Course Directors:

 

Pathology 

 

 

Pathophysiology

 

Pharmacology

 

Kim Boekelheide

&

Calvin Oyer, M.D.       

 

 

Douglas Burtt

&

Hank Wu,

 M.D.      

 

Robert Patrick, Ph.D

 


Questions 1 - 12:

     

      An 82-year old male with a 10-year history of a heart murmur presents to the hospital emergency room with progressive shortness of breath of 24 hours duration.

      On examination, blood pressure is 110/90, pulse is 125 and irregularly irregular, respirations are 28 and temperature is normal

      Neck exam reveals 10 cm jugular venous distension and delayed carotid upstrokes.

      Chest exam reveals a late-peaking systolic murmur at the base, radiating to the neck, with a single second heart sound.

      Chest X-ray reveals pulmonary edema.

 

1. Which valvular abnormality does this patient most likely have?

 

A)     Hypertrophic Cardiomyopathy with outflow tract obstruction

B)     Aortic stenosis

C)     Aortic insufficiency

D)    Mitral stenosis

E)     Mitral insufficiency

 

This patient’s electrocardiographic rhythm strip is shown below:

2. This patient’s heart rhythm irregularity is most likely due to:

 

A)     frequent atrial premature contractions

B)     multifocal atrial tachycardia

C)     atrial fibrillation

D)     frequent ventricular premature contractions

E)     ventricular tachycardia

 

3. This patient’s heart rhythm may cause all of the following, except:

 

A)     predisposition to thrombo-embolism originating in the left atrium

B)     reduced cardiac output due to loss of the “atrial kick”

C)     reduced stroke volume due to increased heart rate

D)    predisposition to development of sudden death with ventricular fibrillation

E)     variation in intensity of the murmur from beat to beat

 
 


4.  During the course of treatment of this patient’s arrhythmia, Digoxin administration is considered. Digoxin increases cardiac intracellular free calcium levels via:

 

A)  Stimulation of calcium release from the sarcoplasmic reticulum

B)   Inhibition of adenylyl cyclase activity

C)   Inhibition of Na+-K+ ATPase activity

D)   Stimulation of voltage-dependent calcium channels

E)   Increasing the affinity of norepinephrine for cardiac b-receptors

5. Which of the following sets of pressures was most likely found on this patient at the time of cardiac catheterization (where RA = right atrial pressure, PA = pulmonary artery pressure, PCW = pulmonary capillary wedge pressure, LV = left ventricular pressure, Ao = aortic pressure):

       

Units = mmHg

RA

PA

PCW

LV

Ao

A)

5

20/10

10

110/10

110/90

B)

10

40/20

20

110/5

110/90

C)

10

70/30

20

110/5

110/90

D)

10

50/30

30

160/30

110/90

E)

15

50/30

30

110/30

110/90

 

6. At which point on the following diastolic pressure/volume curves would this patient most likely be? (A, B, C, or D?)

7. Treating this patient with a diuretic would cause the following change:

 

A)       the patient would move from the upper curve to a new curve, displaced down and to the right

B)       the patient would move from the lower curve to an upper curve, at the same vertical position

C)       the patient would stay on the same curve and move up and to the right

D)       the patient would stay on the same curve and move down and to the left

E)        the patient would move from the upper curve to a new curve, displaced upwards and to the left

 

8. The clinical history in this case is most consistent with which of the following gross images of a heart:

 
 



Questions 9 & 10
pertain to the following series of pressure-volume loops, which was generated in the same patient. 

