Q6 Gen Med Quiz 2 Utah Questions

Pulmonary hypertension

A 2-year-old child has had failure to thrive for a year, becoming increasingly listless. On examination she is found to have a soft, rumbling systolic ejection murmur. An echocardiogram reveals a large membranous ventricular septal defect. Which of the following complications is she most likely to experience as an adult 2 decades later if this lesion remains untreated?

Ventricular septal defect

A 20-year-old primigravida delivers a term baby girl following an uncomplicated pregnancy. No anomalies are noted at the time of birth. Five weeks later, the mother brings the baby to the clinic because she has difficulty breathing and occasionally turns pale. On physical examination a pansystolic murmur is audible. Which of the following congenital cardiac anomalies is most likely to be present in this infant?

Hyperplastic arteriolosclerosis

A 44-year-old African-American man has had elevated blood pressure for years which has not been treated. He now has severe headaches. On physical examination his blood pressure is 275/150 mm Hg. Laboratory studies show Hgb 13.8 g/dL, serum glucose 76 mg/dL, and creatinine 3.5 mg/dL. These findings are most likely to be associated with which of the following pathologic lesions involving his kidneys?

Sodium retention

A study of persons with essential hypertension is performed. They have blood pressures in the range of 140/90 to 160/100 mm Hg. Laboratory studies show normal serum electrolyte values. Which of the following physiologic abnormalities is most likely to account for their hypertension?

Pericardiocentesis

16-year-old healthy adolescent is involved in a schoolyard gang fight and is stabbed in the chest with a knife in the left midclavicular line. He is taken to the emergency department and on arrival his blood pressure is barely obtainable. His lungs are clear to auscultation. His heart sounds are barely audible. Which of the following is the most useful therapeutic approach for this boy?

Fibrillin (Marfan Syndrome)

19-year-old woman has had increasing malaise for the past 5 months. On physical examination she has a cardiac murmur characterized by a mid systolic click. An echocardiogram demonstrates mitral insufficiency with upward displacement of one leaflet. There is aortic root dilation to 4 cm. She has a dislocated right ocular crystalline lens. A year later she dies suddenly and unexpectedly. The medical examiner finds a prolapsed mitral valve with elongation, thinning, and rupture of chordae tendineae. A mutation involving which of the following genes is most likely to be present in this patient?

Myofiber necrosis with neutrophils

45-year-old man was rushed to the hospital following the sudden onset of an episode of crushing substernal chest pain. He receives advanced life support measures. An EKG shows changes consistent with a large transmural anterolateral area of infarction involving wall of the left ventricle. He develops cardiogenic shock. Which of the following microscopic findings is most likely to be present in this area 4 days following the onset of his chest pain?

Mitral valve stenosis

45-year-old woman has had worsening shortness of breath for 3 years. She now has to sleep sitting up on two pillows. She has had difficulty swallowing for the past year. She has no history of chest pain. A month ago, she had a "stroke" with resultant inability to move her left arm. She is afebrile. A chest radiograph reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for her findings?

Calcific aortic stenosis

72-year-old woman has had no major illnesses throughout her life. She has had 3 syncopal episodes during the past 2 weeks. Over the past 2 days she has developed shortness of breath and a cough with production of frothy white sputum. On physical examination she is afebrile. Her blood pressure is 135/90 mm Hg. She has no peripheral edema. A chest radiograph reveals a prominent left heart border in the region of the left ventricle, but the other chambers do not appear to be prominent. There is marked pulmonary edema. Laboratory studies show a total serum cholesterol of 170 mg/dL. Which of the following is the most likely diagnosis?

Ketonuria

A 10-year-old previously healthy child has been noted by her parents to be constantly thirsty. She is consuming large amounts of soft drinks. She is urinating often. Her diet and exercise patterns have not changed, except for an increased appetite, yet she appears cachectic and has lost 7 kg over the past 4 months. On physical examination there are no abnormal findings, other than peripheral muscle wasting and weakness. Which of the following laboratory findings would you most strongly suspect is present in this girl?

