Quiz 2- Heart

1. A 55-year-old woman presents with complaints of chest pain. She states that the chest pain predictably occurs when
she climbs four flights of stairs to reach her apartment or when she has been jogging for more than 10 minutes. She is
particularly concerned because her mother died of a myocardial infarction at 50 years of age. Which of the following
best describes this patient’s state?

(a) Arrhythmia (B) Myocardial infarction (c) Prinzmetal angina (D) Stable angina pectoris (e) Unstable angina pectoris

2. A 59-year-old patient receiving chemotherapy with the anthracycline Adriamycin develops severe heart failure.
Sections from an endocardial biopsy specimen reveal vacuolization of the endoplasmic reticulum of the myocytes.
What type of cardiac damage is Adriamycin most likely to pro- duce?

A. Dilated cardiomyopathy

B. Hyperplastic cardiomyopathy

C. Hypertrophic cardiomyopathy

D. Obliterative cardiomyopathy

E. Restrictive cardiomyopathy

3. An elderly patient who becomes acutely short of breath presents with the combination of hypotension, elevated
jugular venous pressure, and muffled heart sounds. This triad of symptoms is most suggestive of

A. Chronic pericarditis

B. Chronic pericardial effusion

C. Cardiac tamponade

D. Dissecting aortic aneurysm

E. Right heart failure

4. The most common primary tumor of the heart in adults is usually located in the left atrium and is called a

A. Chordoma

B. Rhabdomyoma

C. Leiomyoma

D. Myxoma
 E. Papillary fibroelastoma

5. A 3-year-old boy presents with cyano- sis and shortness of breath that develops when he plays with friends. According to his
mother, the boy was born cyanotic. The boy is very small and short for his age, and he squats on the floor next to his mother.
Chest radiography reveals a boot-shaped heart, normal heart size, and a right aortic arch. Echocardiography reveals a large
ventricular septal defect with an overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. Which of the following
is the most likely diagnosis?

(a) Coarctation of the aorta (B) Patent ductus arteriosus (c) Rheumatic heart disease (D) Tetralogy of Fallot
(e) Transposition of the great vessels

6. A 64-year-old woman presents with dependent peripheral edema in her ankles and feet. She has long-standing chronic
obstructive lung disease and a long history of cigarette smoking. Further investigation reveals that she has cor pulmonale with
right-sided heart failure. Which of the following is the most likely cause of the right-sided heart failure in this patient?
(a) Constrictive pericarditis (B) Disease of the lungs or pulmonary vessels, Cor pulmonare (c) Left-sided heart failure
(D) Pulmonary infundibular or valvular stenosis (e) Systemic hypertension

7. Features exclusive to left sided heart failure include

(a) congestive hepatomegaly
(b) anasarca
(c) ascites
(d) pleural effusions
(e) hemosiderin containing macrophages in the alveoli

8. Regarding Angina Pectoris

(A) Prinzmetal angina can be related to hypertension
(B) Typical angina pectoris refers to the classic pattern of retrosternal chest pain relieved by rest
or glyceryl trinitrate
(C) Prinzmetal angina is a relatively common variant, which is typically difficult to control with
the usual angina medications.
(D) Stable angina typically has coronary artery stenosis of equal or more than 75%
(E) Prinzmetal angina does not cause ECG changes, and is diagnosed with angiography

9... A 6-year-old boy develops fever, joint pain, and a diffuse skin rash approximately 3 weeks after recovering
from a sore throat. Physical examination finds several small skin nodules, and laboratory examination finds an
elevated erythrocyte sedimentation rate along with an elevated antistreptolysin O titer. Which of the following
abnormalities is most characteristic of this boy’s disease?