9. What pharmacologic maneuver might cause the patient’s curve to change from curve 3 to curve 1:

 

A)  Administration of an afterload reducing agent

B)  Administration of a diuretic

C)  Administration of an ACE-inhibitor

D) Administration of a positive inotrope

E)  Administration of nesiritide (B-type natriuretic peptide)

 

10. All of the following effects would occur in changing the patient’s curve from

curve 3 to curve 1, except:

 

A)    End-diastolic volume would be reduced

B)  Stroke volume would be increased

C)  Systolic blood pressure would be reduced

D)    Diastolic blood pressure would be reduced

E)   At the same heart rate, cardiac output would be increased

 

 
11. Which of the following heart structures is least likely to be increased in number in this patient?

 

A)   Myocytes

B)  Interstitial fibroblasts

C)  Mitochondria

D)   Sarcomeres

E)   Myocyte nuclei

 

 
12. At autopsy, myocardial hypertrophy is assessed most accurately by the:

 

A)   Left ventricular wall thickness

B)  Diameter of the left ventricle at a mid-septal level

C)  Measurement of heart size from a chest x-ray

D)   Weight of the heart

E)   Microscopic examination of the left ventricular myocardium

 

Questions 13 – 18:

 

A 74 year-old female with long-standing hypertension presents to the hospital with mid-sternal chest pressure and dyspnea. She is too ill to give an adequate history. Pertinent physical findings include:

              

Heart rate: 110, regular;   Blood Pressure:  180/90;   Respirations: 24

               Neck:  10 cm jugular venous distension; normal carotid upstrokes

               Chest: rales are audible ˝ of the way up both lung fields

Heart:  Rapid, regular S1 and S2 with a III/VI systolic murmur at the left sternal border and apex, radiating to the back

               Extremities: cool; no edema, cyanosis or clubbing

 

               The electrocardiogram reveals sinus tachycardia with ST segment elevation and Q waves in several leads.

 

 

A bedside echocardiogram is performed on the patient and is shown below:

 

 

 
13. The initiating event for this patient’s illness most likely occurred:

 

A)   Within the last  hour

B)   Within the last 12 hours

C)   About 1 day ago

D)   About 3-10 days ago

E)    About 1 month ago

 

 
14. Which of the following microscopic images of the patient’s injured heart muscle at the time of visiting the ER is most consistent with the clinical history?

 


 

15. Treatment of the patient at this time might include all of the following, except:

 

A)     administration of thrombolytic therapy

B)     emergency cardiac catheterization

C)     placement of an intra-aortic balloon pump

D)    surgical consultation for possible open-heart surgery

E)    vasodilator drugs to reduce afterload and augment forward cardiac output

 

16. All of the following statements about this patient’s myocardial infarction are true, except:

 

A)      the “ischemic cascade” starting at the onset of her myocardial infarction includes diastolic dysfunction, systolic dysfunction, EKG changes and chest pain

B)      the myocardial infarction proceeds in a “wavefront” manner, proceeding from epicardium to endocardium

C)      systolic dysfunction caused by the infarction may lead to further ischemia by decreasing coronary perfusion pressure

D)      diastolic dysfunction caused by the infarction may lead to increased wall tension, increased LV end-diastolic pressure, and decreased oxygen delivery to the myocardium

E)       sympathetic stimulation due to the pain of the infarction may increase myocardial oxygen demand (MVO2)

 

 
17. As part of the treatment of this patient, the drug captopril is administered. Indicate which of the following statements concerning captopril is/are correct:

 

A. It reduces circulating levels of bradykinin

B. It can produce a persistent dry cough

C. It is an antagonist of an angiotensin II receptor

D. A and B

E. B and C

 

18. As part of the treatment of this patient, a right heart catheterization is performed. Which right heart catheterization results are most likely from this patient?

 

 

Answer

PCW mean pressure

PCW V wave pressure

RA oxygen saturation

PA oxygen saturation

A

30

30

60%

85%

B

10

10

80%

80%

C

30

60

70%

70%

D

20

20

80%

60%

E

30

30

85%

85%

 

 


Questions 19 – 24:

A thirty-five year old male Egyptian immigrant presents to the medical clinic for a pre-employment physical. He states that he had no prior illnesses but has been having some dyspnea on climbing stairs recently. On physical examination, his main finding is that of a loud first heart sound, a high-pitched sound immediately after S2, and a low-pitched diastolic murmur during diastole.

