Cardiovascular System

Question 1

Which one if the following is not included as major criteria in Jones criteria?
A. Pancarditis
B. Arthritis
C. Subcutaneous nodules
D. Elevated ESR

Answer 1

Answer- D. Elevated ESR

Question 2

The mechanism of development of acute rheumatic fever is which of the following?
A. Cross reactivity with exogenous antigen
B. Innocent bystander effect
C. Due to toxin secretion by streptococci
D. Release of pyrogenic cytokines

Answer 2

Answer- A. Cross reactivity with exogenous antigen.

Acute rheumatic fever results from immune response to group A streptococci which cross-reacts with host tissues. The antibodies directed against M proteins of streptococci cross react with the self antigens in the heart. In addition CD4+ T cells specific for streptococcal peptides also react with self proteins of the heart and produce macrophage activating cytokines. So, the damage to the heart tissue is a combination of antibody and T cell mediated reactions.

Question 3

The presence of stroke, peripheral vascular disease and atherosclerosis is associated with which hormone?
A. Insulin deficiency 
B. Hyperestrogenemia
C. Hypothyroidism
D. Progesterone

Answer 3

Answer- A. Insulin deficiency

All the mentioned features in the question are the macrovascular complications of diabetes mellitus which is caused due to insulin deficiency.

Question 4

Most common cause of abdominal aortic aneurysm is
A. Atherosclerosis
B. Syphilis
C. Trauma
D. Congenital

Answer 4

Answer- A. Atherosclerosis

• At least 90% of all abdominal aortic aneurysm > 4.0 cm are related to atherosclerosis and most are present just below the renal arteries.
• Hypertension is the commonest cause of ascending aortic aneurysm.
• Cystic medial necrosis is characterized by weakness of the media due to degeneration of tunica media and it affects proximal aorta.
• Syphilitic aneurysms affect the ascending aorta or aortic arch.
• Tuberculous aneurysms affect the thoracic aorta
• Traumatic aneurysms affect descending thoracic aorta just below the site of insertion of ligament us arteriosum.

Question 5

Pathogenesis of all of the following is granulomatous, except 
A. Wegener's granulomatosis
B. Buerger's disease
C. Takayasu's arteritis 
D. Microscopic polyangitis

Answer 5

Answer- D. Microscopic polyangitis
Microscopic polyangitis is characterized by segmental fibrinoid necrosis of the media to focal transmural necrotizing lesions; Granulomatous inflammation is absent.

• It is also known as microscopic polyarteritis or leukocytoclastic vasculitis.
• Necrotizing vasculitis affecting arterioles/ capillaries/ venules in which all lesions are of the same age.
• p-ANCA is present in majority of the patients.
• Necrotizing glomerulonephritis and capillaritis are common.
• Fibrinoid necrosis associated with infiltration of neutrophils which become fragmented (leukocytoclasia)