A. Anitschkow cells within the epidermis

B. Aschoff bodies within the myocardium
C. Langhans giant cells within the dermis
D. Psammoma bodies within the endocardium
E. Virchow cells within the nasopharynx

10.. Libman-Sacks endocarditis

(a) is a complication of rheumatic heart disease
(b) produces aortic valvular lesions
(c) is caused by haemophilus infection
(d) produces lesions on both sides of the valve leaflets
(e) produces large lesions, and is a common consequence of systemic lupus

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11.. Regarding cardiomyopathy
(a) Dilated cardiomyopathy is the most common type
(b) is mostly commonly caused by ischemia
(c) Restrictive cardiomyopathy is most often seen in long-term alcohol abusers
(d) Hypertrophic cardiomyopathy causes heart failure due to impairment of contractility
(e) Dilated cardiomyopathy has no associated familial occurrence

12. A heart murmur is noted during the preschool physical examination of a 4-year-old girl. An
echocardiogram reveals a defect between the right and left atrium involving the limbus of the
foramen ovale. What is the most likely diagnosis?

A. (A)  Atrial septal defect (ASD), ostium primum

B. (B)  ASD, ostium secundum

C. (C)  Tetralogy of Fallot

D. (D)  Truncus arteriosus

E. (E)  Ventricular septal defect

13. An 8-month-old girl with Turner syndrome. Physical examination reveals tachypnea, pallor, absent
femoral pulses. There is hypertension in the upper extremities and low blood pressure in both legs.
A chest X-ray shows notching or scalloping of the ribs. What is the appropriate diagnosis?

A. (A)  Aortic valve stenosis

B. (B)  Atrial septal defect

C. (C)  Coarctation of aorta

D. (D)  Patent ductus arteriosus

E. (E)  Tetralogy of Fallot

14. A 44-year-old man presents to the emergency room with acute chest pain. The ECG is normal.
Analysis of which pair of serum markers given below would be most helpful in excluding a
diagnosis of acute myocardial infarction in this patient?

A. (A)  Cardiac troponin-I and myoglobin

B. (B)  CK-BB and myoglobin

C. (C)  CK-MB and cardiac troponin-I

D. (D)  CK-MM and lactate dehydrogenase (LDH)-1

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 E. (E)  Myoglobin and CK-BB

15. A 10-year-old boy with a 2-week history of an upper respiratory infection was admitted to the
hospital with malaise, fever, joint swelling, and diffuse rash. patient suffers from recurrent
pharyngitis and, a few years later, develops a heart murmur. This patient’s heart murmur is most
likely caused by exposure to which of the following pathogens?

A. (A)  Beta-hemolytic streptococcus

B. (B)  Candida albicans
C. (C)  Epstein-Barrvirus
D. (D)  Staphylococcus aureus
E. (E)  Streptococcus viridans

16. Which ONE of the following is an example of acyanotic congenital heart disease?

A. Anomalous venous drainage.

B. Coarctation of the aorta.
C. Fallot's tetralogy.
D. Tricuspid atresia.
E. Truncus arteriosus.

17. A1-month-oldmaleneonateisbroughtintotheemergencydepartment because of difficulty feeding and lethargy. A

loud murmur is heard. Which of the following is the most likely congenital heart disease in this patient?

a. Tetralogy
B. VSD
C. ASD
D. Aortic atresia

18.. A 53-year-old man presents with recurrent chest pain that has gotten progressively worse over the last
several weeks. He says that approximately a year ago the pain would occasionally occur when he was mowing
his yard but now the pain sometimes occurs while he is sitting in a chair at night reading a book. The pain,
which is localized over the sternum, lasts much longer now than it did a few months ago. What type of angina
does this individual have at present?

A. Atypical angina

b. Heberden angina

c. Prinzmetal angina

d. Stable angina

e. Unstable angina

19 Prinzmetal angina (atypical angina )is characterized clinically by chest pain that occurs at rest rather than
with exercise. Which of the following is the most likely cause of this type of angina?

A. Atherosclerosis of a coronary artery

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 B. Dissection of a coronary artery
C. Embolism of a coronary artery
D. Thrombosis of a coronary artery
E. Vasospasm of a coronary artery

20. What is diagnosis of changes that you see on the morphological picture?