Myofiber disarray

A 17-year-old girl "blacks out" while out running for exercise one afternoon, as she has done for many years. Physical examination, chest radiograph, head CT scan, CBC, and chemistry panel are all normal. Over the next year, she develops mild dyspnea and fatigue. She experiences several episodes of near-syncope. After another syncopal episode, she is referred to a cardiologist who orders an EKG that shows changes of left ventricular hypertrophy and broad Q waves. An echocardiogram reveals left ventricular and septal hypertrophy, small left ventricle, and reduced septal excursion. The septum has a "ground glass" appearance. Which of the following is the most likely microscopic feature of her disease process?

Narrowing of the aorta past the ductus arteriosus

A 17-year-old girl is short in stature for her age. She has not yet shown any changes of puberty. On physical examination her vital signs include T 37°C, RR 18/minute, P 75/minute, and BP 165/85 mm Hg. She has a continuous murmur heard over both the front of the chest as well as her back. Her lower extremities are cool with diminished pulses and poor capillary filling. She has a webbed neck. A chest radiograph reveals a prominent left heart border, no edema or effusions, and rib notching. Which of the following cardiovascular abnormalities is she most likely to have?

Positive blood culture for Pseudomonas aeruginosa

A 22-year-old man has had increasing malaise over the past 3 weeks. On physical examination his vital signs show T 39.2°C, P 105/minute, RR 30/minute, and BP 80/40 mm Hg. On auscultation of his chest a loud systolic cardiac murmur is heard, and his lungs have bibasilar crackles. Needle tracks are seen in his left antecubital fossa. He has splinter hemorrhages noted on fingernails, as well as painful erythematous nodules on palmar surfaces. A tender spleen tip is palpable. A chest radiograph shows pronounced pulmonary edema. Which of the following laboratory test findings is most likely to be present in this patient's peripheral blood?

Systemic lupus erythematosus (Libman-Sacks Endocarditis)

A 23-year-old woman has had worsening malaise along with a malar skin rash persisting for 3 weeks. On physical examination, she has an audible friction rub on auscultation of the chest, along with a faint systolic murmur. An echocardiogram reveals small vegetations on the mitral valve and adjacent ventricular endocardium. Laboratory studies show a positive serologic test for anti-Smith antibody, with a titer of 1:2048. Which of the following is the most likely diagnosis?

Calcification

A 24-year-old woman with rheumatic heart disease becomes febrile. On physical examination she has a systolic murmur. An echocardiogram shows vegetations of the aortic valve cusps. A blood culture is positive for Staphylococcus epidermidis. She receives a porcine bioprosthesis because of her desire to have children and not to take anticoagulant medication. After ten years, she must have this prosthetic valve replaced. Which of the following pathologic findings in the bioprosthesis has most likely led to the need for replacement?

Contraction band necrosis

A 25-year-old man dies suddenly and unexpectedly while at a nightclub late one evening. The medical examiner performs an autopsy. There is no evidence for trauma on external examination of the body. There are no gross pathologic findings of internal organs. Postmortem toxicologic findings are significant for high blood levels of cocaine and its metabolite benzoylecgonine. Which of the following is the most likely histopathologic finding involving his heart?

Coxsackie B virus

A 25-year-old previously healthy woman collapses suddenly and unexpectedly. Echocardiography shows global hypokinesis with increased left ventricular end diastolic and systolic size, along with systolic left ventricular dysfunction with decreased ejection fraction. An endomyocardial biopsy is obtained and microscopically, the myocardium shows infiltration by small lymphocytes, with focal myocyte necrosis. Which of the following infectious agents is most likely to have caused these findings?

Echovirus serologic titer of 1:160

A 26-year-old previously healthy woman has had worsening fatigue with dyspnea, palpitations, and fever over the past week. On physical examination her vital signs show T 38.9°C, P 104/minute, RR 30/minute, and BP 95/65 mm Hg. Her heart rate is slightly irregular. An ECG shows diffuse ST-T segment changes. A chest x-ray shows mild cardiomegaly. An echocardiogram shows slight mitral and tricuspid regurgitation but no valvular vegetations. Laboratory studies show a troponin I of 12 ng/mL. She recovers over the next two weeks with no apparent sequelae. Which of the following laboratory test findings best explains the underlying etiology for these events?

