Systems Path EXAM 3

poliomyelitis

On examination of a patient the following findings are obtained. The patient has paraplegia of the right lower limb. the patient also shows loss of pain and temperature sensation of the left lower extremity with loss of position and vibration sense on the right. What is this a description of?

Prinzmetals angina

The type of angina that occurs at rest and is not directly related to vasospastic event:

Streptococcus viridans

The type of bacteria that is associated very commonly with the development of subacute bacterial endocarditis in a previously damaged, native heart valve.

Aortic regurgitation

The valve lesion that presents as a diastolic murmur heard in the 2nd intercostal space just to the right of the sternum and is described as having a water hammer pulse that dies away quickly under the palpating fingers.

none of the above would be wernicke encephalopathy

This type of syndrome(normal associated with korsakoff syndrome) produces lesions in the mamillary bodies and produces opthalmoplegia. -Wilson's syndrome -Niemann pick syndrome -mamillary dysplasia -none of the above: would be wernicke encephalopathy

Berry anerysm

What is the name for the type of aneurysm normally found associated with a congenital weakness in the Circle of Willis vascularity?

Prinzmetal's angina

a patient complains of transient ischemic type chest pain that occurs even at rest and is not relieved by rest or brought on by exercise. On angiography it is found that the symptoms are not related to atherosclerosis, but instead are related to vasospasm. What condition is this a description of?

hydrostatic forces

an edema that develops in a hypertensive individual is most likely due to what factor?

Epidural

bleeding caused by rupture of the middle meningeal artery

Marfan's syndrome

cystic medial necrosis of the aorta is associated with which of the following?

estrogen therapy

in addition to serum cholesterol, each of the following conditions contributes an added risk for the development of atherosclerosis, EXCEPT: -Low serum levels of high-density lipoproteins -Hypertension -Diabetes mellitus -Estrogen therapy -cigarette smoking

hyperplastic arteriolosclerosis

malignant hypertension causes which change in the microvasculature of the kidney?

Iron deficiency

the anemia that is most commonly seen in the world and is especially common in women and children

Myxoma

the most common primary tumor of the heart in adults is:

cerebral infarction

the most serious complication of lower extremity thrombophlebitis is :

Polycythemia rubra vera

the neoplastic disease of bone marrow of unknown etiology that produces an absolute increase in the concentration of erythrocytes. A patient with this condition usually has a dusky red coloration of the skin and thrombosis in small blood vessels due to increased viscosity.

Polycythemia rubra vera

the neoplastic disease of bone marrow of unknown etiology that produces an absolute increase in the concentration of erythrocytes. a patient with this condition usually has a dusky red coloration of the skin and thrombosis in small blood vessels due to increased viscosity.

capillary hemangioma

the tumor of blood vessels of normal luminal size that is really a congenital malformation, and is seen most commonly in the skin and mucous membranes(sometimes referred to as a strawberry birthmark):

Chronic Myeloid Leukemia

the type of leukemia that has been associated with a specific abnormal chromosome known as the Philadelphia chromosome

acute lymphocytic leukemia

the type of leukemia that is usually seen in children and often presents with excessive bruising, recurrent infections and anemia.

all of the above

varicosities of veins characteristically form in which of the following places? -Lower 1/3 of the esophagus -hemorrhoidal veins -channels joining the superficial and deep veins of the legs -all of the above -none of the above

pulmonary edema

which of the following is the backward effect of sudden, acute LVF

Pompe's

which of the following is the disease of the heart muscle that is not only congenital, but is also a genetic problem due to glycogen accumulation

Fatal arrhythmia or cardiac dysrhythmia

50% of all patients die within 2 hours following a myocardial infarction. The most common cause of death is:

Hypertrophic cardiomyopathy

A 20 year old patient presents with sudden death on exertion. On examination of the heart it is found to be enlarged, but with asymmetric enlargement of the interventricular septum and on microscopy the fibers are found to be disorganized. What is the most likely diagnosis in this patient?

Takayasu's disease

A 21-year old asian female patient complains of blurring vision, headaches and some memory loss. you find it difficult to find either radial pulse and have to use the dorsal pedal artery to evaluate heart rate and rhythm. What might be the most likely cause?

Polyarteritis nodosa

A 25-year old woman with a recent history of acute hepatitis B infection presents with reddish-blue lesions at different developing stages on her lower extremities, fever, muscle pain, and mild weight loss. Physical examination reveals numerous regions of red-purple discoloration affecting the skin of both legs. Laboratory test demonstrate an elevated erythrocyte sedimentation rate. Urinalysis shows 2+ proteinuria. Biopsy of skin lesion demonstrates fibrinoid necrosis. Which of the following is the most likely diagnosis?

Congenital berry aneursym

A 30-year-old woman develops the "worst headache of her life" and then becomes comatose. A CT scan of the head reveals subarachnoid hemorrhage. The patient eventually dies, and autopsy reveals rupture of a berry aneurysm. The pathogenesis of this vascular abnormality is most closely linked to which of the following conditions?

