front 1 A patient has left ventricular hypertrophy from chronic outflow obstruction across a stenotic aortic valve. Which hemodynamic load best explains this hypertrophy pattern? A) Volume overload B) Pressure overload C) Low-output unloading D) Diastolic underfilling | back 1 B. Pressure overload |
front 2 Which valve lesion most classically produces pressure-overload hypertrophy? A) Stenotic valve B) Regurgitant valve C) Insufficient valve D) Prolapsed valve | back 2 A. Stenotic valve |
front 3 A patient has ventricular dilation and hypertrophy because blood repeatedly refluxes back through an incompetent valve. Which hemodynamic load is most likely? A) Pressure overload B) Afterload reduction C) Volume overload D) Coronary underfilling | back 3 C. Volume overload |
front 4 Which valve lesion most classically produces volume-load hypertrophy? A) Stenotic valve B) Regurgitant valve C) Calcified valve D) Fused valve | back 4 B. Regurgitant valve |
front 5 An elderly patient has the most common valvular abnormality seen in adults. Which diagnosis is most likely? A) Rheumatic mitral stenosis B) Libman-Sacks endocarditis C) Calcified aortic stenosis D) Myxomatous tricuspid prolapse | back 5 C. Calcified aortic stenosis |
front 6 A middle-aged patient develops calcific aortic stenosis earlier than expected, and family history suggests inherited risk. Which condition most likely explains this? A) Congenitally bicuspid aortic valve B) Rheumatic mitral valve disease C) Libman-Sacks endocarditis D) Nonbacterial thrombotic endocarditis | back 6 A. Congenitally bicuspid aortic valve A bicuspid aortic valve has only 2 leaflets instead of 3. Because the valve is structurally abnormal, blood flow across it is more turbulent over many years. That extra mechanical stress causes earlier fibrosis and calcification. |
front 7 A pathology specimen shows calcific deposits involving the fibrous ring supporting the mitral valve. Where are these deposits located? A) Papillary muscle tips B) Chordae tendineae C) Annular fibrous tissue D) Aortic valve commissures | back 7 C. Annular fibrous tissue The calcific deposits described are characteristic of Mitral Annular Calcification (MAC), a common degenerative process that occurs in the fibrous ring that supports the mitral valve leaflets |
front 8 Mitral annular calcification most directly involves which valve-associated structure? A) Leaflet free edge B) Annular fibrous ring C) Spongiosa layer D) Papillary muscle belly | back 8 B. Annular fibrous ring |
front 9 A patient with mitral valve prolapse has abnormal extracellular matrix signaling implicated in disease pathogenesis. Which cytokine is associated? A) IL-2 B) TNF-α C) IL-8 D) TGF-β | back 9 D. TGF-β TGF-β Signaling: Myxomatous mitral valve prolapse is recognized as a disease driven by aberrant TGF-β-dependent signaling, leading to valve interstitial cell activation and altered extracellular matrix (ECM) remodeling. |
front 10 A valvular disease shows myxomatous degeneration in the spongiosa layer of the valve. Which diagnosis is most likely A) Mitral valve prolapse B) Calcified aortic stenosis C) Rheumatic aortic regurgitation D) Infectious endocarditis | back 10 A. Mitral valve prolapse |
front 11 A young woman has atypical chest pain and a high-pitched sound before S2 heard best at the PMI. Which valvular disorder is suggested? A) Aortic stenosis B) Mitral valve prolapse C) Rheumatic mitral stenosis D) Infectious endocarditis | back 11 B. Mitral valve prolapse |
front 12 Which heart sound most classically identifies mitral valve prolapse? A) Opening snap B) Holosystolic murmur C) Mid-systolic click D) Early diastolic rumble | back 12 C. Mid-systolic click |
front 13 A child develops fever, migratory joint pain, and carditis several weeks after untreated streptococcal pharyngitis. Which immune-mediated disorder is most likely? A) Infectious endocarditis B) Rheumatic fever C) Libman-Sacks endocarditis D) Nonbacterial thrombotic endocarditis | back 13 B. Rheumatic fever |
