He explains that his pain radiates to his left shoulder and is associated with nausea and diaphoresis. Following appropriate work-up, he is diagnosed with ST-segment elevation myocardial infarction (STEMI). He undergoes coronary revascularization and is discharged from the hospital the next day. A histopathological analysis of this patient's myocardium will show which of the following findings on light microscopy 12 days following his STEMI?]] |
Answer A | AnswerA::Formation of contraction bands |
Answer A Explanation | AnswerAExp::Contraction bands, necrotic changes, and neutrophil migration starts 12 hours following the onset of myocardial infarction. Neutrophilic migration persists for a few days. |
Answer B | AnswerB::Normal pathological specimen |
Answer B Explanation | AnswerBExp::A normal pathological specimen may be observed in 2 cases: Either in a normally perfused myocardium or within very early stages (0 to 4 hours) post-MI. |
Answer C | AnswerC::Necrotic cells and neutrophil migration |
Answer C Explanation | AnswerCExp::Contraction bands, necrotic changes, and neutrophil migration starts 12 hours following the onset of myocardial infarction. Neutrophilic migration persists for a few days. |
Answer D | AnswerD::Edema, hemorrhage, and formation of wavy fibers |
Answer D Explanation | AnswerDExp::Edema, hemorrhage, and presence of wavy fibers on microscopy are all observed in early coagulative myocardial necrosis during the early stages (4 to 12 hours) post-MI |
Answer E | AnswerE::Macrophage infiltration and formation of granulation tissue |
Answer E Explanation | AnswerEExp::Macrophage infiltration and granulation tissue are observed starting 3 days post-MI. These findings persist to approximately 15 days post-MI. |
Right Answer | RightAnswer::E |
Explanation | [[Explanation::Following a myocardial infarction, the heart undergoes gross and microscopic changes that are collectively referred to as the evolutionary process of MI:
Educational Objective: At 3 to 15 days post-MI, light microscopy of the heart typically shows infiltration of macrophages and formation of granulation tissue. |
Approved | Approved::Yes |
Keyword | WBRKeyword::Myocardial infarction, WBRKeyword::STEMI, WBRKeyword::Chest pain, WBRKeyword::Inflammation, WBRKeyword::Neutrophilic infiltration, WBRKeyword::Granulation tissue, WBRKeyword::Light microscopy, WBRKeyword::Post-MI |
Linked Question | Linked:: |
Order in Linked Questions | LinkedOrder:: |