1. Which is most typical in Down's syndrome? A. atrial septal defect just above crux of heart (*) B. coarctation of the aorta C. sinus venosus defect D. very low-placed tricuspid valve E. widely patent foramen ovale 2. Sudden death during sleep in a 30 year old Laotian man with no known coronary risk factors suggests A. Brugada's (*) B. cardiac syndrome X C. lipoprotein LpS2 D. Lp(a) E. Tangier's 3. Which fact about a group of vegetations would be most helpful in letting you know that it's Libman-Sacks (as in lupus anticoagulant syndrome) rather than marantic endocarditis (as in cancer of the pancreas)? A. contain numerous plasma cells B. cause damage to the underlying valve C. contain hematoxylin bodies D. contain many neutrophils E. not confined to lines of closure (*) 4. What's the eponym for angina caused by coronary spasm? A. Buerger's B. Ebstein's C. Heberden's D. Osler's E. Prinzmetal's (*) 5. A healthy, sedentary adult's heart usually weighs no more than A. 150 gm B. 250 gm C. 350 gm (*) D. 450 gm E. 550 gm 6. Wavy fibers in the absence of other myocardial pathology suggest what to the autopsy pathologist? A. amyloidosis B. cobalt cardiomyopathy C. hypertrophic cardiomyopathy D. long QT (abnormal waves) E. sudden coronary death (*) 7. Most "unstable angina" is probably due to A. a thrombus forming and lysing (*) B. extreme hypercholesterolemia and rapid atherogenesis C. multiple emboli to the coronaries D. serial hemorrhages within a plaque E. various rhythm disturbances developing and disappearing 8. Which is most likely to produce dextrocardia, i.e., a heart on the right side instead of the left? A. Down's syndrome B. fetal alcohol syndrome C. immotile cilia syndrome (*) D. rubella in the unborn child E. Turner's XO syndrome 9. Which structure is most likely to rupture as a result of Barlow's syndrome? A. mitral chorda (*) B. papillary muscle body C. posterior leaflet, longitudinally D. posterior leaflet, transversely E. ventricular free wall 10. Which is LEAST LIKELY to give you a dilated cardiomyopathy? A. amyloid cardiomyopathy (*) B. autoimmune cardiomyopathy C. Chagas's cardiomyopathy D. Duchenne's cardiomyopathy E. sarcoid cardiomyopathy 11. Listen carefully to your ankylosing spondylitis patients because they are much more likely than other folks to develop A. aortic insufficiency (*) B. aortic stenosis C. carotid bruits D. mitral insufficiency E. pulmonic stenosis 12. Finding a Weibel-Palade body on electron microscopy establishes that the cell is A. endothelium (*) B. myocardium C. myointima D. neoplastic E. smooth muscle 13. A folic-acid deficient diet probably places a person at risk for coronary disease by raising plasma A. homocysteine (*) B. homogentisic acid C. oxidized LDL D. lipoprotein A E. total LDL cholesterol 14. You are LEAST LIKELY to see hyperplastic arteriolar sclerosis as a result of A. hemolytic-uremic syndrome from E. coli B. malignant hypertension C. scleroderma D. severe diabetes (*) E. ventricular septal defect leading to Eisenmenger's 15. ONE KODACHROME. What happened to this aortic valve? A. aortic dissection B. birth defect C. old age changes D. old rheumatic fever (*) E. nothing wrong here, doc 16. TWO KODACHROMES. Section of heart A. eccentric hypertrophy B. hemochromatosis C. hypertrophic cardiomyopathy (*) D. lateral wall infarct E. physiologic or concentric hypertrophy 17. ONE KODACHROME. Microvascular changes of A. common hypertension or diabetes (*) B. malignant hypertension C. polyarteritis nodosa D. scleroderma or some related illness E. nothing wrong here 18. ONE KODACHROME. Your best diagnosis? A. atrial myxoma B. Ebstein's C. patent foramen ovale (*) D. transposition of the great vessels E. truncus 19. ONE KODACHROME. Coronary artery with A. fatty