Cyanosis

A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?

Atrial septal defect

A 27-year-old man has become severely ill with fever and malaise over the past 3 days following tooth extraction. On examination he has a temperature of 38.8°C, heart rate of 105/minute, respiratory rate of 24/min, and blood pressure of 80/40 mm Hg. He has a widely split S2 heart sound and a rumbling mid-diastolic murmur. He has small hemorrhages visible on nail beds. His spleen tip is palpable. Which of the following cardiac conditions is most likely to predispose him to this acute illness?

Lactic acid of 4.8 mmol/L

A 29-year-old woman is involved in a motor vehicle accident that results in severe lacerations to her lower extremities, along with blunt abdominal trauma. In the emergency room she is noted to have cool, pallid skin. She has vital signs showing T 36.9°C, P 110/minute, RR 26/minute, and BP 70/30 mm Hg. She has decreased urine output. Which of the following laboratory findings on a blood sample from this patient is most likely to be present?

Thrombocytopenia

A 34-year-old previously healthy woman notes that she has bruises form on her arms and legs with just minor trauma. Physical examination reveals areas of purpura from 1 to 3 cm in size over her trunk and extremities, but no swelling, warmth, or erythema. Peripheral pulses are all palpable and full. Her blood pressure is 110/70 mm Hg. An ultrasound examination of her lower extremities with Doppler flow measurement reveals no evidence for thrombosis. Laboratory findings include serum urea nitrogen of 16 mg/dL, LDH 300 U/L, total protein 6.9 g/dL, albumin 5.3 g/dL, alkaline phosphatase 50 U/L, AST 40 U/L, and ALT 20 U/L. Which of the following additional laboratory findings is most likely to be present in this patient?

Positive urine screen for opiates

A 35-year-old man was found down, was delirious, and talking incoherently. On examination in the emergency department his temperature is 39.3°C, pulse 110/minute, and blood pressure 70/palpable. He has a heart murmur, palpable spleen tip, and splinter hemorrhages of fingernails. Which of the following laboratory findings is most likely to be present in this man?

Angiosarcoma (rare cardiac neoplasm)

A 37-year-old previously healthy man has had worsening dyspnea along with peripheral edema for the past two years. On physical examination he has diffuse crackles auscultated over both lungs. A chest radiograph shows that the heart nearly fills the chest. A chest CT scan demonstrates a 10 cm mass involving the right ventricle that appears to have areas of hemorrhage and necrosis within it. Which of the following neoplasms is this man most likely to have?

Mitral and aortic

A 43-year-old woman has noted increasing dyspnea for the past 6 years. On examination she is afebrile. Rales are auscultated in both lungs. A chest radiograph shows an enlarged cardiac silhouette and bilateral pulmonary edema. Past history reveals that, as a child she suffered recurrent bouts of pharyngitis with group A beta hemolytic streptococcal infections. Which of the following cardiac valves are most likely to be abnormal in this woman?

Malignant hypertension

A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely condition associated with her findings?

Cold water fish oil

A 44-year-old woman has a family history of heart disease. Her father and mother both developed myocardial infarction and congestive heart failure as a result of occlusive coronary atherosclerosis. A dietary modification to include consumption of which of the following is most likely to reduce her risk for ischemic heart disease?

Renin

A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. On microscopic examination his renal artery branches have concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage of the renal parenchyma. An elevation in which of the following substances in his blood is most likely to be associated with these findings?

Creatine kinase

A 45-year-old man feels some crushing chest pain along with numbness in his left arm after shoveling 15 cm of snow off his driveway. Three hours later he collapses and is taken to the emergency room. Which of the following laboratory tests run on a blood specimen is most useful in this situation?

Serum ferritin of 800 ng/mL

A 45-year-old man has had no major medical problems throughout his life, except for arthritis pain involving all extremities for the past 5 years. He has had worsening orthopnea and pedal edema in the past 6 months. There is no chest pain. On examination he is afebrile. A chest radiograph shows cardiomegaly with prominent left and right heart borders, along with pulmonary edema. Laboratory studies show serum sodium 139 mmol/L, potassium 4.3 mmol/L, chloride 99 mmol/L, CO2 25 mmol/L, urea nitrogen 18 mg/dL, creatinine 1.3 mg/dL, and glucose 167 mg/dL. Which of the following additional laboratory test findings is he most likely to have?