 

 
19. As a teenager, this patient experienced an acute, severe sore throat that resolved after about a week. A month or two later, the patient experienced a period of poor exercise tolerance, shortness of breath, and malaise. The likely inciting event in this patient’s illness is:

 

A)  An infective endocarditis

B)  A transmural myocardial infarction

C)  Chronic pulmonary emboli

D)  An autoimmune response

E)  None of the above

 

 
20. If an endomyocardial biopsy were performed on this patient at the time of clinical cardiovascular illness later in adulthood, the most likely finding would be:

 

A)  Increased fibrosis

B)  Acute inflammation

C)  Anitschkow cells

D)  Caterpillar cells

E)  Fibrinoid necrosis

 
 


21. The most commonly involved valves in this patient’s disease, from most common to least common are:

 

A)     mitral, tricuspid, aortic pulmonary

B)     aortic, mitral, tricuspid, pulmonary

C)     aortic, pulmonary, tricuspid, mitral

D)    mitral, aortic, tricuspid, pulmonary

E)     pulmonary, tricuspid, mitral, aortic

22. This patient is likely to have all of the following anatomical or physiological findings, except:

A)     a normal left ventricle

B)     a dilated left atrium

C)     thinned and elongated chordae tendinae

D)    doming of the mitral valve leaflets

E)    mildly elevated pulmonary artery pressures

23. The predominant physiological abnormality in this patient is:

A)     impaired emptying of the left ventricle

B)     impaired filling of the left ventricle

C)     volume overload of the left ventricle

D)    pressure overload of the left ventricle

E)     diastolic left ventricular dysfunction

24. Cardiac catheterization of this patient might demonstrate a gradient between which two pressures:

A)     Left ventricular and pulmonary capillary wedge pressure during diastole

B)     Ascending aortic pressure and left ventricular pressure during systole

C)     Right atrial and right ventricular pressure during diastole

D)    Right ventricular and pulmonary artery pressure during systole

E)     Left ventricular and left atrial pressure during systole

 

Questions 25 – 28:

A 48 year old patient with history of treated tuberculosis presents to the doctor’s office with progressive fatigue, dyspnea on exertion, abdominal swelling and ankle edema. 

Physical findings include:

               Pulse: 110 and regular; BP: 100/70 without a pulsus paradoxus; Resp: 20          

Elevated neck veins, which elevate further with inspiration

Minimal rales at the lung bases

An early diastolic sound shortly after S2

Distension of the abdomen consistent with ascites, with hepatomegaly

2 – 3+ pitting edema of the ankles

 

 
25. The LEAST likely cause of this patient’s illness is:

A)     a prior viral infection

B)     a prior bacterial infection

C)     a prior mycobacterial infection

D)    a prior fungal infection

 

26. Cardiac catheterization findings on this patient are likely to include all of the following, except:

 

A)     A blunted y-descent due to impaired rapid ventricular filling of the RV

B)     Elevated and equalized diastolic intra-cardiac pressures

C)     A “dip and plateau” during rapid ventricular filling of the RV

D)    A prominent y-descent due to rapid RA emptying

E)     An inspiratory rise in jugular venous pressure

 

27. This patient’s current clinical condition would be likely to:

 

A)     respond to treatment with non-steroidal anti-inflammatory drugs

B)     be accompanied by a fever

C)     respond to pericardiocentesis

D)    be associated with fusion of the pericardial tissue layers

E)     manifest an accentuated decrease in systolic blood pressure with inspiration

 

28. Of the following right atrial pressure tracings, which most closely resembles this patient’s:

 

 


 Questions 29 – 40:

A patient presents to the hospital with an acute anterior myocardial infarction associated with congestive heart failure. A right heart catheterization is performed in the CCU.

This patient’s Frank Starling curve is represented below as the lower of the two curves below.

Please answer the next TRUE or FALSE questions based on this diagram (A = TRUE ; B = FALSE).