Elevated CK-MB

A 45-year-old males experiences crushing substernal chest pain on arriving at work in the morning. Over the next few hours the pain persists and begins to radiate to his left arm. He becomes diaphoretic and short of breath, but he waits until the end of his 8-hour shift to go to the hospital. Which of the following serum laboratory test findings is most useful to diagnose his condition on admission to the hospital?

Atherosclerotic narrowing of coronary arteries

A 50-year old experiences episodes of severe substernal chest pain every time he performs any task requiring moderate exercise. These episodes have become more frequent and severe in the past year, but they can be relieved by use of sublingual nitroglycerin. Which of the following cardiac lesions is probably present?

left to right shunt

A 6-month old infant with tetralogy of fallot is likely to demonstrate all of the following, EXCEPT: -cyanosis -a systolic murmur suggesting pulmonary stenosis -ventricular septal defect -Left to right shunt -Decreased pulmonary blood flow

Atherosclerosis

A 60-year-old mildly obese woman is admitted to the hospital with a chief compliant of recurrent chest pain on exertion. The patient reports several episodes of chest pain over the past several years and painful leg cramps when walking. Fasting blood glucose (160 mg/dL) and total serum cholesterol (370 mg/dL) are high. The ECG is normal and blood tests for cardiac-specific proteins are negative. Chest pain in this patient is most likely due to which of the following underlying conditions?

Sudden headache with blindness

A 75-year-old male has had headaches for several months. On physical examination, he has a prominent palpable right temporal artery that is painful to touch. The biopsied segment of thickened temporal artery shows focal granulomatous inflammation. Which of the following complications is most likely untreated patients?

Pernicious anemia

A deficiency of B12 caused by a lack of intrinsic factor due to the development of chronic atrophic gastritis is called:

Macrocytic, megaloblastic

A deficiency of B12 is characterized as producing which morphological type of anemia?

Senile purpura

A disorder of coagulation that is caused by a loss of collagen in the skin and hence the production of increased blood vessel fragility?

Patent ductus arteriosus (PDA) "all machinery requires duct tape"

A harsh, waxing and waning, machinery-like murmur is auscultated in the upper chest of a 2-year-old with a history of infective endocarditis. Angiography reveals mild pulmonary hypertension. Echocardiography shows all valves to be normal in configuration. Which of the following lesions did the angiogram most likely show?

Papillary muscle rupture

A patient with acute myocardial infarction suddenly develops acute mitral insufficiency on the fourth day after the infarction. The BEST explanation for this is:

Acute Idiopathic Thrombocytopenic Purpura

A probable autoimmune condition of platelets that is seen in young children following a viral infection and that causes hemorrhage due to destruction of platelets by the spleen

microcytic, hypochromic

An iron-deficiency anemia is characterized by which of the following morphological types?

Rupture of the left ventricle

Acute cardiac tamponade is typically due to which of the following events or conditions that occurs following a myocardial infarction?

This is an incidental finding

After a fall, a 59-year-old female experiences some right hip pain. A radiograph reveals no fractures, but there are calcified, medium-sized arterial branches in the region of the pelvis. What is the significance of this finding?

Pulmonary valvular stenosis

Carcinoid heart disease is MOST likely to be associated with which one of the following conditions?

4-10 days

Following an acute myocardial infarction, rupture of the left ventricle is most likely after:

Diabetes mellitus

For which of the following conditions is hypertension NOT a risk factor? -peripheral vascular disease -stroke -renal disease -diabetes mellitus

Thalassemia minor

Hemoglobin defect, heterozygous, beta chain gene depletion, mild anemia. This is consistent with:

Liquefactive necrosis

If the myocardium ruptures following a myocardial infarction, what abnormal process occurred to cause the rupture?

Rheumatic heart disease

In which of the following conditions is a "bread and butter" pericarditis found?

Anterior descending branch of the left coronary artery

Infarction of the anterior half of the interventricular septum is caused by an occlusion of the:

Hyperplastic arteriosclerosis

Malignant hypertension typically produces which type of small vessel disease?

Pancreatic carcinoma

Migratory thrombophlebitis (Trousseau syndrome) is associated with which one of the following?

Aplastic anemia

Occupational exposure to Benzene could result in which of the following?

Streptococcus pharyngitis

Rheumatic fever is a non-infectious complication following:

TRUE

T/F: not every patient who has a myocardial infarction has a heart attack.

Aschoff body

The characteristic endocardial lesion of acute rheumatic heart disease is the:

Arrythmia's

The complication of myocardial infarction that is responsible for the majority of deaths occurring immediately following the infarction.

Transposition of the great vessels

The congenital heart disease that necessitates the presence of an atrial septal defect, a ventricular septal defect, or a patent ductus arteriosus to maintain life immediately after birth.

aortic incompetence

The disorder of cardiac valves that produces a "water-hammer" pulse is which of the following?