Arrhythmia

A 49-year-old man has the sudden onset of substernal chest pain with radiation to his left arm. This persists for the next 6 hours. He goes to the emergency department and on examination is afebrile. Laboratory studies show a serum troponin I of 18 ng/mL and CK-MB of 8%. Angiography reveals a thrombosis of the left anterior descending coronary artery. During the next 24 hours, which of the following is the most likely complication he will experience?

Rheumatic heart disease

A 49-year-old woman had atrial fibrillation that was poorly controlled, even with amiodarone therapy. She suffered a "stroke" and died. At autopsy, her 600 gm heart is noted to have a mitral valve with partial fusion of the leaflets along with thickening and shortening of the chordae tendineae. There is an enlarged left atrium filled with mural thrombus. Which of the following underlying causes of death is she most likely to have?

Atherosclerosis

A 49-year-old woman has experienced marked pain in her lower extremities on ambulation more than 300 meters for the past 5 months. On physical examination, her lower extremities are cool and pale, without swelling or erythema. No dorsalis pedis or posterior tibial pulses are palpable. Her body mass index is 32. She is a smoker. Which of the following abnormalities of the vasculature is most likely to account for these findings?

Pulmonary interstitial fibrosis

A 50-year-old man has noted increasing swelling of his lower legs along with shortness of breath for 5 months. On physical examination he is afebrile, but diffuse crackles are heard over the lung bases. His heart rate is 80/minute and regular, with no murmurs, rubs, or gallops, but there is a prominent widened split S2. A chest radiograph reveals an increased size to the right heart border, along with bilateral pleural effusions. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following conditions is he most likely to have?

Troponin I of 32 ng/mL

A 50-year-old man has the sudden onset of substernal chest pain. The pain persists for the next three hours. He then becomes short of breath and diaphoretic. He goes to the emergency department and on physical examination his vital signs include T 37°C, P 100/minute, RR 26/minute, and BP 130/90 mm Hg. A chest x-ray shows a slightly enlarged heart and mild pulmonary edema. An EKG shows ST segment elevation in anterior leads V1 - 6. Which of the following serum laboratory test findings is most likely

Contraction band necrosis

A 51-year-old man has the sudden onset of substernal chest pain which radiates to his left arm and neck. He becomes light-headed and diaphoretic over the next 3 hours. He goes to the emergency room. On examination he is afebrile but has a heart rate of 96/minute with an irregular rhythm. Laboratory studies show a serum CK-MB of 15% with total CK of 524 mg/dL. Which of the following features would be most prominent by histopathologic examination of his myocardium at this point in time?

Left atrial myxoma

A 51-year-old woman has had several syncopal episodes over the past year. Each episode is characterized by sudden but brief loss of consciousness. She reports no chest pain. On physical examination her vital signs show T 36.9°C, P 80/minute, RR 16/minute, and BP 110/75 mm Hg. She has no pedal edema. On brain MR imaging there is a 1.5 cm cystic area in the left parietal cortex. A chest radiograph shows no cardiac enlargement, and her lung fields are normal. Her serum total cholesterol is 165 mg/dL. Which of the following cardiac lesions is she most likely to have?

Response to thrombolytic therapy

A 52-year-old woman has experienced marked substernal, crushing chest pain for the past 3 hours. Her vital signs show T 36.9°C, P 90/minute, RR 18/minute, and BP 100/60 mm Hg. Laboratory studies include a serum creatine kinase MB fraction of 10 microgm/L as well as a serum troponin I of 4.5 ng/mL. Which of the following findings is the best evidence for the presence of a coronary arterial thrombus as the etiology for her chest pain?

Metastatic carcinoma

A 53-year-old man has had malaise for the past 3 months. On physical examination he is afebrile. On auscultation of the chest, heart sounds are distant and there is a friction rub. An echocardiogram shows a pericardial fluid collection. A pericardiocentesis yields 10 mL of bloody fluid. Which of the following conditions is most likely to give rise to these findings?