 

29. This patient’s prognosis is better if he is on point A rather than point B on the curve.

30. This patient can be moved from point B to point C by administering fluids.

31. This patient can be moved from point A to point B by administering a positive inotrope.

32. Patients falling into Quadrant IV have a mortality rate of less than 30 percent.

33. Patients falling into Quadrant III usually have clear lungs and low blood pressure.

34. Patients in Quadrant II have the worst prognosis of all.

35. The Fick Method of determining this patient’s cardiac output predicts all of the following, except:

A)     An increase in mixed venous oxygen saturation suggests an increase in cardiac output

B)     A decrease in oxygen consumption suggests an increase in cardiac output

C)     The cardiac output can be estimated using three parameters: the oxygen consumption, the arterial oxygen saturation and the mixed venous oxygen saturation

D)    The calculation of the cardiac output using the Fick method is independent of the ability of the lungs to oxygenate the blood

E)     An increase in cardiac output coincides with a lower A-V O2 saturation difference


36. As part of this patient’s treatment you plan to use a positive inotropic agent. Which of the following inotropic agents also has significant vasodilating properties:

A)    

 
Digoxin

B)     Dopamine

C)     Epinephrine

D)    Milrinone

E)     Norepinephrine

 

 
37. With regard to the pharmacotherapy of patients with congestive heart failure, which of the following drug-pairs DO NOT exhibit potentiation of action when used in combination to improve symptoms in congestive heart failure:

 

A)     Angiotensin converting enzyme inhibitors and loop diuretics

B)     Hydralazine and isosorbide  (nitrates)

C)     Metolazone (a thiazide) and loop diuretics

D)    Beta blockers and dobutamine

E)     All of the above

 

 
38.  The mechanisms of action by which angiotensin converting enzyme inhibitors (ACE inhibitors) may be effective in the treatment of congestive heart failure are:

 

A)     Afterload reduction by inducing vasodilation

B)     Preload reduction by promoting diuresis

C)     Increase in myocardial contractility through neurohormonal antagonism

D)    a. and b.

E)     b. and c.

 

 
39.  Several weeks after his myocardial infarction the patient undergoes echocardiography which demonstrates an ejection fraction of 30% (normal = 55 – 70%).  You want to make sure that the medications you are planning to prescribe have proven efficacy on prolonging the survival of patients with heart failure.  Examples of such medications include:

 

A)     Angiotensin converting enzyme inhibitors

B)     Beta blockers

C)     Phosphodiesterase inhibitors

D)    a. and b.

E)     a. and c.

 

 
40.  After several years, this patient has been using digoxin for the treatment of his heart failure without any problems.  His doctor recently told him that his renal function has gotten progressively worse, so the digoxin levels as well as serum electrolytes have to be monitored more closely to avoid the development of digoxin toxicity.  Please point out the set of electrolyte abnormalities that would predispose the patient to develop digoxin toxicity:

 

A)     Hypermagnesemia, hypokalemia and hypercalcemia

B)     Hypomagnesemia, hypokalemia and hypercalcemia

C)     Hypermagnesemia, hyperkalemia and hypercalcemia

D)    Hypermagnesemia, hypokalemia and hypocalcemia

E)     Hypomagnesemia, hypokalemia and hypocalcemia

 

 

 


Questions 41 – 67 are all Pharmacology               questions:

 
41. A patient presents with excessive salivation together with episodes of vomiting and shows signs of general skeletal muscle weakness.  Untreated, the patient suffers clonic convulsions and requires artificial respiration.  Poisoning with which one of the following should be suspected?:

 

A. Pralidoxime

B. Atropine

C. Tubocurare

D. Muscarine

E. Nicotine

 

42. The figure below depicts the dose-response curves for drug X, Y, and Z.  A comparison of the curves shows that drug X:

 

A. has greater efficacy than drug Y

B. has less efficacy than drug Y

C. has the same potency as drug Y

D. is more potent than drug Y

E. is safer than drug Y and drug Z

 

 

 

           

 

 

 

43. The figure below depicts the dose-response curve when drug X is given alone and when it is given in the presence of a fixed dose of either drug Y or drug Z.  Neither drug Y nor drug Z elicit any response when given alone.  Drug Y in this figure is a:

 

A. Competitive antagonist

B.  Full agonist

C.  Noncompetitive antagonist

D.  Partial agonist

E.  Irreversible competitive antagonist

 

 

 

 

 

 

 

 

 

 

