CARDIOVASCULAR PATHOLOGY — Past Paper OmpathStudy

CARDIOVASCULAR PATHOLOGY — Questions and Answers Complete review bank: 45 questions recovered from all 30 source pages. 1. A 63-year-old woman has the sudden onset of 'knife-like' pain in the chest radiating to the back. She has been previously healthy except for a history of poorly controlled hypertension. She is transported to the hospital and on arrival she has a heart rate of 90/minute, respirations 20/minute, temperature 36.8°C, and blood pressure 150/100 mm Hg. No murmurs, rubs, or gallops are audible. A chest radiograph reveals a widened mediastinum. Laboratory findings include a total serum creatine kinase of 55 U/L, creatinine 0.9 mg/dL, and glucose 123 mg/dL. Which of the following is the most likely diagnosis? A. Fibrinous pericarditis B. Aortic dissection C. Infective endocarditis D. Dilated cardiomyopathy E. Myocardial infarction Answer: B. This is a classic history for an aortic dissection. A tear in the aortic intima is followed by dissection of blood outward, into the medial layer, and then through the adventitia, often into the thoracic cavity, with fatal hemothorax. The risk factors in most adults include atherosclerosis and hypertension. In Marfan syndrome, the risk for aortic dilation and dissection results from cystic medial necrosis, but this occurs at a much younger age. 2. A 45-year-old man was rushed to the hospital following the sudden onset of an episode of crushing substernal chest pain. He receives advanced life support measures. An EKG shows changes consistent with a large transmural anterolateral area of infarction involving wall of the left ventricle. He develops cardiogenic shock. Which of the following microscopic findings is most likely to be present in this area 4 days following the onset of his chest pain? A. Fibroblasts and collagen deposition B. Capillary proliferation and macrophages C. Myofiber necrosis with neutrophils D. Granulomatous inflammation E. Perivascular lymphocytic infiltrates Answer: C. After 3 to 4 days following infarction, the muscle will still be necrotic and many neutrophils will persist, while macrophage infiltration will be beginning. The transmural necrosis is a risk for rupture of the myocardium, leading to hemopericardium. 3. A 45-year-old woman has had worsening shortness of breath for 3 years. She now has to sleep sitting up on two pillows. She has had difficulty swallowing for the past year. She has no history of chest pain. A month ago, she had a 'stroke' with resultant inability to move her left arm. She is afebrile. A chest radiograph reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for her findings? A. Essential hypertension B. Cardiomyopathy C. Mitral valve stenosis D. Aortic coarctation E. Patent foramen ovale Answer: C. Mitral valve stenosis leads to left atrial enlargement, but the left ventricle is usually small. THere is typically a 'fishmouth' shaped mitral valve that has stenosis as well as insufficiency, since it does not close completely. Most mitral valvular disease in adults results from rheumatic valvulitis. The episode(s) of rheumatic fever occurred years before and the scarring of the valve developed slowly. 4. A 16-year-old healthy adolescent is involved in a schoolyard gang fight and is stabbed in the chest with a knife in the left midclavicular line. He is taken to the emergency department and on arrival his blood pressure is barely obtainable. His lungs are clear to auscultation. His heart sounds are barely audible. Which of the following is the most useful therapeutic approach for this boy? A. Coronary angioplasty B. Aortic repair C. Pericardiocentesis D. Antibiotic therapy E. Antiarrhythmic drugs Answer: C. A stab wound into heart can lead to hemopericardium with cardiac tamponade. The blood around the heart interferes with cardiac motion, reducing the ejection fraction, and diminishes the heart sounds. 5. A 19-year-old woman has had increasing malaise for the past 5 months. On physical examination she has a cardiac murmur characterized by a mid systolic click. An echocardiogram demonstrates mitral insufficiency with upward displacement of one leaflet. There is aortic root dilation to 4 cm. She has a dislocated right ocular crystalline lens. A year later she dies suddenly and unexpectedly. The medical examiner finds a prolapsed mitral valve with elongation, thinning, and rupture of chordae tendineae. A mutation involving which of the following genes is most likely to be present in this patient? A. Beta-myosin B. CFTR C. FGFR D. Fibrillin E. Spectrin F. Dystrophin Answer: D. Marfan syndrome is a connective tissue disorder that is associated with floppy mitral valve and also with cystic medial necrosis that predisposes to aortic dissection. The sudden cardiac death in this case is due to the valvular abnormality. 6. A 72-year-old woman has had no major illnesses throughout her life. She has had 3 syncopal episodes during the pas