Path 12C Flashcards

Which form of calcific aortic stenosis has a familial component?

A. Rheumatic aortic stenosis

B. Congenitally bicuspid aortic valve

C. Senile calcific stenosis

D. Infectious valvular stenosis

Which cytokine is implicated in some forms of mitral valve prolapse?

A. IL-1

B. TNF-α

C. TGF-β

D. IFN-γ

Which heart sound is classically associated with mitral valve prolapse?

A. Mid-systolic click

B. Opening snap

C. Fixed split S2

D. Early diastolic knock

Where is the mitral valve prolapse click heard best?

A. Right upper sternal border

B. Left upper sternal border

C. Lower left sternal border

D. Point of maximal impulse

The characteristic click of mitral valve prolapse occurs at what point in the cardiac cycle?

A. Immediately after S2

B. Before S2

C. Immediately after S1

D. During early diastole

A cardiac biopsy from a patient with rheumatic fever shows foci containing T lymphocytes. What are these lesions called?

A. Anitschkow cells

B. Libman-Sacks lesions

C. Aschoff bodies

D. Carcinoid plaques

Aschoff bodies within the heart are characteristic of which disease?

A. Rheumatic fever

B. Infectious endocarditis

C. Carcinoid syndrome

D. Calcific stenosis

What are the characteristic macrophages found in rheumatic heart disease called?

A. Reed-Sternberg cells

B. Touton giant cells

C. Langhans giant cells

D. Anitschkow cells

Which type of necrosis occurs in cardiac valves during rheumatic fever?

A. Caseous necrosis

B. Fibrinoid necrosis

C. Liquefactive necrosis

D. Fat necrosis

Chronic rheumatic mitral stenosis produces which characteristic gross appearance?

A. Fish-mouth appearance

B. Boot-shaped appearance

C. Tree-bark appearance

D. Bread-and-butter appearance

Which finding is included in the JONES pentad of rheumatic fever?

A. Hematuria

B. Splenomegaly

C. Migratory polyarthritis

D. Digital clubbing

Which cardiac manifestation is included in the JONES pentad?

A. Myocardial infarction

B. Aortic aneurysm

C. Pericardial effusion

D. Pancarditis

Which cutaneous finding is part of the rheumatic fever pentad?

A. Subcutaneous nodules

B. Osler nodes

C. Janeway lesions

D. Petechial rash

Which rash is included among the major rheumatic fever findings?

A. Erythema nodosum

B. Erythema marginatum

C. Erythema multiforme

D. Malar erythema

Which neurologic manifestation completes the JONES pentad?

A. Resting tremor

B. Hemiballismus

C. Sydenham chorea

D. Intention tremor

A patient develops fever, chills, fatigue, destructive valvular lesions, and vegetations with a stormy onset. Which diagnosis is most likely?

A. Rheumatic heart disease

B. Mitral valve prolapse

C. Nonbacterial thrombotic endocarditis

D. Infectious endocarditis

Which organism can cause infectious endocarditis on previously normal valves?

A. Staphylococcus aureus

B. Viridans streptococci

C. Enterococcus faecalis

D. Streptococcus gallolyticus

What is the major cause of infectious endocarditis in intravenous drug users?

A. Viridans streptococci

B. Staphylococcus aureus

C. Enterococcus faecium

D. Streptococcus pneumoniae

Infectious endocarditis of a previously damaged valve is most likely caused by which organism?

A. Staphylococcus aureus

B. Enterococcus faecalis

C. Viridans streptococci

D. Streptococcus pneumoniae

Viridans streptococcal endocarditis is generally characterized by which course?

A. Fulminant and highly destructive

B. Acute and highly virulent

C. Rapidly fatal

D. Subacute and less virulent

A patient with malignancy and a hypercoagulable state develops small sterile valvular vegetations that repeatedly embolize. Which diagnosis is most likely?

A. Nonbacterial thrombotic endocarditis

B. Infectious endocarditis

C. Rheumatic heart disease

D. Libman-Sacks endocarditis

Which setting is classically associated with nonbacterial thrombotic endocarditis?

A. Immunodeficiency

B. Hypercoagulable states

C. Viral infection

D. Hypertension

Endocarditis occurring in the setting of systemic lupus erythematosus is called what?