All of the above

The etiology for acute rheumatic fever includes which of the following? -Non-infectious complications that follows a streptococcal pharyngitis -Associated with development of a cross-reacting antibody to antigens on the outside of heart components -Associated particularly with the HLA-B5 antigen -Associated with an infection with a type A streptococcus -All of the above

aplastic anemia

The exposure to IV chloramphenicol as well as oral preparations of selected antifungals can lead to ________ in a small percentage of the population.

thromboangiitis obliterans

The inflammatory condition of blood vessels that is seen to develop in young males who are cigarette smokers particularly in mediterranean countries such as israel

Septic emboli

The lesions associated with acute rheumatic fever typically may include all of the following EXCEPT: a. myocardial inflammation b. acute valvulitis c. septic emboli d. pericardial inflammation

Coxsackie B virus

The most common cause of an infectious myocarditis in the U.S. is:

Ischemic heart disease

The most common cause of left heart failure is

VSD (ventricular septal defect)

The most common type of congenital cardiac abnormality as diagnosed in childhood is which of the following?

subacute combined degeneration

The neurological problem in the spina cord produced by a deficiency of B12 is called:

Troponin

The protein that is the first to increase in the serum following a myocardial infarction is:

Kaposi's sarcoma

The tumor of blood vessels that is associated with AIDS:

All of the above are involved

Which of the following are conditions are involved in the clinical definition of portal hypertension? a. splenomegaly b. ascites c. esophageal varices d. all of the above are involved e. only a and c are involved

Amyloidosis

Which of the following are known to produce a restrictive type of cardiomyopathy?

amyloidosis

Which of the following are known to produce a restrictive type of cardiomyopathy?

Syphilitic aneurysm

Which of the following diseases associated with inflammation of the vasa vasorum?

Dissecting aneurysm of distal one 3rd of aorta

Which of the following is a potential complication of syphilitic aortitis

VSD

Which of the following is most commonly associated with the development of an Eisenmenger complex?

ASD

Which of the following is most commonly associated with the development of an eissenmenger complex?

Left ventricular hypertrophy

Which of the following is the change in size of the heart that is produced by systemic hypertension.

Coarctation of the aorta

Which of the following is the congenital disease of the heart that is characterized by having increased blood pressure in the brachial artery but low blood pressure in the femoral artery?

Trypanosoma cruzi infection

Which of the following is the etiology of the myocarditis known as Chaga's disease?

cor pulmonale

Which of the following is the most common cause of a pure RVF i.e. there is only failure of the right ventricle?

Mitral stenosis

Which of the following is the most common valvular lesion that is found in chronic rheumatic heart disease

Mitral stenosis

Which of the following is the most common valvular lesion that is found in chronic rheumatic heart disease?

Eisenmenger's syndrome

Which of the following is the name given to the condition in which there is reversal of a previously left to right shunt thus causing cyanosis?

Idiopathic

Which of the following is the overall most common cause of congenital hearth disease?

Pulmonary edema

Which of the following is the result of a chronic backward failure of the left ventricle?

coarctation of the aorta

Which of the following is the type of congenital heart disease that is often associated with Turner's syndrome

Aschoff body

Which of the following is the typical lesion that is seen in the myocardium in acute rheumatic fever?

Large, red, friable vegetations (cause saccular aneurysm)

Which of the following is the typical lesion that is seen on the heart valves in acute bacterial endocarditis?

Staphyloccocus aureus bacteremia

Which of the following is/are factor(s) that is/are involved in the etiology of acute bacterial endocarditis?

Pulmonary emphysema secondary to smoking

Which of the following pathologies is responsible for left cardiac concentric hypertrophy?

Chronic right ventricular failure

Which of the following produces a "nutmeg" liver?

Tetralogy of Fallot

Which of these is a congenital cardiac defect with a shunt that is cyanotic at birth?

coarctation of the aorta

While examining a 25-year old patient you notice that the head and neck appear pink and flushed. Radiographic examination shows evidence of "notching" of the ribs. During a further examination you discover that the femoral pulse is weak and delayed as compared to the brachial pulse while the femoral blood pressure is lower than that obtained from the brachial artery. Which of the following diseases or conditions is the most likely cause of the above findings?

idiopathic dilated cardiomyopathy

a 44-year old previously healthy male has experienced worsening exercise tolerance accompanied by marked shortness of breath for the past 6 months. A chest radiograph shows an enlarged heart and pulmonary edema. An echocardiogram shows four-chamber cardiac dilation and demonstrates mitral and tricuspid valvular regurgitation. A coronary angiogram demonstrates no more than 10% narrowing of the major coronary arteries. The underlying condition that is most likely to be present in this patient is:

carotid atherosclerosis

a frequent cause of cerebral embolism in the days following a myocardial infarction