front 14 Rheumatic fever is one of the few major causes of stenosis involving which valve? A) Aortic valve B) Mitral valve C) Pulmonic valve D) Tricuspid valve | back 14 B. Mitral valve |
front 15 Cardiac histology after rheumatic fever shows inflammatory foci containing T lymphocytes and activated macrophages. What are these lesions called? A) Aschoff bodies B) Osler nodes C) Janeway lesions D) Mural thrombi | back 15 A. Aschoff bodies |
front 16 A heart biopsy from rheumatic carditis shows activated macrophages with characteristic caterpillar-like chromatin. What are these cells called? A) Reed-Sternberg cells B) Touton giant cells C) Anitschkow cells D) Langhans giant cells | back 16 C. Anitschkow cells |
front 17 Anitschkow cells are characteristic macrophages associated with which condition? A) Rheumatic heart disease B) Nonbacterial thrombotic endocarditis C) Calcified aortic stenosis D) Prinzmetal angina | back 17 A. Rheumatic heart disease |
front 18 During rheumatic fever, immune-mediated damage produces necrosis in affected valves. Which necrosis pattern is expected A) Liquefactive necrosis B) Caseous necrosis C) Fat necrosis D) Fibrinoid necrosis | back 18 D. Fibrinoid necrosis During rheumatic fever, the immune-mediated damage (specifically type II hypersensitivity, where antibodies cross-react with host tissue) causes inflammatory destruction of collagen and other connective tissues within the heart valves. This specific pattern of damage is characterized by a bright pink, amorphous, proteinaceous deposit, known as fibrinoid necrosis. |
front 19 A patient has chronic rheumatic mitral stenosis. Which gross valve finding is most likely? A) Fish-mouth valve orifice B) Large friable vegetations C) Annular calcium nodules D) Floppy myxomatous leaflets | back 19 A. Fish-mouth valve orifice |
front 20 A stenotic mitral valve from chronic rheumatic disease has a narrowed slit-like orifice. Which gross appearance is classic A) Buttonhole appearance B) Fish-mouth appearance C) Bread-and-butter appearance D) Tree-bark appearance | back 20 B. Fish-mouth appearance |
front 21 Which clinical feature belongs to the classic rheumatic fever pentad? A) Hemoptysis B) Migratory polyarthritis C) Splinter hemorrhages D) Pulsus paradoxus | back 21 B. Migratory polyarthritis |
front 22 A patient has migratory polyarthritis, pancarditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea after pharyngitis. Which diagnosis fits best? A) Infectious endocarditis B) Rheumatic fever C) Libman-Sacks endocarditis D) Calcific valve disease | back 22 B. Rheumatic fever |
front 23 A patient presents with stormy onset of fever, chills, fatigue, destructive valve lesions, and bulky vegetations. Which diagnosis is most likely? A) Infectious endocarditis B) Stable angina C) Mitral valve prolapse D) Chronic cor pulmonale | back 23 A. Infectious endocarditis "bulky vegetations"—masses of platelets, fibrin, and microorganisms—that often lead to destructive valve lesions and impaired heart function |
front 24 Which presentation best suggests infectious endocarditis rather than nonbacterial thrombotic endocarditis? A) Small sterile embolizing vegetations B) Hypercoagulable sterile vegetations C) Stormy fever with destructive lesions D) Myxomatous valve degeneration | back 24 C. Stormy fever with destructive lesions |
front 25 An IV drug user develops acute infective endocarditis with destructive valvular vegetations. Which organism is the major cause? A) S. viridans B) S. epidermidis C) Enterococcus faecalis D) S. aureus | back 25 D. S. aureus |
front 26 A patient with a previously damaged valve develops subacute infectious endocarditis caused by a less virulent organism. Which organism is most likely? A) S. aureus B) S. viridans C) Neisseria gonorrhoeae D) Coxsackievirus B | back 26 B. S. viridans |