A. Aschoff disease

B. Carcinoid endocarditis

C. Libman-Sacks disease

D. Marantic stenosis

A patient has valvular plaques accompanied by flushing, diarrhea, and dermatitis. Which underlying malignancy is most likely?

A. Small cell carcinoma

B. Colon adenocarcinoma

C. Pancreatic carcinoma

D. Carcinoid tumor

Which laboratory finding would support a diagnosis of carcinoid tumor in this patient?

A. Elevated urinary 5-HIAA

B. Elevated serum troponin

C. Elevated serum BNP

D. Elevated urinary VMA

Which cardiomyopathy primarily causes systolic contractile dysfunction?

A. Restrictive cardiomyopathy

B. Dilated cardiomyopathy

C. Hypertrophic cardiomyopathy

D. Arrhythmogenic cardiomyopathy

Which cardiomyopathies are characterized primarily by diastolic dysfunction?

A. Dilated and ischemic

B. Hypertrophic and restrictive

C. Restrictive and dilated

D. Hypertrophic and dilated

Truncating mutations in which structural protein are associated with dilated cardiomyopathy?

A. Titin

B. Dystrophin

C. Desmin

D. Myosin

Chronic ingestion of which toxin can lead to dilated cardiomyopathy?

A. Methanol

B. Carbon monoxide

C. Ethanol

D. Cyanide

Hypertrophic cardiomyopathy most commonly results from mutations involving which proteins?

A. Cytoskeletal proteins

B. Collagen proteins

C. Membrane proteins

D. Sarcomeric proteins

A patient presents with angina, and myocardial biopsy shows lymphocytic and eosinophilic inflammatory infiltrates. Which diagnosis is most likely?

A. Infectious myocarditis

B. Dilated cardiomyopathy

C. Restrictive cardiomyopathy

D. Pericardial effusion

Lymphocytic myocardial infiltrates are particularly associated with which type of infection?

A. Parasitic infection

B. Viral infection

C. Fungal infection

D. Bacterial infection

Eosinophilic myocardial infiltrates are particularly associated with which type of infection?

A. Viral infection

B. Bacterial infection

C. Parasitic infection

D. Mycobacterial infection

A chest X-ray demonstrates characteristic globular enlargement of the cardiac silhouette. Which diagnosis is most likely?

A. Hypertrophic cardiomyopathy

B. Dilated cardiomyopathy

C. Left ventricular hypertrophy

D. Pericardial effusion

What is the most common primary cardiac tumor in adults?

A. Myxoma

B. Fibroma

C. Lipoma

D. Rhabdomyoma

Although myxoma is the most common primary adult cardiac tumor, what represents the most common cardiac tumor overall?

A. Fibromas

B. Metastases

C. Myxomas

D. Lipomas

Cardiac myxomas most commonly arise in which chamber?

A. Right ventricle

B. Left ventricle

C. Left atrium

D. Right atrium

Which cytokine is characteristically elevated in patients with cardiac myxomas?

A. IL-1

B. IL-2

C. TNF-α

D. IL-6

Disruption of the supporting structures of a cardiac valve most directly results in which functional abnormality?

A. Insufficiency

B. Stenosis

C. Calcification

D. Fibrosis

Which type of valve lesion produces volume-overload hypertrophy?

A. Stenotic valve

B. Regurgitant valve

C. Calcified valve

D. Fibrotic valve

Which type of valve lesion produces pressure-overload hypertrophy?

A. Regurgitant valve

B. Prolapsed valve

C. Stenotic valve

D. Ruptured valve

Calcific deposits involving the mitral valve most commonly form at which location?

A. Papillary muscles

B. Chordae tendineae

C. Valve leaflets

D. Fibrous annulus

Which histologic finding is characteristic of mitral valve prolapse?

A. Myxomatous degeneration

B. Fibrinoid necrosis

C. Caseous necrosis

D. Hyaline deposition

In rheumatic fever, CD4+ T cells directed against which streptococcal antigen cross-react with cardiac tissue?

A. Streptolysin O

B. M protein

C. Streptokinase

D. DNase-B

The autoimmune cardiac injury of rheumatic fever results from immune recognition of bacterial M protein resembling what?

