MCQ Book Questions

Q60362. A 55-year-old man with idiopathic dilated cardiomyopathy receives a heart transplant. Which of the following is the most likely cause of death in this patient 2 years after transplanta- tion?

Q60363. A 19-year-old college basketball player suddenly collapses on the court. A cardiac monitor shows ventricular tachycardia and then ventricular fi brillation. He is successfully resusci- tated and hospitalized. The patient’s history indicates that his father died suddenly at 38 years of age. The boy’s echocardio- gram reveals a thickened left ventricular wall, with a small slit-like chamber. The interventricular septum is also mark- edly thickened. Five years later the patient expires suddenly. Histologic examination of the heart muscle at autopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60364. For the patient described in Question 30, which of the following is the most common life-threatening complication of his valvular heart disease?

Q60365. A 34-year-old intravenous drug abuser presents to the emer- gency room with a 24-hour history of fever and shaking chills. His temperature is 38.7°C (103°F), pulse rate 110 per min- ute, and blood pressure 140/80 mm Hg. Physical examination reveals a harsh systolic murmur. The patient rapidly develops a headache and right-arm paralysis. A CT scan of the brain demonstrates an infarct of the right frontal lobe. Which of the following is the most likely cause of stroke in this patient?

Q60366. A 68-year-old woman with metastatic breast cancer develops multiple organ dysfunction and expires. The heart at autopsy weighs 380 g (normal = 230 to 280 g in women). The patient’s myocardium (right) is compared to normal myocardium (left). These pathologic fi ndings are mostly likely due to which of the following conditions?

Q60367. A 50-year-old woman presents with fatigue and shortness of breath. Physical examination shows clinical evidence of pul- monary edema, enlargement of the left atrium, and calcifi ca- tion of the mitral valve. A CT scan demonstrates a large mass in the left atrium. Before open heart surgery can be performed, the patient expires of an ischemic stroke. The heart at autopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60368. A 58-year-old man presents with dyspnea on exertion and fatigue. Physical examination shows evidence of congestive heart failure and echocardiography discloses a dilated left ven- tricle and a left ventricular ejection fraction of 20%. The liver appears fatty by MRI. Cardiac catheterization demonstrates minimal coronary artery atherosclerosis. Which of the follow- ing is the most likely cause of these signs and symptoms?

Q60369. A 60-year-old man presents with increasing girth and fatigue. Physical examination reveals peripheral edema, ascites, and hepatomegaly. Liver function tests are normal. An echocardio- gram shows a remarkably enlarged right heart and no signs of valvular heart disease. Endomyocardial biopsy discloses inter- stitial, pink amorphous deposits between cardiac myocytes. Which of the following is the appropriate diagnosis?

Q60370. A 50-year-old man underwent heart transplantation for low- output heart failure that was unresponsive to medical treat- ment. The affected heart at autopsy is shown in the image. It weighs 950 g (normal up to 350 g) and shows no evidence of coronary artery atherosclerosis. Histologically, the myocar- dium demonstrates hypertrophic myocytes and foci of myo- cardial fi brosis but no evidence of infl ammation or myofi ber disarray. Which of the following is the most likely diagnosis?

Q60371. A 40-year-old man with a history of intravenous drug abuse develops rapidly progressive right-sided heart failure. These symp- toms are most likely due to which of the following conditions?

Q60372. A 53-year-old woman presents with a 6-week history of fever, fatigue, and weight loss. Her temperature is 38.7°C (103°F), pulse rate 110 per minute, and blood pressure 140/80 mm Hg. Physical examination reveals petechiae and clubbing of the fi ngers. The patient develops mental status changes, suffers a massive stroke, and expires. The mitral valve is examined at autopsy (shown in the image). Which of the following is the appropriate pathologic diagnosis?

Q60373. A 72-year-old woman dies of congestive heart failure. The aor- tic valve is examined at autopsy (shown in the image). Which of the following is the most likely cause of aortic stenosis in this patient?

Q60374. A 43-year-old woman with Marfan syndrome suffers a dis- secting aneurysm of the aortic arch and expires. An abnormal mitral valve is noted at autopsy (shown in the image). Patients with this valve disorder are at greater risk for developing which of the following conditions?

Q60375. A 63-year-old man with small cell carcinoma of the left mainstem bronchus begins chemotherapy. During the treat- ment period, he becomes febrile and develops a productive cough. The temperature is 38.7°C (103°F), respirations are 32 per minute, and blood pressure is 125/85 mm Hg. A CBC shows leukocytosis (WBC = 18,500/μL). The patient’s cough worsens, and he begins expectorating large amounts of foul- smelling sputum. A chest X-ray shows a distinct cavity with an air/fl uid level distal to the tumor area. Which of the following is the most likely diagnosis?

Q60376. A 64-year-old man presents with fever, chills, and increasing shortness of breath. The patient appears in acute respiratory distress and complains of pleuritic chest pain. Physical exami- nation shows crackles and decreased breath sounds over both lung fi elds. The patient exhibits tachypnea, with fl aring of the nares. The sputum is rusty-yellow and displays numerous neutrophils and erythrocytes. Which of the following patho- gens is the most common cause of this patient’s pulmonary infection?

Q60377. If the patient described in Question 2 is appropriately treated with antibiotics, which of the following is the most likely outcome?

Q60378. A 40-year-old alcoholic man is admitted to the hospital in severe respiratory distress. The temperature is 38.7°C (103°F), respirations are 32 per minute, and blood pressure is 130/90 mm Hg. He coughs constantly and expectorates “currant-jelly” sputum. A chest X-ray reveals bilateral diffuse pulmonary consolidation. Physical examination shows bilat- eral crackles, dullness to percussion over both pulmonary fi elds, and use of accessory muscles. The patient subsequently dies from complications of bacterial sepsis. The left lung at autopsy (shown in the image) shows a red, engorged lower lobe. What is the appropriate diagnosis?

Q60379. A 3-day-old girl shows signs of cyanosis and respiratory distress. Her temperature is 38.7°C (103°F), pulse rate is 140 per minute, respirations are 60 per minute, and blood pressure is 90/58 mm Hg. Laboratory studies indicate that the baby is positive for HIV. The infant does not respond to conventional antibiotic therapy and expires. Histo- logic examination of the lungs at autopsy is shown in the image. The alveolar cells are very large and display single basophilic nuclear inclusions, with a peripheral halo and multiple cytoplasmic basophilic inclusions. Which of the following is the most likely etiologic agent in this child’s pulmonary infection?

Q60380. A 56-year-old woman with disseminated breast cancer undergoes multidrug chemotherapy. Ten days later, she develops cough and a fever of 38.7°C (103°F). A chest X-ray shows multiple areas of consolidation and a large cavity in the right upper lobe. Multiple pulmonary infarcts are also identifi ed. The patient subsequently dies of multisystem organ failure. Histologic examination of the lungs at autopsy is shown in the image. Which of the following is the most likely diagnosis?

Q60381. A 60-year-old alcoholic woman presents to the emergency room with fever, chills, and shortness of breath. The sputum is rusty-yellow and contains numerous neutrophils, red blood cells, and Gram-positive cocci. A chest X-ray shows diffuse haziness over both lungs. One week following admission, the patient develops empyema. This pulmonary condition is asso- ciated with the spread of bacterial infection to which of the following anatomic locations?