MCQ Book Questions

Q60342. A 2-week-old girl is found to have a harsh murmur along the left sternal border. The parents report that the baby gets “blu- ish” when she cries or drinks from her bottle. Echocardiogram reveals a congenital heart defect associated with pulmonary stenosis, ventricular septal defect, dextroposition of the aorta, and right ventricular hypertrophy. What is the appropriate diagnosis?

Q60343. 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?

Q60344. A 35-year-old man presents with acute chest pain and nausea. ECG and laboratory studies confi rm the diagnosis of myocar- dial infarction. The patient expires 2 days later. A photomicro- graph of his left main coronary artery is shown in the image. This patient most likely suffered from which of the following hereditary diseases?

Q60345. A 60-year-old man with a history of emphysema returns home from the hospital after suffering a myocardial infarc- tion involving the apex of the left ventricle. Six months later, an echocardiogram reveals the development of a ventricular bulge that does not contract during systole. The patient subse- quently suffers a massive stroke and suddenly expires. Which of the following is an expected pathologic fi nding at autopsy?

Q60346. A 29-year-old woman complains of a 3-month history of ner- vousness and weakness. She feels hot and sweaty and has experienced a 9-kg (20-lb) weight loss over the past 2 months, despite increased caloric intake. She frequently fi nds her heart racing and can feel it pounding in her chest. Physical exami- nation reveals an enlarged thyroid, warm hands, and bulging eyes. This patient is at risk of developing which of the follow- ing cardiovascular complications?

Q60347. A 48-year-old man complains of chest pain upon exertion. He had been well until 4 months previously, when he fi rst devel- oped a chest discomfort while jogging. His symptoms have progressed to the point that he now develops chest pain after climbing a single fl ight of stairs. He has a history of diabetes controlled by diet and of 25 pack-years of cigarette smoking. His father and maternal grandfather both died of heart dis- ease before the age of 60. On the 5th hospital day, the patient develops chest pain during periods of mild activity, which is minimally responsive to sublingual nitroglycerin. Results of laboratory studies include WBC of 8,100/μL, CK-MB of 4.5 ng/mL, and troponin-I of 0.5 ng/mL. Which of the follow- ing is the most likely diagnosis?

Q60348. A 50-year-old man with familial hyperlipidemia undergoes resection of an abdominal aneurysm. Signs of congestive heart failure develop shortly after surgery. Despite treatment, the patient becomes hypotensive and expires 2 days later. Autopsy reveals marked narrowing of coronary arteries, without thrombo- sis. Multiple foci of necrosis are found circumferentially around the inner walls of both ventricles. Which of the following is the most likely cause of congestive heart failure in this patient?

Q60349. A 68-year-old obese woman (BMI = 32 kg/m2) presents with substernal chest pain and a history of recurrent angina pectoris and intermittent claudication. The following day, she develops a fever of 38°C (101°F). Results of laboratory studies include an elevated WBC count (13,000/μL), CK-MB of 6.6 ng/mL, and troponin-I of 2.5 ng/mL. ECG confi rms a myocardial infarction of the left ventricular wall. Which of the follow- ing mechanisms is most likely responsible for the myocardial infarction in this patient?

Q60350. Two months later, the patient described in Question 14 expe- riences several days of severe, sharp, retrosternal chest pain radiating to the neck and shoulders. The pain is worse when she is in the supine position and less intense when she is sit- ting upright and leaning forward. Which of the following is the most likely cause of the patient’s symptoms?

Q60351. A 65-year-old man with a 2-year history of angina pectoris is admitted to the hospital with excruciating substernal chest pain that is not relieved by rest or medication. Physical exami- nation shows diaphoresis and dyspnea. Results of laboratory studies include WBC of 13,000/μL, CK-MB of 6.8 ng/mL, and troponin-I of 3.0 ng/mL. An ECG shows ST segment elevation. The patient expires 1 hour after admission. At autopsy, the heart is found to be enlarged but otherwise anatomically nor- mal. Which of the following is the most likely cause of death?