A. Viral capsid proteins

B. Bacterial exotoxins

C. Cardiac self-antigens

D. Complement proteins

Which pair represents the characteristic histologic findings of acute rheumatic fever?

A. Vegetations and thrombi

B. Myxomas and fibrosis

C. Calcifications and plaques

D. Aschoff bodies and Anitschkow cells

Acute infective endocarditis is classically caused by which highly virulent organism?

A. Staphylococcus aureus

B. Viridans streptococci

C. Enterococcus faecalis

D. Streptococcus bovis

Subacute infective endocarditis is classically associated with which lower-virulence organism?

A. Staphylococcus aureus

B. Viridans streptococci

C. Streptococcus pyogenes

D. Streptococcus pneumoniae

Vegetations on cardiac valves are the hallmark of which condition?

A. Rheumatic fever

B. Mitral valve prolapse

C. Infective endocarditis

D. Dilated cardiomyopathy

Nonbacterial thrombotic endocarditis is characterized by deposition of what on cardiac valve leaflets?

A. Large infected vegetations

B. Calcific plaques

C. Fibrinous exudates

D. Small sterile thrombi

A patient has flushing, diarrhea, dermatitis, and bronchoconstriction caused by a neuroendocrine malignancy. Which syndrome is most likely?

A. Rheumatic fever

B. Carcinoid syndrome

C. Cushing syndrome

D. Lambert-Eaton syndrome

Which bioactive compound is particularly responsible for manifestations of carcinoid syndrome?

A. Histamine

B. Dopamine

C. Serotonin

D. Acetylcholine

A patient undergoes prosthetic heart valve replacement. Which major long-term complication must be prevented?

A. Myocarditis

B. Pericarditis

C. Rheumatic fever

D. Thromboembolism

Which long-term medication strategy is indicated after placement of a prosthetic heart valve according to these notes?

A. Lifelong anticoagulation

B. Lifelong antibiotics

C. Lifelong corticosteroids

D. Lifelong antiplatelet monotherapy

A patient has progressive enlargement of all cardiac chambers with impaired contraction. Which cardiomyopathy best fits?

A. Dilated cardiomyopathy

B. Restrictive cardiomyopathy

C. Hypertrophic cardiomyopathy

D. Arrhythmogenic cardiomyopathy

Dilated cardiomyopathy is characterized morphologically by progressive cardiac what?

A. Fibrosis

B. Dilation

C. Calcification

D. Stenosis

Which functional abnormality characterizes dilated cardiomyopathy?

A. Isolated diastolic dysfunction

B. Normal ventricular function

C. Contractile systolic dysfunction

D. Restrictive filling only

Cardiac dilation in dilated cardiomyopathy is usually accompanied by what additional finding?

A. Valve calcification

B. Pericardial fibrosis

C. Septal rupture

D. Myocardial hypertrophy

Does dilated cardiomyopathy typically involve primary valvular dysfunction?

What happens to ejection fraction in dilated cardiomyopathy?

A. Increases markedly

B. Decreases

C. Remains unchanged

D. Becomes supranormal

An autosomal dominant cardiomyopathy causes right-sided heart failure, rhythm disturbances, and sudden cardiac death. Which diagnosis is most likely?

A. Dilated cardiomyopathy

B. Restrictive cardiomyopathy

C. Arrhythmogenic right ventricular cardiomyopathy

D. Hypertrophic cardiomyopathy

Which feature of arrhythmogenic right ventricular cardiomyopathy can directly cause sudden cardiac death?

A. Rhythm disturbances

B. Valve stenosis

C. Pericardial effusion

D. Septal calcification

Hypertrophic cardiomyopathy is characterized by what type of left ventricular myocardium?

A. Highly compliant

B. Poorly compliant

C. Severely dilated

D. Thin-walled

Poor left ventricular compliance in hypertrophic cardiomyopathy primarily causes abnormal what?

A. Systolic ejection

B. Valve closure

C. Diastolic filling

D. Coronary perfusion

Which cardiac layer is hypertrophied in hypertrophic cardiomyopathy?

