11-06-2006, 06:36 PM
A 12-year-old male presented with a sore throat and
fever. Throat culture was positive for /J-hemolytic Strepto-
coccus. Three weeks later, the sore throat had resolved, but
the patient developed a reddish rash. On examination, the
pediatrician noticed a murmur of mitral regurgitation rales over both of the lungs. The patient was admitted to
the hospital. During the hospital stay, he had several epi-
sodes of atrial fibrillation, and he developed signs of acute
left ventricular failure and died of pulmonary edema 2 days
after admission. Which of the following changes is least
likely to be seen in the heart?
O (A) Fibrinous pericarditis
O (B) Aschoff nodules in the myocardium
O © Fibrosis of mitral valve with fusion of commis-
sures
O (D) Foci of fibrinoid necrosis in mitral valve
O (E) Dilatation of the left ventricle
For each of the patient histories in questions 13 through
16, match the most closely associated description of a
cardiovascular disease process:
(A) Congenitally stenotic pulmonic valve associated
with a VSD
(B) Dilation of the aortic valve ring with an aneurysm
of the arch of aorta
© Fibrinoid necrosis of medium-sized arteries in many
organs
(D) Fibrotic mitral valve associated with thickening and
fusion of the chordae tendineae
(E) Fragmentation of elastic fibers in the media of the
aortic arch
(F) Granulomatous inflammation and fibrosis of the me-
dia of the aortic arch with narrowing of aortic lu-
men
(G) Heavily calcified aortic valve with three cusps
(H) Heavily calcified, congenitally bicuspid aortic valve
(I) "Hooding" deformity and myxomatous degeneration
of the mitral valve
(J) Large, destructive vegetations involving the aortic
valve
(K) Small, nondestructive vegetations on an otherwise
normal mitral valve
2. A 30-year-old African-American male with long-
standing essential hypertension collapses after the sudden
onset of severe chest pain. On physical examination, his
radial pulses are weak but femoral pulses are normal. A chest
radiograph reveals widening of the mediastinum. ( )
3. A 35-year-old asymptomatic female is found to have
a mid-systolic click heart murmur during a routine physical
examination for an insurance policy. (
4. A 50-year-old male with a history of a mucin-produc-
ing adenocarcinoma of the pancreas dies after a 6-month
course complicated by wasting, bronchopneumonia, and
stroke. ( )
5. A 35-year-old male with a history of intravenous
drug abuse is brought to the hospital emergency room for
evaluation of acute onset fever and altered mental status. A
head CT scan reveals evidence of a right parietal, 3-cm
abscess. (
fever. Throat culture was positive for /J-hemolytic Strepto-
coccus. Three weeks later, the sore throat had resolved, but
the patient developed a reddish rash. On examination, the
pediatrician noticed a murmur of mitral regurgitation rales over both of the lungs. The patient was admitted to
the hospital. During the hospital stay, he had several epi-
sodes of atrial fibrillation, and he developed signs of acute
left ventricular failure and died of pulmonary edema 2 days
after admission. Which of the following changes is least
likely to be seen in the heart?
O (A) Fibrinous pericarditis
O (B) Aschoff nodules in the myocardium
O © Fibrosis of mitral valve with fusion of commis-
sures
O (D) Foci of fibrinoid necrosis in mitral valve
O (E) Dilatation of the left ventricle
For each of the patient histories in questions 13 through
16, match the most closely associated description of a
cardiovascular disease process:
(A) Congenitally stenotic pulmonic valve associated
with a VSD
(B) Dilation of the aortic valve ring with an aneurysm
of the arch of aorta
© Fibrinoid necrosis of medium-sized arteries in many
organs
(D) Fibrotic mitral valve associated with thickening and
fusion of the chordae tendineae
(E) Fragmentation of elastic fibers in the media of the
aortic arch
(F) Granulomatous inflammation and fibrosis of the me-
dia of the aortic arch with narrowing of aortic lu-
men
(G) Heavily calcified aortic valve with three cusps
(H) Heavily calcified, congenitally bicuspid aortic valve
(I) "Hooding" deformity and myxomatous degeneration
of the mitral valve
(J) Large, destructive vegetations involving the aortic
valve
(K) Small, nondestructive vegetations on an otherwise
normal mitral valve
2. A 30-year-old African-American male with long-
standing essential hypertension collapses after the sudden
onset of severe chest pain. On physical examination, his
radial pulses are weak but femoral pulses are normal. A chest
radiograph reveals widening of the mediastinum. ( )
3. A 35-year-old asymptomatic female is found to have
a mid-systolic click heart murmur during a routine physical
examination for an insurance policy. (
4. A 50-year-old male with a history of a mucin-produc-
ing adenocarcinoma of the pancreas dies after a 6-month
course complicated by wasting, bronchopneumonia, and
stroke. ( )
5. A 35-year-old male with a history of intravenous
drug abuse is brought to the hospital emergency room for
evaluation of acute onset fever and altered mental status. A
head CT scan reveals evidence of a right parietal, 3-cm
abscess. (