streak only B. fresh thrombus C. lots of "vulnerable plaque", no thrombus (*) D. Monckeberg's medial calcific sclerosis E. organized thrombus 20. ONE KODACHROME. Mitral valve showing A. bacterial endocarditis B. Barlow change (*) C. marantic endocarditis D. old rheumatic fever E. ruptured papillary muscle 21. TWO KODACHROMES. What's your diagnosis? A. hypoplastic left heart B. recent infarct C. tetralogy of Fallot (*) D. transposition of the great vessels E. truncus arteriosus 22. TWO KODACHROMES. Left atrium and mitral valve A. acute rheumatic fever B. bacterial endocarditis C. Barlow's valve D. old rheumatic fever (*) E. ruptured papillary muscle 23. ONE KODACHROME. Why did this aortic valve become stenotic? A. congenitally bicuspid (*) B. metastatic calcification C. previous rheumatic fever D. Q-fever E. senile calcification 24. ONE KODACHROME. Aorta showing A. coarctation B. dissection (*) C. just fatty streaks D. syphilitic changes (consistent with) E. Takayasu's 25. ONE KODACHROME. Coronary artery showing A. freshly-ruptured plaque and thrombus (*) B. hemorrhage into a plaque C. recanalized thrombus D. stable plaque E. vulnerable plaque, unruptured 26. ONE KODACHROME. Heart. A. acute MI B. dilated cardiomyopathy C. hypertrophic cardiomyopathy D. old MI with aneurysm (*) E. syphilitic aneurysm 27. ONE KODACHROME. Aortic valve leaflet. This is most consistent with A. acute rheumatic fever B. old rheumatic fever C. marantic endocarditis D. senile calcification E. staphylococcal endocarditis (*) 28. ONE KODACHROME. Sudden death, no previous symptoms, clean coronaries A. amyloidosis (*) B. hypertrophic cardiomyopathy C. iron overload D. right ventricular dysplasia / fibrolipomatosis E. Wolff-Parkinson-White 29. ONE KODACHROME. What's your diagnosis? A. patent ductus arteriosus B. syphilitic aneurysm C. tetralogy of Fallot D. transposition of the great vessels E. truncus arteriosus (*) 30. ONE KODACHROME. What's your diagnosis? A. acute myocardial infarct (*) B. Barlow's syndrome C. calcification of the mitral annulus D. dilated cardiomyopathy E. myocardial abscess BONUS ITEMS: 31. TWO KODACHROMES. What's the diagnosis? Be specific. Wegener's 32. ONE KODACHROME. Superior vena cava and right atrium have been opened. What is the diagnosis? Be very specific. sinus venosus ASD 33. ONE KODACHROME. What's the diagnosis. This one's easy. coarctation 34. TWO KODACHROMES. This one's even easier. rupture is sufficient 35. ONE KODACHROME. Based on what you see, what probably caused the right ventricular hypertrophy? old rheumatic fever involving the mitral valve 36. ONE KODACHROME. Do you think this is an atrial myxoma or a round atrial mural thrombus? Explain. thrombus; the atrium is huge and the mitral valve is bad 37. TWO KODACHROMES. Your best diagnosis? endocardial fibroelastosis 38. THREE KODACHROMES. Your best diagnosis? rheumatic fever is sufficient 39. How can looking at the neck veins help you recognize cardiac tamponade? pressure rises during inspiration 40. McCallum's plaques in acute rheumatic fever usually appear on the endocardial surface of what structure? left atrium 41. Explain how "stasis ulcers" form on the lower legs in people with varicose veins. Be clear. ischemia due to poor venous return 42. Which inflammatory cell, when abundant in the endocardium, suggests Loeffler's? eosinophil NAME: ________________ 15 points maximum SEAT #: ________ UHS PATHOLOGY Cardiovascular 2002-2003 INSTRUCTIONS: There are no trick questions, but read each carefully. This is a fairly tough exam, like a medical school exam is supposed to be. Do not phonate during the exam. You will see each carousel twice. If you are in the first exam group, do not leave the classroom except with the entire group at the end. GOOD LUCK!