A. Endocardium

B. Pericardium

C. Epicardium

D. Myocardium

Hypertrophic cardiomyopathy classically causes myocardial hypertrophy with what ventricular dilation pattern?

A. Without ventricular dilation

B. Severe ventricular dilation

C. Right ventricular dilation

D. Biventricular dilation

Which region is characteristically asymmetrically hypertrophied in hypertrophic cardiomyopathy?

A. Lateral wall

B. Interventricular septum

C. Right atrium

D. Posterior papillary muscle

What happens to stroke volume in hypertrophic cardiomyopathy?

A. Remains unchanged

B. Increases

C. Decreases

D. Doubles

Endomyocardial fibrosis, Loeffler endomyocarditis, and endocardial fibroelastosis are examples of which disorder?

A. Dilated cardiomyopathy

B. Hypertrophic cardiomyopathy

C. Arrhythmogenic cardiomyopathy

D. Restrictive cardiomyopathy

Which condition is an example of restrictive cardiomyopathy?

A. Amyloidosis

B. Viral myocarditis

C. Rheumatic fever

D. Infective endocarditis

In the United States, what is the most common cause of myocarditis?

A. Parasitic infections

B. Viral infections

C. Fungal infections

D. Bacterial infections

Serous pericarditis is characteristically associated with which category of disease?

A. Acute bacterial infections

B. Coronary thrombosis

C. Noninfectious inflammatory diseases

D. Congenital heart disease

Which group contains conditions associated with serous pericarditis?

A. MI, pneumonia, endocarditis

B. TB, sepsis, pneumonia

C. Asthma, COPD, bronchitis

D. Rheumatic fever, SLE, scleroderma

Besides inflammatory diseases, serous pericarditis may occur with which conditions?

A. Tumors and uremia

B. Hypertension and diabetes

C. Asthma and emphysema

D. Endocarditis and pneumonia

Which type of pericarditis most commonly occurs after myocardial infarction?

A. Serous

B. Fibrinous

C. Purulent

D. Hemorrhagic

What is the major complication following cardiac transplantation?

A. Arrhythmia

B. Valve stenosis

C. Allograft rejection

D. Pericardial effusion

Infective endocarditis most directly produces which valvular dysfunction?

A. Stenosis

B. Prolapse

C. Calcification

D. Insufficiency

According to these notes, tricuspid regurgitation produces what type of murmur?

A. Rumbling systolic murmur

B. Blowing diastolic murmur

C. Opening snap

D. Mid-systolic click

During acute rheumatic fever, severe inflammation may involve all three layers of the heart. What is this called?

A. Pericarditis

B. Pancarditis

C. Myocarditis

D. Endocarditis

Which three inflammatory processes comprise pancarditis in acute rheumatic fever?

A. Pericarditis, vasculitis, myocarditis

B. Endocarditis, arteritis, myocarditis

C. Pericarditis, endocarditis, myocarditis

D. Pericarditis, endocarditis, valvulitis

The Jones criteria are used to diagnose which condition?

A. Infective endocarditis

B. Myocarditis

C. Pericarditis

D. Rheumatic fever

The mnemonic “FROM JANE” is used for which condition?

A. Bacterial endocarditis

B. Rheumatic fever

C. Dilated cardiomyopathy

D. Pericarditis

In the bacterial endocarditis mnemonic “FROM JANE,” what does F represent?

A. Fibrosis

B. Fever

C. Fatigue

D. Fibrin

In “FROM JANE,” what does R represent?

A. Rheumatic fever

B. Regurgitation

C. Roth spots

D. Right-sided failure

In “FROM JANE,” what does O represent?

A. Orthopnea

B. Osseous lesions

C. Ophthalmoplegia

D. Osler nodes

In “FROM JANE,” what does M represent?

A. Murmur

B. Myocarditis

C. Myxoma

D. Meningitis

In “FROM JANE,” what does J represent?

A. Jones criteria

B. Janeway lesions

C. Jaundice

D. Joint pain

In “FROM JANE,” what does A represent?

A. Arrhythmia

B. Aortic stenosis

C. Anemia of chronic disease

D. Aneurysm

In “FROM JANE,” what does N represent?

