1.   Which is LEAST LIKELY to cause high-output heart failure?

A.   anemia
B.   high fever
C.   hypertrophic cardiomyopathy (*)
D.   hyperthyroidism
E.   Paget's osteitis deformans

2.   "Fibrolipomatosis", a newly-discovered cause of sudden death
in athletic young people, is usually found by the pathologist in
the

A.   aortic valve cusps
B.   right atrium
C.   right ventricle (*)
D.   left atrium
E.   left ventricle

3.   At autopsy of a "victim" of cocaine abuse, which of these
would be most helpful to the pathologist in confirming that
cocaine actually caused the death?

A.   amyloid deposition
B.   contraction band necrosis (*)
C.   endocardial fibrosis
D.   mycotic aneurysm(s)
E.   septal hypertrophy

4.   What did the brewers in Quebec add to their beer, causing
the epidemic cardiomyopathy?

A.   adriamycin
B.   cobalt (*)
C.   dioxin
D.   homocysteine
E.   selenium

5.   Which of these bacteria is most likely to set up acute
bacterial endocarditis on a previously-normal valve?

A.   clostridia
B.   staphylococcus (*)
C.   streptococcus pyogenes
D.   streptococcus viridans
E.   pseudomonas

6.   Cardiomyopathy of pregnancy is most closely related
epidemiologically to

A.   alcohol abuse
B.   folic acid deficiency
C.   high salt intake
D.   poverty (*)
E.   tobacco smoking


7.   Which systemic disease often features sterile vegetations
located on the surfaces of valve leaflets, and not just their
lines of closure?


A.   amyloidosis B
B.   hemophilia
C.   lupus (*)
D.   rheumatoid arthritis
E.   scleroderma

8.   What accumulates in the heart in Pompe's disease?

A.   cholesterol
B.   glycogen (*)
C.   lipofuscin
D.   mitochondria
E.   non-pigmented lipid breakdown products

9.   Which is most likely to produce tricuspid valve stenosis?

A.   carcinoid heart disease (*)
B.   Ebstein's anomaly
C.   endocarditis from IV drug use
D.   severe atherosclerosis
E.   tetralogy of Fallot

10.  In Kawasaki's disease, you will probably NOT see

A.   enlarged lymph nodes containing granulomas (*)
B.   erythema of the palms
C.   fever
D.   reddening of the oral mucosa
E.   reddening of the surfaces of the eyes

11.  What's the major risk factor for Buerger's thromboangiitis
obliterans?

A.   alcohol abuse
B.   cocaine use
C.   old age
D.   sexual promiscuity / multiple partners
E.   smoking (*)

12.  In Osler-Weber-Rendu, you'll first notice the little
vascular malformations on the

A.   conjunctiva
B.   digits
C.   lips (*)
D.   retina
E.   skin of the face



13.  Unable to make HDL...

A.   common familial hypercholesterolemia
B.   Milroy's disease
C.   Noonan's syndrome
D.   Refsum's disease
E.   Tangier's disease (*)

14.  ONE KODACHROME.  What's this?

A.   aortic dissection
B.   coarctation (*)
C.   endocarditis
D.   patent ductus
E.   syphilitic aneurysm

15.  ONE KODACHROME.   What made these arterioles look so
strange?

A.   atheroembolization
B.   diabetes (*)
C.   scleroderma
D.   septic embolization
E.   Wegener's granulomatosis

16.  ONE KODACHROME.  What's this?

A.   carcinoid heart disease
B.   Ebstein's anomaly
C.   endocardial cushion defect
D.   mural thrombus (*)
E.   myxoma

17.  ONE KODACHROME.  Least convincing as a risk factor?

A.   diabetes
B.   hypercoagulable blood syndromes
C.   hypertension
D.   lack of exercise
E.   tobacco chewing (*)

18.  TWO KODACHROMES.  Diagnosis, please.

A.   amyloid cardiomyopathy
B.   atrial myxoma
C.   hypertrophic cardiomyopathy
D.   myocardial infarct
E.   rheumatic fever (*)