front 27 A cancer patient with a hypercoagulable state develops small sterile valve vegetations that embolize. Which diagnosis best fits? A) Infectious endocarditis B) Rheumatic fever C) Nonbacterial thrombotic endocarditis D) Mitral valve prolapse | back 27 C. Nonbacterial thrombotic endocarditis |
front 28 A patient with systemic lupus erythematosus develops sterile vegetations on both sides of valve leaflets. What is this endocarditis called? A) Rheumatic endocarditis B) Libman-Sacks endocarditis C) Infectious endocarditis D) Calcific endocarditis | back 28 B. Libman-Sacks endocarditis
Libman-Sacks endocarditis
Infective endocarditis
Rheumatic endocarditis
|
front 29 Which pairing correctly matches valvular load type with typical valve lesion? A) Pressure-regurgitant; volume-stenotic B) Pressure-stenotic; volume-regurgitant C) Pressure-prolapsed; volume-calcified D) Pressure-insufficient; volume-stenotic | back 29 B. Pressure-stenotic; volume-regurgitant |
front 30 A patient has valvular plaques with episodic flushing, diarrhea, and dermatitis. Urine testing shows elevated 5-HIAA. Which malignancy is most likely? A) Carcinoid tumor B) Cardiac myxoma C) Renal cell carcinoma D) Adrenal pheochromocytoma | back 30 A. Carcinoid tumor |
front 31 A patient receives a mechanical prosthetic valve. What is the major long-term concern requiring careful prevention? A) Ventricular septal rupture B) Thromboembolism C) Restrictive cardiomyopathy D) Myxomatous degeneration | back 31 B. Thromboembolism |
front 32 A patient with a porcine biological prosthetic valve develops progressive obstruction years later. Which complication is most characteristic of biological valves? A) Thromboembolism B) Stenosis C) Ventricular arrhythmia D) Carcinoid plaques | back 32 B. Stenosis |
front 33 A patient has a cardiomyopathy dominated by impaired ventricular contractility and reduced systolic pumping. Which cardiomyopathy best fits? A) Hypertrophic cardiomyopathy B) Restrictive cardiomyopathy C) Dilated cardiomyopathy D) Arrhythmogenic cardiomyopathy | back 33 C. Dilated cardiomyopathy |
front 34 Which cardiomyopathy is most associated with systolic contractile dysfunction? A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Restrictive cardiomyopathy D) Amyloid cardiomyopathy | back 34 A. Dilated cardiomyopathy |
front 35 Which cardiomyopathy pair causes diastolic dysfunction? A) Dilated and Takotsubo B) Hypertrophic and restrictive C) Arrhythmogenic and dilated D) Myocarditis and rhabdomyoma | back 35 B. Hypertrophic and restrictive |
front 36 Which pairing correctly matches cardiomyopathy type with the primary functional defect? A) Dilated-diastolic; restrictive-systolic B) Hypertrophic-systolic; dilated-diastolic C) Dilated-systolic; hypertrophic-diastolic D) Restrictive-systolic; Takotsubo-diastolic | back 36 C. Dilated-systolic; hypertrophic-diastolic |
front 37 A cardiology review asks which cardiomyopathy is most common overall. Which answer is correct? A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Hypertrophic cardiomyopathy D) Arrhythmogenic cardiomyopathy | back 37 B. Dilated cardiomyopathy |
front 38 Which cardiomyopathy is least common among the major cardiomyopathy categories? A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Restrictive cardiomyopathy D) Takotsubo cardiomyopathy | back 38 C. Restrictive cardiomyopathy |
front 39 A patient with familial dilated cardiomyopathy has truncating mutations in a giant sarcomeric structural protein. Which protein is implicated? A) Dystrophin B) Titin C) Desmin D) Lamin | back 39 B. Titin Titin is a huge sarcomeric structural protein that helps maintain elasticity and alignment in cardiac muscle. Truncating mutations in TTN, the gene for titin, are a major genetic cause of familial dilated cardiomyopathy. |
front 40 Which exposure is a classic toxic cause of dilated cardiomyopathy? A) Ethanol ingestion B) Silica inhalation C) Mercury vapor D) Arsenic ointment | back 40 A. Ethanol ingestion |