44. For increasing heart rate: Drug A has an ED50 of 8 mg/kg and Drug B has an ED50 of 20 mg/kg. From this we can conclude that:

 

A. Drug B is more potent compared to Drug A

B. Drug B has a greater efficacy (maximal effect) compared to Drug A

C. Drug A is a partial agonist

D. Drug B is a partial agonist

E. None of the above

 

 

    All Pharmacology 

 
 

 


45.  Drug C has an ED50 of 20 mg/kg and a TD50  of  4 mg/kg. Indicate the Therapeutic Index (TI) of Drug C:

 

A. 80

B. 20

C. 5

D. 0.20

E. None of the above

 

 

46.  An ophthalmologist instills a 2.5% solution of phenylephrine into a patient’s eyes before examining them.  The drug causes mydriasis by:

 

A. Decreasing the level of cyclic adenosine monophosphate (cAMP)

B. Increasing the levels of IP3 and diacylglycerol (DAG)

C. Facilitating the binding of ATP and the opening of a K-channel

D. Increasing the levels of cAMP

E. Increasing the synthesis of proteins through gene expression mechanisms

 

 

47.  An example of a direct agonist of the cholinergic receptor located at the neuromuscular junction (skeletal muscle):

 

A. Atropine

B. Clonidine

C. Nicotine

D. Prazosin

E. Atenolol

 

 

48.  The main neurotransmitter utilized by the preganglionic neurons of the sympathetic nervous system is:

 

A. Dopamine

B. Acetylcholine

C. Epinephrine

D. Norepinephrine

E. Choline

 

 

49.  Indicate which of the following statements concerning cholinergic receptors are CORRECT:

 

A. The main targets of postganglionic parasympathetic innervation of the heart are nicotinic receptors
B. Muscarinic receptors are G-protein coupled receptors

C. Blockade of muscarinic receptors in the eye leads to pupil dilation

D. A and B

E. B and C

 

 

50.  Indicate which of the following statements concerning catecholamines is/are CORRECT:

 

A. Catecholamine stimulation of b2 receptors on vascular smooth muscle produces vasoconstriction

B. Propranolol can precipitate a dangerous bronchoconstriction in an asthmatic patient

C. In catecholamine neurons, dopamine is synthesized from epinephrine

D. A and B

E. B and C

    All Pharmacology 

 
 

 

 

 


51.  Inhibition of acetylcholinesterase activity, as by nerve gases, is associated with all of the following, EXCEPT:

 

A. Involuntary urination

B. Bradycardia

C. Excessive tear formation in the eyes

D. Constipation

E. Excessive saliva production

 

------------------------------------------

 

Questions 52 – 55 – match each question with the correct drug(s):

 


52. Action at the heart is blocked by atenolol

 

53. Needs to be taken up from the circulation since neurons cannot synthesize it

 

54. Action at gut smooth muscle is blocked by atropine

 

55. Main route of inactivation in the synaptic cleft is via nerve terminal reuptake

 

----------------------------------------

 

A. Acetylcholine

 

B. Norepinephrine

 

C. Both

 

D. Neither

 

 

 


 

56. Prazosin produces less tachycardia compared to phentolamine. The most likely explanation for this is:

 

A. Prazosin is less effective in blocking a2 receptors

B. Prazosin is less effective in stimulating b2 receptors

C. Prazosin is less effective in blocking monoamine oxidase (MAO) activity

D. Prazosin is less effective in stimulating muscarinic receptors

E. Prazosin is less effective in blocking b1 receptors

 

57. Which of the following does NOT result from stimulation of beta-1 and/or beta-2 receptors by epinephrine?

 

A. Bronchodilation

B. Increased heart rate

C. Increased glycogenolysis

D. Arteriolar vasoconstriction

E.  Intestinal muscle relaxation

 

58. Which of the following statements regarding dopamine is FALSE?

 

A. Dopamine is an endogenous catecholamine that is a precursor for norepinephrine formation

B. Dopamine directly stimulates dopamine, beta-1, and alpha-1 receptors.

C. Given exogenously, dopamine causes dose-related effects, with high doses showing a predominance of renal/mesenteric vasodilation resulting in hypotension.