Left ventricle

A 53-year-old man has the sudden onset of chest pain. He is found to have a serum troponin I of 5 ng/mL. A year later he has reduced exercise tolerance. An echocardiogram reveals an akinetic segment of left ventricle, and he has reduced cardiac output, with an ejection fraction of 25%. He then experiences a transient ischemic attack (TIA). His serum troponin I is now <0.5 ng/mL. Thrombus formation involving which of the following locations is most likely to have put him at greatest risk for the TIA?

Increased Plasma renin activity

A 53-year-old woman is found on a routine physical examination to have vital signs with T 37°C, P 78/minute, RR 16/minute, and BP 165/110 mm Hg. There are no other significant findings. She has an abdominal ultrasound examination that shows the right kidney to be atrophic. Angiography reveals markedly reduced blood flow to the right renal artery from an occlusion at the orifice in the abdominal aorta. Which of the following laboratory findings is she most likely to have?

Immobilization

A 54-year-old previously healthy woman is hospitalized for pneumonia. On the 10th hospital day she is found to have swelling and tenderness of her right leg, which has developed over the past 48 hours. Raising the leg elicits pain. An ultrasound examination reveals findings suggestive of femoral vein thrombosis. Which of the following conditions is most likely to have contributed the most to the appearance of these findings?

Pulmonary congestion

A 56-year-old man has a routine checkup. He is found to have a blood pressure of 175/110 mm Hg. A month later his blood pressure is 170/105 mm Hg. He elects to do nothing about this, because he feels fine. If he remains untreated, this man is at greatest risk for which of the following conditions?

Atherosclerosis

A 56-year-old reports reduced exercise tolerance over the past 5 years. In the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. On examination he has a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include a total serum cholesterol of 245 mg/dL with an HDL cholesterol of 22 mg/dL. Which of the following vascular abnormalities is he most likely to have?

Hyaline arteriolosclerosis

A 57-year-old man has had blood pressure measurements in the range of 160/95 to 180/110 mm Hg for many years. He has taken no medications. A renal scan reveals kidneys of normal size for age. These findings with benign nephrosclerosis are most likely to occur with which of the following vascular changes?

Artery

A 57-year-old woman has had episodes of abdominal pain following meals for the past year. Her BMI is 31. She has hypertension. Her total serum cholesterol is increased. Which of the following types of blood vessel is the most likely location for the pathologic abnormality causing her pain?

Atrial septal defect

A 58-year-old man develops deep venous thrombosis during a hospitalization for prostatectomy. He exhibits decreased mental status 10 days postoperatively, with right hemiplegia. A CT scan of the head shows an acute cerebral infarction in the distribution of the left middle cerebral artery. A chest radiograph reveals cardiac enlargement and prominence of the main pulmonary arteries consistent with pulmonary hypertension. Laboratory studies show a serum troponin I of <0.4 ng/mL. Which of the following lesions is most likely to be present on echocardiography?

Dilated cardiomyopathy

A 58-year-old man has had an enlarging abdomen for 5 months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid wave. An abdominal CT scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest radiograph shows a globally enlarged heart. He has vital signs showing T 37.1°C, P 78/minute, RR 16/minute, and BP 115/75 mm Hg. Which of the following cardiovascular conditions is he most likely to have?

Placement of a hip prosthesis (immobilization post-surgery)

A 58-year-old woman has the sudden onset of severe dyspnea with chest pain and diaphoresis. A chest CT scan shows areas of decreased attenuation within the main pulmonary arteries. Her D-dimer assay is elevated. Her acute event is most likely to be a consequence of which of the following?

Necrosis with neutrophils and macrophages

A 60-year-old man had chest pain and was hospitalized. On the first day of admission, his CK-MB fraction was 9.8% with total CK of 423 U/L. A coronary angiogram revealed 75% stenosis of the left anterior descending artery. Four days later he suddenly becomes worse, with marked hypotension. A pericardiocentesis is performed and returns 150 cc of bloody fluid. Which of the following microscopic findings is most likely to be present in his left ventricular myocardium at the time of this hypotensive episode?