Q60352. A 60-year-old woman with a 30-pack-year history of smok- ing and a 10-year history of emphysema expires of congestive heart failure. There is no evidence of coronary artery disease or valvular heart disease. The heart at autopsy is shown in the image. Which of the following is the most likely cause of right ventricular hypertrophy?

Q60353. A 69-year-old woman presents with crushing substernal chest pain and nausea. She is treated with plasminogen activa- tor, oxygen, and morphine sulfate. Laboratory studies show a WBC count of 13,000/μL, CK-MB of 6.6 ng/mL, and tro- ponin-I of 2.5 ng/mL. An ECG shows ST segment elevation. Cardiac catheterization reveals diffuse atherosclerosis of all major coronary arteries. The patient subsequently becomes acutely hypotensive and undergoes cardiac arrest. The surface of the heart at autopsy is shown in the image. At what point in time following acute myocardial infarction did this pathologic condition most likely occur?

Q60354. A 66-year-old woman collapses while shopping and expires suddenly of cardiac arrest. Her past medical history is signifi - cant for long-standing type 2 diabetes mellitus. Her relatives note that she had complained of chest heaviness and short- ness of breath for the past 2 weeks. Sterile fi brinous peri- carditis and pericardial effusion are observed at autopsy. What additional fi nding would be expected during autopsy of this patient?

Q60355. A 78-year-old man with a history of recurrent syncope under- goes surgery for aortic valve disease. A hard, markedly deformed valve is observed, but the patient expires during surgery. The aortic valve at autopsy is shown in the image. What is the appropriate diagnosis?

Q60356. A 16-year-old girl, who arrived in the United States from Africa, comes to the hospital with chest pain and respira- tory distress. On physical examination, the patient is short of breath, wheezing, and gasping for air. A prominent pansys- tolic heart murmur and a prominent third heart sound are heard on cardiac auscultation. An X-ray study of the chest shows marked enlargement of the heart. The patient expires despite intense supportive measures. At autopsy, microscopic examination of the myocardium discloses aggregates of mono- nuclear cells arranged around centrally located deposits of eosinophilic collagen. What is the appropriate diagnosis?

Q60357. A 10-year-old boy with a 2-week history of an upper respi- ratory infection was admitted to the hospital with malaise, fever, joint swelling, and diffuse rash. The patient is treated and discharged. However, the 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?

Q60358. A 72-year-old man presents with diffi culty breathing. He says that he becomes short of breath at night unless he uses three pillows to prop himself up. Measurements of vital signs reveal normal temperature, mild tachypnea, and a blood pressure of 180/100 mm Hg. Physical examination discloses obesity, bilateral 2+ pitting leg edema, hepatosplenomegaly, and rales at the bases of both lungs. An X-ray fi lm of the chest shows mild enlarge- ment of the heart and a mild pleural effusion. Echocardiogra- phy reveals left ventricular hypertrophy without valvular heart defects. Which of the following is the most likely diagnosis?

Q60359. A 62-year-old man with a history of hypertension is brought to the emergency room with severe left chest and back pain. His blood pressure is 80/50 mm Hg. Physical examination shows pallor, diaphoresis, and a murmur of aortic regurgita- tion. An ECG does not show myocardial infarction. An X-ray fi lm of the chest reveals mediastinal widening. Which of the following is the most likely diagnosis?

Q60360. A 30-year-old woman presents with a heart murmur. There is a history of recurrent episodes of arthritis, skin rash, and glom- erulonephritis. Blood cultures are negative. Laboratory tests for antinuclear antibodies (ANA) and anti–double-stranded DNA are positive. Which of the following is the most likely cause of heart murmur in this patient?

Q60361. A 40-year-old woman with a history of rheumatic fever pres- ents with shortness of breath, weight loss, fatigue, and abdom- inal distension. Physical examination shows rales in the lungs, hepatosplenomegaly, and 2+ pitting edema of the legs. A chest X-ray reveals only left atrial enlargement and pulmonary edema. What is the most likely cause of pulmonary edema in this patient?