D. Due to rapid metabolism, dopamine cannot be given orally.

E. Dopamine is metabolized by monoamine oxidase (MAO)

 


 

    All Pharmacology 

 
 

 


59. Indicate which of the following will increase cardiac cyclic AMP levels:

 

A. Milrinone

B. Dobutamine

C. Atenolol

D. A and B

E. A, B and C

 

60. Which of the following statements concerning nitroglycerin are CORRECT?

 

A. It produces nitric oxide in the body

B. Following its administration, cellular cyclic GMP concentrations increase

C. With chronic nitroglycerin usage, drug-free intervals are used to prevent tolerance

D. A and B

E. A, B and C

 

61.  Which of the following calcium channel blockers are significantly more potent at

vascular smooth muscle compared to the heart?

 

A. Nifedipine

B. Verapamil

C. Diltiazem

D. A and B

E. B and C

 

----------------------------------------------

 

Questions 62 – 65: Match the numbered cardiac antiarrhythmic drug with the single most appropriate lettered description. Each lettered description may be used once, more than once, or not at all. Classifications refer to the Vaughn Williams 4 class scheme.

 


62. Amiodarone

 

63. Metoprolol

 

64. Lidocaine

 

65. Diltiazem

 

 

 

 

--------------------------------------------------

 

A. A Class I agent used in the treatment of ventricular arrhythmias occurring during myocardial infarction

B. A Class II agent with greater selectivity for b-2 receptors compared to b-1 receptors

C. A Class III agent that shows use-dependent blockade

D. An agent with Class III effects and possessing a very long half-life (several weeks)

E. A Class II agent with greater selectivity for b-1 receptors compared to b-2 receptors

 

 


66.  An agent used for acute management of supraventricular arrhythmias and which has a duration of action of less than 20 seconds following intravenous administration is:

 

A. Enalapril

B. Reserpine

C. Adenosine

D. Amrinone

E. Scopolamine

 


67.  Indicate which of the following statements concerning cardiac antiarrhythmic drugs

 
are CORRECT:

 

A. Digoxin can be used for ventricular, but not supraventricular, arrhythmias

B. Many antiarrhythmic drugs can themselves cause arrhythmias

C. Quinidine blocks voltage-gated sodium channels

D. A and B

E. B and C

PATHOLOGY QUESTIONS

 

 
68. During systole, the diameter of the coronary arteries is affected by both internal forces (blood pressure) and external forces (compression by surrounding tissue). For these three portions of a typical coronary artery—epicardial, intramyocardial, and subendocardial— choose the best answer describing their relative diameter during systole.

 

a) All three areas are dilated.

b) All three areas are compressed.

c) All three areas pretty much stay the same.

d) The epicardial and subendocardial portions are dilated while the intramyocardial portion is compressed.

e) The epicardial portion is dilated while the intramyocardial and subendocardial portions are compressed.

 

 
69. From the following list of congenital heart diseases, choose the one disease most likely to benefit from prostaglandin (PGE2) infusion to keep the ductus arteriosus open.

a)      Patent ductus arteriosus.

b)      Large ventricular septal defect.

c)      Patent foramen ovale.

d)      Transposition of the great vessels.

e)      Tetralogy of Fallot

 
 


70. A cardiac disorder associated with aging is:

a)      mitral valve annulus calcification

b)      calcific aortoc stenosis

c)      cardiac amyloidosis

d)      brown atrophy of the heart

e)      all of the above

 

 
71. Each of the following blood vessel lesions is malignant EXCEPT:

a)      pyogenic granuloma

b)      angiosarcoma

c)      hemangiopericytoma

d)      Kaposi sarcoma

e)      hemangiosarcoma

 

 
72. Giant cell (temporal) arteritis is characterized by all of the following features EXCEPT:

a)      Occurs most frequently in young adults

b)      Granulomatous inflammation is seen in the media

c)      Grossly evident nodular swellings occur along the arteries

a)      Often accompanied by polymyalgia rheumatica

b)      May involve large, medium, or small blood vessels

 