Reperfusion injury

A 61-year-old man has the sudden onset of severe chest pain. Vital signs include T 37°C, P 102/minute, RR 20/minute, and BP 80/40 mm Hg. An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. He is given thrombolytic therapy with tissue plasminogen activator (tPA) 3 hours after the onset of chest pain. However his serum creatinine kinase is found to be 450 U/L 3 hours after this therapy. Which of the following cellular events has most likely occurred?

Left ventricle

A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of coronary arteries. In which of the following locations is a mural thrombus most likely to occur in this man?

Myocardial infarction

A 63-year-old man has had increasing exercise intolerance for the past 6 years so that he now becomes short of breath upon climbing a single flight of stairs. Laboratory studies have shown fasting blood glucose measurements from 145 to 210 mg/dL for the past 25 years, but he has not sought medical treatment. If he dies suddenly, which of the following is most likely to be the immediate cause of death?

Mesenteric artery occlusion

A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is indicated by the laboratory finding of hemoglobin A1C 10.1%. He has noted episodes of abdominal pain following meals. These episodes have worsened over the past year. On physical examination, there are no masses and no organomegaly of the abdomen, and he has no tenderness to palpation. Which of the following pathologic findings is most likely to be present in this man?

Aortic dissection

A 63-year-old woman has the sudden onset of "knife-like" pain in the chest radiating to the back. She has been previously healthy except for a history of poorly controlled hypertension. She is transported to the hospital and on arrival she has a heart rate of 90/minute, respirations 20/minute, temperature 36.8°C, and blood pressure 150/100 mm Hg. No murmurs, rubs, or gallops are audible. A chest radiograph reveals a widened mediastinum. Laboratory findings include a total serum creatine kinase of 55 U/L, creatinine 0.9 mg/dL, and glucose 123 mg/dL. Which of the following is the most likely diagnosis?

Atherosclerotic aortic aneurysm

A 65-year-old man has sudden onset of severe abdominal pain that has persisted for 3 hours. Physical examination reveals his temperature is 37°C, heart rate 110/minute, respirations 25/minute, and blood pressure 145/100 mmHg. He has diminished pulses in the lower extremities. There is a pulsatile abdominal mass. His serum creatine kinase is not elevated. He has had fasting blood glucose measurements in the range of 140 to 180 mg/dL for over 20 years. Which of the following conditions is he most likely to have?

Calcified bicuspid aortic valve

A 66-year-old man has had congestive heart failure with increasing pulmonary congestion and edema for the past year. He had been previously healthy all his life with no major illnesses. On physical examination his blood pressure is 125/85 mm Hg and he is afebrile. A systolic ejection click is auscultated. A chest x-ray shows cardiomegaly with a prominent left heart border and pulmonary edema. Laboratory studies show a serum glucose of 95 mg/dL and total serum cholesterol of 175 mg/dL. His serum creatine kinase is not elevated. Which of the following underlying diseases is he most likely to have?

Fibrinous

A 66-year-old man has had increasing malaise for the past year. On physical examination auscultation of the chest reveals a friction rub. Laboratory studies show a serum urea nitrogen of 100 mg/dL and creatinine of 9.8 mg/dL. Which of the following forms of pericarditis is he most likely to have?

Embolism

A 66-year-old man with Parkinson disease develops pleuritic chest pain. On exam, he has guarding over the right lower lung with dullness to percussion. A chest CT scan shows a focal, wedge-shaped pleural based area of hemorrhage in the right lower lobe. Which of the following is the most likely cause for his pulmonary lesion?

Oxidized LDL

A 66-year-old woman has the sudden loss of movement on part of the left side of her body. She has smoked a pack of cigarettes a day for the past 45 years. She has vital signs including T 37.1°C, P 80/minute, RR 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery. Laboratory findings include a hemoglobin A1C of 9%. Which of the following components of blood lipids is most important in contributing to her disease?

Non-bacterial thrombotic endocarditis

A 69-year-old woman with a 7 kg weight loss over the past 6 months now has developed painless jaundice over the past 2 weeks. On physical examination she is afebrile. An abdominal CT scan shows a large mass involving the head of the pancreas, along with widespread nodules in the liver. Nodules are seen in both lungs by chest radiograph. Which of the following cardiac abnormalities is she most likely to develop?