A. Nodules

B. Neutrophilia

C. Necrosis

D. Nails

In “FROM JANE,” what does E represent?

A. Emboli

B. Edema

C. Effusion

D. Erythema

Dilated cardiomyopathy may result from which chronic exposure?

A. Chronic alcoholism

B. Cigarette smoking

C. Cocaine withdrawal

D. Lead exposure

When no identifiable cause is found, dilated cardiomyopathy may be classified as what?

A. Restrictive

B. Idiopathic

C. Hypertrophic

D. Ischemic

A patient with a bioprosthetic valve develops progressive valvular dysfunction years later. Which complication is especially common?

A. Valve rupture

B. Endocardial fibrosis

C. Valve stenosis

D. Septal hypertrophy

Reduced cardiac chamber compliance is characteristic of which cardiomyopathy?

A. Dilated

B. Hypertrophic

C. Arrhythmogenic

D. Restrictive

What is the most common cause of fibrinous pericarditis according to these notes?

A. Uremia

B. Tuberculosis

C. Viral infection

D. Rheumatic fever

The uremia associated with fibrinous pericarditis most commonly results from what?

A. Heart failure

B. Renal failure

C. Liver failure

D. Respiratory failure

An inspiratory fall in systolic blood pressure greater than 10 mm Hg is called what?

A. Pulsus alternans

B. Water-hammer pulse

C. Pulsus paradoxus

D. Pulsus bisferiens

Which conditions can produce pulsus paradoxus according to these notes?

A. Myocarditis and VSD

B. Endocarditis and stenosis

C. Myxoma and ASD

D. Pericarditis and tamponade

Coxsackievirus infection is classically associated with which cardiac disease?

A. Myocarditis

B. Endocarditis

C. Aortic stenosis

D. Cardiac myxoma

A patient develops a hemorrhagic pericardial effusion. Which causes should be strongly considered?

A. Uremia and MI

B. Tumor or tuberculosis

C. Rheumatic fever and SLE

D. Coxsackievirus and influenza

A patient with an atrial myxoma experiences recurrent episodes of passing out. What most directly explains the syncope?

A. Pulmonary embolization

B. Ventricular arrhythmia

C. Mitral valve obstruction

D. Coronary artery occlusion

During acute rheumatic fever, what is the most common cause of death?

A. Valve rupture

B. Pulmonary embolism

C. Cardiac tamponade

D. Cardiac failure

Cardiac failure during acute rheumatic fever most commonly occurs secondary to what?

A. Myocarditis

B. Pericarditis

C. Endocarditis

D. Aortic stenosis

Which congenital defect can allow a paradoxical embolism later in life?

A. Ventricular septal defect

B. Atrial septal defect

C. Patent ductus arteriosus

D. Coarctation of aorta

Which description best characterizes Staphylococcus aureus endocarditis in these notes?

A. Sterile and embolic

B. Small and indolent

C. Chronic and nondestructive

D. Large vegetations and rapid onset

What is the most common congenital heart defect?

A. Ventricular septal defect

B. Atrial septal defect

C. Tetralogy of Fallot

D. Patent ductus arteriosus

According to these notes, a murmur from a ventricular septal defect should be heard over what region?

A. Cardiac apex

B. Septum

C. Carotid arteries

D. Pulmonic area

A patient develops infective endocarditis with symptoms progressing over several weeks. Which organism is most likely?

A. Staphylococcus aureus

B. Streptococcus pneumoniae

C. Streptococcus viridans

D. Streptococcus pyogenes

What happens to ejection fraction in dilated cardiomyopathy?

A. Remains normal

B. Becomes increased

C. Becomes variable

D. Decreases

What is the typical ejection fraction in hypertrophic cardiomyopathy?

A. Normal or increased

B. Severely decreased

C. Mildly decreased

D. Always below 35%

Which valvular disorder can eventually produce left-sided congestive heart failure?

A. Mitral valve prolapse

B. Calcific aortic stenosis

C. Tricuspid regurgitation

D. Pulmonic stenosis

A patient with calcific aortic stenosis progresses to left-sided heart failure. Which pulmonary finding is expected?

A. Pneumothorax

B. Lung abscess

C. Pulmonary edema

D. Pleural fibrosis