19.  TWO KODACHROMES.  What is this?

A.   amyloidosis
B.   bacterial endocarditis
C.   endocardial fibroelastosis (*)
D.   myocardial infarct
E.   tetralogy of Fallot

20.  ONE KODACHROME.  What is your best diagnosis?

A.   Buerger's thromboangiitis obliterans
B.   erythema nodosum (*)
C.   giant cell arteritis
D.   Kawasaki's
E.   Takayasu's

21.  ONE KODACHROME.  What is this?

A.   dilated cardiomyopathy
B.   hypertrophic cardiomyopathy
C.   restrictive cardiomyopathy
D.   ventricular aneurysm after myocardial infarct (*)
E.   no pathology

22.  ONE KODACHROME.  Heart.  Your best diagnosis?

A.   amyloidosis (*)
B.   contraction band necrosis
C.   hypertrophic cardiomyopathy
D.   rheumatic fever
E.   sarcoidosis

23.  TWO KODACHROME.  Your best diagnosis?

A.   atherosclerosis
B.   mycotic aneurysm
C.   polyarteritis nodosa
D.   temporal arteritis
E.   Wegener's granulomatosis (*)

24.  ONE KODACHROME.  Heart muscle.  Your best diagnosis?

A.   acute infarct
B.   giant cell myocarditis
C.   healed infarct
D.   rheumatic fever (*)
E.   sarcoidosis



25.  ONE KODACHROME.  Looking down into the left atrium.

A.   Barlow's floppy valve
B.   infarct with ruptured papillary muscle
C.   myxoma
D.   old rheumatic fever (*)
E.   ostium secundum defect

26.  ONE KODACHROME.  What murmur?

A.   blowing, holosystolic, radiating to axilla
B.   early diastolic best hard at upper right sternal border
C.   machinery murmur, lasts through the cardiac cycle
D.   rough, diamond-shaped, systolic, radiating up carotids (*)
E.   soft, rumbly, mid-diastolic, best heard in left lateral
decubitus position

27.  ONE KODACHROME.  Aorta.  Your best diagnosis?

A.   aortic dissection
B.   atherosclerotic aneurysm (*)
C.   coarctation
D.   gunshot wound
E.   Takayasu's

28.  ONE KODACHROME.  What's your diagnosis?

A.   angiosarcoma (*)
B.   giant cell arteritis
C.   Kaposi's sarcoma
D.   rheumatic fever
E.   sarcoidosis

29.  ONE KODACHROME.  What's your diagnosis?

A.   anomalous venous return
B.   aortic dissection
C.   patent ductus arteriosus
D.   tetralogy of Fallot
E.   truncus arteriosus (*)

30.  ONE KODACHROME.  Which is most likely?

A.   dilated cardiomyopathy from some cause
B.   emphysema (*)
C.   mutant beta-myosin
D.   severe atherosclerosis
E.   uncomplicated aortic valve stenosis


BONUS ITEMS

31.  TWO KODACHROMES.  What's the matter here?  Be very specific.

[ruptured MI]


32.  TWO KODACHROMES.  I need a specific diagnosis.

[tetralogy of Fallot]


33.  THREE KODACHROMES.  What's this?

[hypertrophic cardiomyopathy]


34.  ONE KODACHROME.  What do cardiologists mean by "vulnerable
plaque"?

[the loose stuff / cholesterol-rich stuff]




35.  ONE KODACHROME.  Aortic valve, not rheumatic fever.  What's
the diagnosis?

[I need "bicuspid?]


36.  What do we mean by "prerenal azotemia"?

[all I need is kidneys not being perfused under enough pressure]


37.  What ethnic group is most likely to have Brugada's?

[Southeast Asian / credit for any reasonable answer]


38.  When do you see "tiger-stripes" on the heart at autopsy?

[anemia]

NAME:______________________
30 points maximum





UHS PATHOLOGY
Cardiovascular Practical Exam
2001-2002






Instructions:

You know the routine.  If you have a question, please do not
phonate.  If you are in the first hour, please do not leave until
time is called.


Good Luck!