Natriuretic peptide

A 72-year-old man suffered a myocardial infarction involving half the left ventricular free wall 3 months ago. He now has increasing dyspnea and orthopnea. On echocardiography his ejection fraction is 29%. On examination he has poor capillary filling in hands and feet. A chest x-ray shows pulmonary edema. Which of the following laboratory test analytes is most likely to be increased in this man at this point in time?

Monckenberg Calcific medial sclerosis

A 73-year-old woman who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries lateral to her uterus. What is the probable vascular lesion which accounts for this calcification?

Erythrocyte sedimentation rate of 110 mm/hr

A 74-year-old man has had increasingly severe headaches for 2 months, centered on the right. His vital signs include T 36.9°C, P 82/minute, RR 14/minute, and BP 130/85 mm Hg. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities. A biopsy of this lesion is obtained, and microscopic examination reveals a muscular artery with luminal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy. Which of the following laboratory test findings is most likely to be present with this man's disease?

Tertiary syphilis

A 77-year-old man with decreasing mental function has developed increasing dyspnea for the past 3 years. On physical examination he has a diastolic murmur. A chest CT scan shows an enlarged heart and prominent aorta. He dies from complications of pneumonia. At autopsy, the thoracic aorta is aneurysmally dilated. A microscopic section of the aorta shows chronic inflammation and luminal narrowing of vasa vasora. There is disruption of the aortic medial elastic fibers. Which of the following conditions is most likely to cause these findings?

Libman-Sacks endocarditis

A clinical study is performed to document complications in persons with glomerulonephritis and with laboratory studies showing an elevated antinuclear antibody and anti-ds-DNA titer. Which of the following cardiac abnormalities is most likely to be present?

C-reative protein

A longitudinal study is conducted to detect serum markers that predict risk for death from acute coronary syndromes. A marker is identified that is synthesized and released from the liver in response to formation of cytokines in atheromatous plaques. This marker increases endothelial adhesiveness to platelets. What is this marker most likely to be?

Endothelial dysfunction

A study of atherogenesis is performed. There is a propensity for atheromas to form at muscular arterial branch points, such as the carotid and aortic bifurcations. Which of the following events in the arteries at these locations is most likely to initiate atherogenesis?

Hypertension

An autopsy study is conducted involving the gross appearance of the aorta of adults ranging in age from 60 to 90. In some of these patients, the aorta demonstrates atheromatous plaques covering from 70 to 95% of the intimal surface area, mainly in the abdominal portion, with ulceration and calcification. Which of the following contributing causes of death are these patients most likely to have?

Fatty streak

An autopsy study reveals that evidence for atheroma formation can begin even in children. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence for the formation of an atheroma?

Ventricular aneurysm

An epidemiologic study of eating habits is performed. Dietary patterns of adult patients are recorded and compared to risk for cardiovascular diseases. It is observed that persons who eat bacon for breakfast are more likely to have cardiovascular disease than persons who eat oat bran cereal. Which of the following conditions is the "bacon" group most likely to have?

Scleroderma

At autopsy, the kidneys of a 44-year-old woman who died suddenly are found to be of normal size. Their surfaces appear finely granular. There are small hemorrhages noted. The cortices appear pale. Microscopically, many small renal arteries and arterioles demonstrate concentric intimal thickening with marked luminal narrowing. These findings are most likely to be present as a result of which of the following underlying diseases?

Organization

During hospitalization, a 40-year-old woman develops thrombophlebitis. She recovers and is discharged. She returns to her job as an electrician. A couple of months later, which of the following terms would best describe the process seen in a femoral vein after recovery from her thrombophlebitis:

Coagulative

In an experiment, a glass bead is embolized to a branch of the renal artery. A day later there is a focal area in which the renal parenchymal cells in the distribution of the occluded artery show karyolysis and karyorrhexis. The outlines of the cells are still visible, but the nuclei have lost basophilic staining and the cytoplasm is eosinophilic but pale. Which of the following types of cellular necrosis is most likely present?