front 41 A patient with hemochromatosis develops cardiomyopathy, and myocardial biopsy shows intracellular hemosiderin in a spindle-shaped pattern. Which cardiomyopathy types are associated? A) Dilated and restrictive B) Hypertrophic and arrhythmogenic C) Takotsubo and hypertrophic D) Restrictive and Brugada | back 41 A. Dilated and restrictive Iron deposits in the heart → toxic injury + stiffness → dilated or restrictive cardiomyopathy. |
front 42 A woman develops acute LV contractile dysfunction after severe emotional stress. Imaging shows apical ballooning. Which cardiomyopathy is most likely? A) Takotsubo cardiomyopathy B) Restrictive cardiomyopathy C) Arrhythmogenic cardiomyopathy D) Hypertrophic cardiomyopathy | back 42 A. Takotsubo cardiomyopathy |
front 43 A patient develops “broken heart syndrome” after intense psychological stress. Which term best describes this condition? A) Dilated cardiomyopathy B) Takotsubo cardiomyopathy C) Infectious myocarditis D) Fibrinous pericarditis | back 43 B. Takotsubo cardiomyopathy |
front 44 A cardiomyopathy patient has severe systolic dysfunction with an ejection fraction below 25%. Which diagnosis is most likely? A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Restrictive cardiomyopathy D) Pericardial effusion | back 44 A. Dilated cardiomyopathy |
front 45 Which cardiomyopathy commonly causes passing out in young men due to rhythm disturbances? A) Restrictive cardiomyopathy B) Takotsubo cardiomyopathy C) Arrhythmogenic cardiomyopathy D) Infectious myocarditis | back 45 C. Arrhythmogenic cardiomyopathy |
front 46 A patient presents with right-sided heart failure and ventricular rhythm disturbances rather than isolated LV systolic failure. Which diagnosis best fits? A) Arrhythmogenic cardiomyopathy B) Hypertrophic cardiomyopathy C) Dilated cardiomyopathy D) Fibrinous pericarditis | back 46 A. Arrhythmogenic cardiomyopathy Arrhythmogenic cardiomyopathy classically affects the right ventricle. It causes: fibrofatty replacement of myocardium → weak RV contraction + electrical instability |
front 47 A patient with familial hypertrophic cardiomyopathy has mutations affecting contractile apparatus proteins. Which protein class is most often involved? A) Sarcomeric proteins B) Basement membrane proteins C) Lysosomal enzymes D) Collagen crosslinking proteins | back 47 A. Sarcomeric proteins |
front 48 A patient has myocardial hypertrophy without ventricular dilation and marked asymmetric septal thickening. Which cardiomyopathy is most likely? A) Dilated cardiomyopathy B) Restrictive cardiomyopathy C) Hypertrophic cardiomyopathy D) Takotsubo cardiomyopathy | back 48 C. Hypertrophic cardiomyopathy |
front 49 Which structural pattern best supports hypertrophic cardiomyopathy? A) Ventricular dilation with thin walls B) Asymmetric septal hypertrophy C) Amyloid-stiffened normal ventricles D) Globular pericardial enlargement | back 49 B. Asymmetric septal hypertrophy |
front 50 A patient has diastolic dysfunction from asymmetric septal hypertrophy without ventricular dilation. Which diagnosis best integrates these findings? A) Hypertrophic cardiomyopathy B) Dilated cardiomyopathy C) Chronic myocarditis D) Carcinoid heart disease | back 50 A. Hypertrophic cardiomyopathy |
front 51 A patient has restrictive ventricular filling due to amyloid deposition in the myocardium. Which cardiomyopathy is most characteristic? A) Dilated cardiomyopathy B) Hypertrophic cardiomyopathy C) Restrictive cardiomyopathy D) Arrhythmogenic cardiomyopathy | back 51 C. Restrictive cardiomyopathy |
front 52 Amyloidosis is most strongly associated with which cardiomyopathy pattern? A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Takotsubo cardiomyopathy D) Arrhythmogenic cardiomyopathy | back 52 A. Restrictive cardiomyopathy |
front 53 A patient has angina-like chest pain, and biopsy shows lymphocytic and eosinophilic inflammatory infiltrates in myocardium. Which diagnosis is most likely? A) Infectious myocarditis B) Calcified aortic stenosis C) Cardiac myxoma D) Carcinoid valvulopathy | back 53 A. Infectious myocarditis |
