The Heart and Blood Vessels

Question 1

severe sub-sternal chest pain with exertion 
relieved by nitroglycerine 
no murmors or gallops
normal Sr Cr
high cholesterol 
high blood glc 

What is the most likely etiology of the chest pain?

Answer 1

chronic stable angina dur to coronary artherlosclerosis 
#1

Question 2

44 yo woman with RHD with aortic stenosis had a valve replacement and has been stable for the past 8 years. She then develops diminished exercise tolerance. What is the most likely complication involving the prosthesis?

Answer 2

stenosis

thrombosis and embolism is less likey bc pts are on anti-coagulants 
#3

Question 3

Child with rheumatic fever develops left ventricular fibrillation and acute left ventricular failure. What is the most likely cause of the left ventricular heart failure?

Answer 3

myocarditis

*ARF also assc with pericarditis and endocarditis 
#4

Question 4

complication of ventricular aneurysm

Answer 4

systemic thromboembolism 
#6

Question 5

Where do ventricular aneurysm commony form?

Answer 5

weakness in the wall due to an MI

Question 6

atrial myxoma

Answer 6

primary cardiac neoplasm

Question 7

Cardiac rupture with temponade is a complication of …

Answer 7

5 to 7 days after an MI

Question 8

endocarditis is a likely complication of …

Answer 8

valvular heart disease or septal defects

Question 9

splinter hemorrhages seen with ….

Answer 9

bacterial endocarditis

Question 10

What are elevated antistreptolysin O titers assc with?

Answer 10

acute rheumatic fever

Question 11

postive ANCA is assc with

Answer 11

vasculitis

Question 12

high ds DNA auto ab is assc with

Answer 12

libman-sacks endocarditis

Question 13

10 year old girl who is normally developed with progressive exercise intolerance
cardiomegaly
mild pulmonary edema
ECG: severe left ventricular hypertrophy with a prominent inter-ventricular septum;l during systole the anterior leaflet of the mitral valve moves into the outflow tract of the left ventricle
abnormally high ejection fraction with low CO and ventricular volume.

What is the most likely cause of the abnormalities?

Answer 13

Beta-myosin heavy chain in hypertrophic cardiomyopathy 
#8

Question 14

19 y/o man with:
low grade fever
low BP
tender spleen
tender hemorrhages on soles and palms 
high WBC
heart murmur

Answer 14

infective endocarditis
#11

Question 15

Why complication is most lilly to occur 1 hr after an MI?

Answer 15

ventricular tachycardia
#12

Question 16

T or F: senile calcific stenosis involves the mitral valve

Answer 16

F: AORTIC VALVE

Question 17

72 yo woman with:
-episodes of disorientation, difficulaty speaking, weakness on right side
-afebrile
-normal HR, BP, RR
-Asculation: irregular HR, midsystolic click
ECG: nodular deposits with the density of Ca around mitral valve, one leaflet of mitral valve balloons upward
-dec ejection fraction

Answer 17

mitral annular calcification 
#13

Question 18

82 yr old with inc fatigue for the past 2 years:
dizziness and syncope 
afebrile
HR: 44/min
BP: normal
clear lungs
ECG: notmal
ejection fraction: 50%
After treatment with digoxin causes the HR to become irregular 

What part of the conduction system is likely to be damaged?

Answer 18

SA node

HR below 50/min = SA node dysfunction

SA node dysfunction may worsen with cardioactive drugs 
#14

Question 19

WHat is the common cause of stable angina –> unstable angina (ACS)?
How does the pt presnet?

Answer 19

rupture of the plaque + superimposed thrombus

exertional pain to pain even at rest

Question 20

ANA test = lupus, duh. But what type of pericarditis will the lupus pt most likely have?
What type post MI/over infarcted area?
post rhuematic fever?

Answer 20

serous

fibrinous
fibrinous

Question 21

Most likely cause of HF in a 40 yo woman during 17th century?

Answer 21

rheumatic heart disease

Question 22

machinery-like murmur

Answer 22

Patent ductus arteriosus

Question 23

complication of myxoma

Answer 23

stroke

Question 24

prussion blue stain =

Answer 24

hemachromatosis = decreased ventriculae compliance = dec filling = dec EDV

Question 25

Young person dies of artherlosclerosis with superimposed thrombi, what is the most likely underlying cause of death

Answer 25

SHODDY

Diabetes Mellitus

Question 26

adenocardinoma
DIC
hypercoagulable

Answer 26

marantic endocarditis

Question 27

young person dies and has right ventricualr dilation

Answer 27

right ventricular cardiomyopathy

mut in desmosomes

Question 28

Lab test that is best predictor of CVD risk

Answer 28

C- reactive protein

Question 29

cycstic medial degeneration

Answer 29

marfan –> aortic dissection