Special Patho-CVS Class test RMC 2011

9:55 AM Ahmed Chishti 1 comment

DEPARTMENT OF PATHOLOGY RAWALPINDI MEDICAL COLLEGE RAWALPINDI 4th year 2nd term test (23/5/2011) SEQ`s Paper Time allowed: 50 minutes Total Marks: 50 INSTRUCTIONS: 1.As usual. Any questions? Ask quietly. 2.Attempt all questions. Mark the appropriate square on the response sheet 3. Be precise and answer in one word preferably what has been asked.
Be sure you hand in your answer and response sheets with your names and roll numbers. Failure to return both will result in a grade of zero. There are 10 SEQ`s and 25 MCQ`s. questions in total.

Q. No 1: A young 38 year old man presents in the emergency with history of paroxysmal recurrent sub sternal chest discomfort. a. Enlist the types of Angina. 1.5 b. What is the mechanism underlying unstable angina? 3. Q. N0 2: A young patient from Rawalpindi lands in the emergency with chest pain, the patient could not be managed properly due to deteriorating health care delivery system, and died.. a. Enumerate the specific biomarkers used for the diagnosis of myocardial infarction? 4 b. Which is the most useful and why? 1 Q. No 3. 12 year old boy develops migratory arthritis after an episode of Phryrangitis weeks earlier. He is having fever with tachycardia. b. What is the most probable diagnosis? 1 b. Write the Jones diagnostic criteria for this condition. 4 Q. No 4: Tabulate the differences between acute and subacute infective endocarditis. 5 Q. No 5:a. Enumerate the complications of myocardial infarction. 2.5 b. Enlist the causes of Left sided heart failure. 2.5 Q. No 6. A fifty year old diagnosed patient of HIV develops red purple lesions on the skin of his feet. On investigation the lesions are found to be vascular tumor . a. What is the diagnosis? 1.5 b. Name four different type of this tumor 2 3. Name the three different morphological appearances of the disease. 1.5 Q. No 7. A thirty year old women gas had coldness and numbness in her arms and decreased vision in her Eye for the past five months. On examination radial pulses are not palpable. Femoral pulses are strong with decreased sensation and cyanosis in her arms with no warmth or swelling. a. Name the probable diagnosis? 0.5 b. List three morphological changes seen in this condition. 1.5 c. Enlist three major groups of vasculitis and give two examples of each 3

Q, No 8. . A woman brings her 2 yr child with a soft bluish swelling on her face, which was present at birth. She also told that it is expanding for last 2 year. Diagnosis of capillary hemangioma was made. a. Give gross and microscopic picture of this condition? 2 b. Give classification of vascular tumors? 3 Q. No. 9 A 58-year-old male Principal of a Medical College reports having repeated and progressively prolonged and severe episodes of pericardial chest pain over the last 6 months. The episodes have become more frequent over the past 2 months and occur on minimal physical exertion. Angiography shows 50% stenosis of left anterior descending artery (LAD). a. Given that this degree of stenosis in itself does not precipitate an acute myocardial event, what changes in the atherosclerotic plaque must have precipitated these attacks in this patient? b. What do you understand by vulnerable plaques? (4+1)

Q. No 10 A 58-year old bureaucrat is diagnosed with acute myocardial infarction after he collapsed on his office desk. He is a known hypertensive and smokes 10 to 12 cigarettes per day and drinks socially. Serum cholesterol level is elevated and he confesses being fond of desserts and Gulab jamans. His BMI and waist circumference are increased for his height. His father died of myocardial infarction, and his mother has stable angina. a. Enumerate the identified the major risk factors for atherosclerosis in this patient and categorize them as constitutive (non modifiable) and potentially controllable. b. Also list the minor risk factors for atherosclerosis in this patient. (3+2)
The first person finishing gets bonus 5 marks if claimed. Also write your challenges on it. You are also allowed to follow the standard procedure (see us for a challenge form) -- but why wait? If u have time jot down. This exam is not intended to be especially difficult. Be prepared for somewhat more challenging exams in the future GOOD LUCK!
Paper setters: Prof. Abbas Hayat Dr. Atifa Dr. Homera Niazi Dr. Aiman.Aijaz Dr. Fareeha Dr.Saad Amjad Dr. Azer Majeed Dr. Fahim Dr.M. Fateen Rashed

DEPARTMENT OF PATHOLOGY RAWALPINDI MEDICAL COLLEGE RAWALPINDI 2nd term test 3rd Prof. 2011 MCQ`s Paper Time allowed: 25 minutes Total Marks: 2 x25= 50 INSTRUCTIONS: 1. As usual. Any questions? Ask quietly. 2.Attempt all questions. Mark the appropriate square on the response sheet
a. b. 1. Pressure overload is not associated with: Ventricular hypertrophy Concentric hypertrophy

c. d. e. 2. a. b. c. d. e. 3. a. b. c. d. e. 4. a. b. c. d. e. 5. a. b. c. d. e. 6. a. b. c. d. e. 7. a. b. c. d. e. 8. a. b. c. d. e.

