Welcome to your Cardiac Cycle, Murmurs, Valvular Disease, Rheumatic Heart Disease & Endocarditis
1.
An elderly patient with temporal headache develops sudden visual loss. Which pathological explanation is most appropriate?
2.
A patient with infective endocarditis suddenly develops severe aortic regurgitation and pulmonary edema. Which hemodynamic change best explains the rapid deterioration?
3.
A patient with polyarteritis nodosa develops abdominal pain after meals. Which vascular event best explains the symptom?
4.
A patient develops a pulsatile swelling after a penetrating arterial injury. Imaging shows blood outside the vessel wall communicating with the lumen. Which lesion is most likely?
5.
Which morphological feature best differentiates degenerative calcific aortic stenosis from rheumatic aortic stenosis?
6.
Which feature best separates thromboangiitis obliterans from atherosclerotic peripheral vascular disease in an exam stem?
7.
Which combination of findings best supports granulomatosis with polyangiitis rather than polyarteritis nodosa?
8.
A young smoker has recurrent superficial thrombophlebitis, rest pain and ischemic toe ulcers. Microscopy of an affected vessel is most likely to show:
9.
A resected abdominal aortic aneurysm shows severe intimal atheroma, thinning of media and laminated clot attached to the wall. The laminated clot represents:
10.
A CT angiogram shows a dissection involving the ascending aorta. Which classification and clinical implication best fit?
11.
An intravenous drug user develops fever, pleuritic chest pain and multiple cavitating lung lesions. A tricuspid valve vegetation is identified. Which complication best explains the lung findings?
12.
A young patient with Marfan syndrome develops aortic dissection. Which underlying wall abnormality is most relevant?
13.
A child with mucocutaneous inflammation later develops myocardial ischemia. Which vascular pathology best explains this outcome?
14.
A patient with chronic rheumatic mitral regurgitation has irregular fibrous thickening of the posterior wall of the left atrium. What is this lesion called?
15.
Which finding most directly distinguishes aortic dissection from a simple aneurysmal dilatation?
16.
Aortic dissection extends into a major branch artery supplying abdominal viscera. Which clinical consequence is most expected?
17.
A child with suspected acute rheumatic fever has carditis, fever, raised C-reactive protein and a prolonged PR interval. How should the prolonged PR interval be interpreted?
18.
In large-vessel granulomatous vasculitis, luminal narrowing most directly results from:
19.
An adolescent presents with involuntary movements several months after a sore throat. Inflammatory markers and antistreptococcal antibody titres are now normal. Which interpretation is most appropriate?
20.
A patient with aortic-valve infective endocarditis develops a new atrioventricular conduction block. Which complication should be suspected?
21.
A child with a previous documented attack of rheumatic fever develops fever, arthralgia and raised inflammatory markers after another sore throat. No major manifestation is identified. Which criterion combination may support recurrent rheumatic fever after excluding alternatives?
22.
A woman with systemic lupus erythematosus has sterile vegetations involving both surfaces of the mitral valve leaflets. Which lesion is most likely?
23.
In syphilitic thoracic aortic aneurysm, medial weakening is mainly caused by:
24.
A patient with chronic rheumatic valve disease develops low-grade fever, weight loss and a changing murmur several weeks after dental manipulation. Which organism is the most likely cause?
25.
A patient with a large aortic aneurysm develops sudden pain and pallor of one lower limb. Which mechanism best explains this complication?
26.
A medium-sized muscular artery shows segmental transmural necrotizing inflammation. Different portions of the same artery show lesions at different stages of healing. Which diagnosis is most likely?
27.
A patient with advanced mucin-producing adenocarcinoma develops multiple cerebral infarcts. Blood cultures remain negative, and small vegetations are present along valve closure lines without inflammation. What is the most likely diagnosis?
28.
Which finding is most characteristic of acute rheumatic valvulitis?
29.
A patient with mitral stenosis has a very short interval between the aortic component of S2 and the opening snap. What does this finding indicate?
30.
Immune complex-mediated vasculitis produces vessel injury mainly through which mechanism?
31.
A man develops sudden breathlessness and hypotension three days after a myocardial infarction. Echocardiography shows acute severe mitral regurgitation. Which structural event is the most likely cause?
32.
A young woman with absent upper limb pulses is found to have hypertension due to renal artery narrowing. Which disease best explains both findings?
33.
A low-pitched apical mid-diastolic murmur is heard in a patient with severe aortic regurgitation, but the mitral valve is structurally normal. What is the best explanation?
34.
In an atherosclerotic abdominal aortic aneurysm, which sequence best explains progressive weakening of the vessel wall?
35.
A patient with fever and a predisposing valve lesion has positive cultures for a typical organism, vascular emboli and immunological phenomena. Echocardiography is initially inconclusive. Which combination fulfils the traditional clinical criteria for definite infective endocarditis?
36.
A woman with mitral stenosis develops atrial fibrillation. Which auscultatory feature is most likely to disappear?
37.
A lung biopsy from a patient with chronic sinus disease and hematuria shows necrotizing granulomatous inflammation. Which serological marker is most supportive?
38.
A child had rheumatic fever with carditis and now has persistent valvular disease. Which secondary prophylaxis duration is most appropriate according to the commonly examined framework?
39.
A child has migratory polyarthritis after streptococcal pharyngitis. No murmur is heard, but Doppler echocardiography shows pathological mitral regurgitation. How should this cardiac finding be classified?
40.
A patient with native rheumatic mitral stenosis receives regular benzathine penicillin. Which statement best explains the purpose of this treatment?