front 54 Which inflammatory pattern is correctly matched with infectious myocarditis causes? A) Lymphocytes-viral; eosinophils-parasitic B) Neutrophils-amyloid; lymphocytes-carcinoid C) Eosinophils-ischemia; macrophages-myxoma D) Plasma cells-ethanol; neutrophils-titin | back 54 A. Lymphocytes-viral; eosinophils-parasitic |
front 55 A chest x-ray shows a characteristically globular enlargement of the cardiac silhouette. Which condition is suggested? A) Pericardial effusion B) Aortic stenosis C) Ventricular aneurysm D) Mitral prolapse | back 55 A. Pericardial effusion |
front 56 Which pericarditis subtype is most common? A) Fibrinous pericarditis B) Tuberculous pericarditis C) Suppurative pericarditis D) Cholesterol pericarditis | back 56 A. Fibrinous pericarditis |
front 57 The most common primary tumor of the adult heart is which lesion? A) Myxoma B) Rhabdomyoma C) Lipoma D) Mesothelioma | back 57 A. Myxoma |
front 58 Where do cardiac myxomas most commonly arise? A) Right ventricle B) Left atrium C) Aortic valve D) Pericardium | back 58 B. Left atrium Myxoma = benign “jelly-like” heart tumor, usually in the left atrium, that can obstruct flow or embolize. |
front 59 A patient has a left atrial primary cardiac tumor producing constitutional symptoms through cytokine release. Which cytokine is elevated? A) IL-1 B) IL-6 C) IL-12 D) IL-17 | back 59 B. IL-6 Atrial myxoma → ↑ IL-6 → systemic inflammatory symptoms |
front 60 A fetus is found to have the most common primary tumor of the fetal heart. Which tumor is most likely? A) Myxoma B) Rhabdomyoma C) Angiosarcoma D) Papillary fibroelastoma | back 60 B. Rhabdomyoma |
front 61 A fetus with a cardiac rhabdomyoma is evaluated for an associated genetic disease. Which condition is classically linked? A) Tuberous sclerosis B) Marfan syndrome C) Down syndrome D) Wilson disease | back 61 A. Tuberous sclerosis |
front 62 Which condition is best matched with severe psychological stress and transient LV contractile dysfunction? A) Takotsubo cardiomyopathy B) Restrictive cardiomyopathy C) Infectious myocarditis D) Cardiac rhabdomyoma | back 62 A. Takotsubo cardiomyopathy |
front 63 A patient has pericarditis with an exudate containing blood mixed with fibrinous inflammatory material. Which pericarditis subtype best fits? A) Serous pericarditis B) Hemorrhagic pericarditis C) Purulent pericarditis D) Constrictive pericarditis | back 63 B. Hemorrhagic pericarditis |
front 64 A patient with systemic lupus erythematosus develops pericarditis with a thin, nonpurulent effusion. Which pericarditis subtype is most consistent? A) Purulent pericarditis B) Hemorrhagic pericarditis C) Serous pericarditis D) Caseous pericarditis | back 64 C. Serous pericarditis |
front 65 Which group of conditions is most associated with serous pericarditis? A) SLE, scleroderma, uremia B) Staph aureus, sepsis, abscess C) Trauma, rupture, anticoagulation D) Tuberculosis, fungi, sarcoidosis | back 65 A. SLE, scleroderma, uremia |
front 66 Which underlying process most directly produces serous pericarditis? A) Microbial invasion of pericardium B) Noninfectious inflammatory disease C) Blood leaking into exudate D) Ventricular free-wall rupture | back 66 B. Noninfectious inflammatory disease Serous means thin, watery, clear fluid. |
front 67 A patient has fever and pericardial fluid filled with neutrophil-rich pus after bacteria invade the pericardial space. Which subtype is present? A) Purulent pericarditis B) Serous pericarditis C) Hemorrhagic pericarditis D) Rheumatic pericarditis | back 67 A. Purulent pericarditis Purulent simply means pus filled. |
front 68 A pericardial effusion is caused by active infection within the pericardial space. Which term best describes this pericarditis A) Serous pericarditis B) Hemorrhagic pericarditis C) Suppurative pericarditis D) Uremic pericarditis | back 68 C. Suppurative pericarditis Suppurative inflammation usually means there is an active infection, especially a bacterial infection. |