(89) A 45-year-old woman has had increasing malaise for 3 weeks. Yesterday she had an episode of hemoptysis. On physical examination her vital signs show T 37.5 C, P 80/minute, RR 19/minute, and BP 140/90 mm Hg. A chest radiograph reveals a reticulonodular pattern of infiltrates. Laboratory studies show her serum creatinine is 3.8 mg/dL with urea nitrogen of 40 mg/dL. Her serum antinuclear antibody test is negative, but her anti-neutrophil cytoplasmic autoantibody test is positive. A lung biopsy is performed and reveals necrotizing granulomas with vasculitis. Which of the following is the most likely diagnosis?
(90) A 76-year-old man has experienced decreased visual acuity for the past week in his left eye. He also has had a left-sided headache during this time. On physical examination his temperature is 37.4 C with blood pressure 135/85 mm Hg. There is a tender cord-like area palpable over his forehead just above and posterior to his left eye. Laboratory studies show an erythrocyte sedimentation rate of 99 mm/hr. His condition improves with corticosteroid therapy. Which of the following is the most likely diagnosis?
A Giant cell arteritis
B Hypersensitivity angiitis
C Polyarteritis nodosa
D Systemic lupus erythematosus
E Takayasu arteritis
F Thromboangiitis obliterans
G Wegener granulomatosis
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(91) A 55-year-old man has noted incresing frequency of transient episodes of palpitation brought on by exercise during the past 7 months. On physical examination there are no abnormal findings. Coronary angiography reveals no occlusions. Which of the following pathologic abnormalities of the heart is he most likely to have?
(92) A 48-year-old woman with a history of diabetes mellitus has the sudden onset of marked dyspnea. On physical examination there are diffuse rales in all lung fields. A chest radiograph reveals extensive pulmonary congestion. An echocardiogram reveals mitral insufficiency. Which of the following pathologic abnormalities of the heart is she most likely to have?
A Hemorrhagic pericarditis
B Amyloidosis
C Papillary muscle rupture
D Mural thrombosis
E Myocarditis
(93) A 77-year-old man has worsening exercise tolerance. On physical examination he has prominent peripheral pulses. A chest radiograph reveals prominence of the aortic knob. A chest CT scan reveals a thoracic aortic aneurysm. Laboratory studies show a positive serologic test for syphilis. Which of the following pathologic findings is most likely to be present?
(94) An 88-year-old woman has had headaches for the past 2 weeks. On physical examination she has a palpably tender right temporal artery. Which of the following pathologic findings is most likely to be present?
A Cystic medial necrosis
B Aschoff nodules
C Small platelet and fibrin vegetations
D Inflammation with giant cells
E Obliterative endarteritis
(95) A 22-year-old G3 P2 woman gives birth following an uncomplicated pregnancy to a male infant at 37 weeks gestation. No external congenital anomalies are noted. The baby develops respiratory distress within an hour following delivery. Which of the following congenital heart diseases is this infant most likely to have?
(96) 33-year-old man is able to run marathon races with a respectable time for his age group. On physical examination there are no remarkable findings. Which of the following congenital heart diseases is this infant most likely to have?
A Large ventricular septal defect
B Bicuspid aortic valve
C Hypoplastic left heart syndrome
D Mitral stenosis
E Post-ductal aortic coarctation
(97) A 41-year-old man has been an injection drug user for over a decade. He has an acute febrile illness developing over the last 3 days. On physical examination his temperature is 37.9 C. There is a heart murmur. On echocardiography a 1 cm vegetation of the tricuspid valve is seen. Which of the following forms of endocarditis is he most likely to have?
(98) A 25-year-old woman has had a low grade fever and chills for 3 weeks. On physical examination a shrill systolic murmur is present. An echocardiogram reveals a ventricular septal defect. Which of the following forms of endocarditis is she most likely to have?
A Acute bacterial endocarditis
B Non-bacterial thrombotic endocarditis
C Libman-Sacks endocarditis
D Subacute bacterial endocarditis
E Verrucous endocarditis
(99) A 10-month-old infant has displayed less activity over the past 2 months. On physical examination there is peripheral edema. A chest radiograph shows an enlarged heart and pulmonary edema. Which of the following cardiac neoplasms is this infant most likely to have?
(100) A 42-year-old healthy woman has been bothered by episodic syncope for the past 3 months. On physical examination there are no abnormal findings. A chest x-ray is unremarkable. Which of the following cardiac neoplasms is this woman most likely to have?
A Left atrial myxoma
B Rhabdomyosarcoma
C Papillary fibroelastoma
D Rhabdomyoma
E Metastatic carcinoma
(101) A 55-year-old man has worsening dyspnea for the past year. On physical examination he is afebrile and normotensive. A chest x-ray shows left ventricular hypertrophy. An echocardiogram shows aortic insufficiency with aortic root dilation. Which of the following infectious agents is most likely to produce these findings?