 
73. This question is designed to test your understanding of normal fetal anatomy and blood circulation. Choose the site of the most oxygenated blood.

a) ascending aorta

b) abdominal aorta

c) superior vena cava (right before entering the right atrium)

d) inferior vena cava (right before entering the right atrium)

e) umbilical arteries

     ALL PATHOLOGY 

 
 

 

 

 


74. When compared with hypertrophic cardiomyopathy, dilated cardiomyopathy more often has the following characteristics EXCEPT:

a)      the left ventricular wall is thinner

b)      the heart weighs less

c)      the heart is flabbier (more flexible)

d)      caused by a toxic exposure or nutritional deficiency

e)      ventricular dilation

 

75. Hypertrophic cardiomyopathy has been associated with defects in each of the following genes EXCEPT:

a) dystrophin

b) myosin heavy chain

c) troponin T

d) tropomyosin

e) myosin-binding protein C

 

76. Each of the following associations between a vasculitis and an involved anatomic site is true EXCEPT:

a) Wegener’s granulomatosis and kidneys

b) leukocytoclastic vasculitis and skin

c) thromboangiitis obliterans and GI capillaries

d) Takayaso arteritis and aorta

e) Kawasaki disease and coronary arteries

 

77. The patient without prior heart disease presented to the ER acutely ill with a high fever, a bounding pulse and markedly increased pulse rate, a loud high-pitched diastolic murmur, and pulmonary congestion. The most likely diagnosis is:

a) non-bacterial thrombotic endocarditis

b) subacute bacterial endocarditis

c) acute bacterial endocarditis

d) Libman-Sacks endocarditis

e) rheumatic fever

 

78. All of the following are true of cardiac myxomas EXCEPT:

a) rarely recur after resection

b) heterogeneous histopathologically, being composed of an apparent mixture of different cell types

c) can cause strokes

d) more frequent in the atria than the ventricles

e) more frequent on the right than the left

 

79. From the following list of diseases affecting the heart, identify that which is a secondary cause of heart failure.

a) acute cor pulmonale

b) congenital hypertrophic cardiomyopathy

c) ventricular septal defect

d) Tetralogy of Fallot

e) aortic stenosis

 


Final Pathophysiology Questions

 

Questions 80 – 84:  Match each equation with the appropriate definition
 

80.

{Pressure x Radius} / {2 x wall thickness}measured during systole

A: Preload

81.

{Pressure x Radius} / {2 x wall thickness}measured during diastole

B: Afterload

82.

{Pressure x Radius} / {2 x wall thickness}measured at any point in time

C: Wall tension

83.

Change in pressure / Change in volume

D: Compliance

84.

Change in volume / Change in pressure

E: Stiffness

 

85. The current primarily responsible for depolarization of atrial and ventricular myocardial cells is carried predominantly by which ion?

 

A)     Sodium

B)     Calcium

C)     Magnesium

D)    Potassium

 

86.  Which phase of the action potential in pacemaker cells leads to their "automatic" depolarization?

 

A)     Phase 0

B)     Phase 1

C)     Phase 2

D)    Phase 3

E)     Phase 4

 

87.  The current responsible for depolarization of sinus and AV node cells is carried predominantly by which ion?

 

A)     Sodium

B)     Calcium

C)     Magnesium

D)    Potassium

 

88.  Tetralogy of Fallot is a constellation of four associated anomalies:

 

A)     Ventricular septal defect; pulmonic insufficiency; transposition of the great vessels; right ventricular hypertrophy

B)     Atrial septal defect; tricuspid stenosis; right ventricular hypertrophy; Eisenmenger’s syndrome

C)     Ventricular septal defect; infundibular, valvular or supravalvular pulmonic stenosis; an anteriorly displaced aorta that receives blood flow from both ventricles; right ventricular hypertrophy

D)    Atrial septal defect; pulmonic stenosis; right ventricular hypertrophy; an anteriorly displaced aorta that receives blood flow from both ventricles

E)     Ventricular septal defect; pulmonary atresia; left ventricular hypertrophy; left atrial enlargement