(102) A 49-year-old woman who had undergone orthotopic heart transplantation a year ago for dilated cardiomyopathy myocarditis recently had acute cellular rejection diagnosed by endomyocardial biopsy. Her immunosuppressive therapy was increased. Over the past 2 weeks she has become febrile. On examination she has diffuse lung rales. There is 2+ pitting edema of her lower legs. Which of the following infectious agents is most likely to produce these findings?
A Toxoplasma gondii
B Treponema pallidum
C Trypanosoma cruzii
D Corynebacterium diphtheriae
E Mycobacterium tuberculosis
(103) A clinical study of patients with congenital heart disease is conducted. Some of these patients are observed to develop cor pulmonale by the age of 20. This complication is most likely to result from an abnormality of which of the following cardiac structures?
(104) A clinical study of elderly patients with congenital heart disease is conducted. It is observed that some of these patients have calcification noted in the heart on chest CT scan. This complication is most likely to result from an abnormality involving which of the following cardiac structures?
A Foramen ovale
B Aortic valve
C Mitral valve
D Aortic root
E Pulmonic valve
(105) A 48-year-old man undergoing routine cholecystectomy develops intractable arrhythmias during the surgery and the anesthetist has difficulty in restoring a normal cardiac rhythm. Which of the following is the most likely cardiac abnormality in this man?
(106) A 56-year-old woman has experienced increasing lethargy and nausea for the past 5 months. On physical examination she appears pale. Upper GI endoscopy is performed and she is found to have chronic atrophic gastritis. Which of the following is the most likely cardiac abnormality in this woman?
A Fatty degeneration of myocardium
B Eosinophilic myocarditis
C Dilated cardiomyopathy
D Cardiac amyloidosis
E Hypertrophic subaortic stenosis
(107) A 53-year-old woman has lost 5 kg over the past 6 months. On physical examination her heart sounds are distant, but the rate and rhythm is normal. On echocardiography a pericardial effusion is noted. There are small epicardial mass lesions. Which of the following neoplasms involving the heart is she most likely to have?
(108) An autopsy study is performed to determine the frequency and histopathologic types of primary cardiac neoplasms. It is observed that the frequency of such primary neoplasms is less than 0.1% of adult persons. Which of the following is likely to be the most frequently encountered type of primary cardiac neoplasm?
A Rhabdomyoma
B Melanoma
C Angiosarcoma
D Myxoma
E Papillary fibroelastoma
A 47-year-old woman is brought to the emergency room unconscious. On physical examination her heart sounds are faint. Her blood pressure is 80/50 mm Hg, and a paradoxical pulse with a greater than 10 mm Hg inspiratory decrease in systolic arterial pressure is noted. There is an area of red discoloration and swelling beneath the skin of her anterior chest. Pericardiocentesis is performed, and 250 ml of frankly bloody fluid is removed. Which of the following conditions most likely produced these findings?
A Hepatic cirrhosis
B Chronic renal failure
C Rheumatic heart disease
D Scleroderma
E Motor vehicle accident
F Coronary thrombosis
A 50-year-old man has a long history of chronic alcohol abuse. He now presents with increasing leg edema as well as shortness of breath for the past 3 weeks. He does not report any chest pain. His vital signs include temperature 37.1 C, pulse 85/minute, respirations 25/minute, and blood pressure 125/75 mm Hg. His neck veins are distended. On palpation of the abdomen his liver is firm and the spleen tip is palpable. Which of the following cardiovascular abnormalities is he most likely to have?
A Occlusive coronary atherosclerosis
B Aortic cystic medial necrosis
C Verrucous endocarditis
D Four chamber dilation
E Hemorrhagic pericarditis
An 18-year-old man has had increasing lethargy and dyspnea on exertion for the past month. On physical examination he has marked bounding pulses in the upper extremities, but only weak pulses palpable in the lower extremities. He does not have cyanosis. Pulmonary function testing is normal. Which of the following congenital diseases is he most likely to have?
A Pulmonic stenosis
B Tetralogy of Fallot
C Coarctation of the aorta
D Transposition of the great vessels
E Patent ductus arteriosus
A 45-year-old woman with headaches for 5 months goes to her physician. On physical examination her blood pressure is 160/100 mm Hg. No other abnormalities are noted. She is given antihypertensive therapy. Her blood pressure remains in good control for a year, but then she develops severe headaches for 2 days. Her blood pressure is now recorded at 250/150 mm Hg. Laboratory studies show a serum urea nitrogen of 4.5 mg/dL with creatinine of 49 mg/dL. Which of the following pathologic lesions involving her arterial circulation is most likely to accompany these findings?
A Monckeberg medial calcific sclerosis
B Hyperplastic arteriolosclerosis
C Fibromuscular dysplasia
D Renal artery thrombosis
E Benign nephrosclerosis
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