Hypertension Aortic stenosis Aortic regurgitation Which of the following is not a feature of Fallots tetrology? Aortic stenosis Pulmonary stenosis Ventricular septal defect Overriding of aorta Right ventricular hypertrophy An I/V drug abuser complains of high grade fever with shortness of breath and tachycardia. His blood CP shows leucocytosis and raised ESR.. What is the likely diagnosis? Acute thrombophlebitis Acute infective endocarditis Acute urinary tract infection Acute chest infection Pyrexia of unknown origin What is the likely causative organism for the above answer.. Streptococcus Viridans B hemolytic streptococcus Staphylococcus aureus CMV Salmonella The earliest biochemical change developing after myocardial ischemia is: ATP depletion to 10% of normal Cessation of aerobic metabolism with onset of ATP depletion ATP depletion to 50% normal Loss of contractility Irreversible cell injury Irreversible cell injury develops in ischemic heart disease after: 10 15 min 20 30 min One hour 12 hours One day Granulation tissue begins to appear at the site of myocardial infarction on: 1st day 3rd day 5th day 7th day 2 weeks Myocardial infarction becomes grossly visible after:

2 hours of ischemia 12 hours of ischemia 24 hours of ischemia 48 hours of ischemia 3 days of ischemia 9. A young boy is diagnosed to be suffering from acute Rheumatic fever. His heart will show all the following morphological changes except one, which? a. Pancarditis b. Aschoff bodies

c. d. e.

Vegetations on mitral valve Ring abscesses in myocardium Mitral stenosis

a. b. c. d. e. a. b. c. d. e. a. b. c. d. e. a. b. c. d. e.

10. A patient underwent cardiac valve replacement 6 months back. Now he develops PUO and is suspected to be suffering from infective endocarditis. Which organism is the most likely cause for his infection. Staph Aureus Streptococcus viridans Hemolytic streptococcus HACEK group of viruses Staph epidermidis 11. Hypertrophy of heart seen in CCF is associated with: Increased protein synthesis Myocyte proliferation Induction of fetal gene program Abnormal proteins Inadequate vasculature 12. Pulmonary congestion seen in left sided heart failure is not associated with: Pulmonary edema Widening of alveolar septa Heart failure cells Accumulation of edema fluid in alveoli Shrunken collapsed lungs 13. The commonest tumor of the heart in children are: Fibroma Lipoma Myxoma Rhabdomyoma Rhabdomyosarcoma 14. 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 15. 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 16. Most "unstable angina" is probably due to

a. b. c. d. e. a. b. c. d. e. a. b. c. d. e.

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 17. 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 18. Primary site of involvement in AS is: Intima Media Adventitia Endothelium ECM 19. Various factors influencing plaque change include all but: Cholesterol content of plaque Collagen metabolism Emotional stress Hypertension Total triglyceride levels in blood 20. One of the following statements is not true, which one? Myocardial infarction leading to severe pump failure is associated with 70% mortality. Cardiac rupture leads to formation of true aneurysms. Acute plaque change triggers Unstable Angina Thromboembolism is an important complication of Myocardial infarction Maximum granulation tissue formation occurs around 10 14 days after infarction.

a. b. c. d. e. a. b. c. d. e. a.

21. Dilated Cardiomyopathy is associated with: Conduction defect Systolic dysfunction Diastolic dysfunction Vavular dysfunction Myocardial ischaemia 22. All statements about Rheumatic Heart disease are true except: Carditis is immune mediated Aschoff Bodies are pathognomonic of RHD Bread and Butter Pericarditis is a feature of RHD Aortic valve is most commonly affected in RHD Fibrosis in valvular leaflets leads to Fishmouth stenosis 23. An increased incidence of atherosclerosis has been correlated with all of the following except HTN

b. c. d. e.

a. b. c. d. e.

a. b. c. d. e.

Diabetes mellitus Increased serum high density lipoprotein Increased serum low density lipoprotein Use of oral contraceptives 24. A child with fever, arthralgias, GIT and renal involvement and hemorrhagic urticaria like lesions of the skin most likely diagnosis is: Takayasu arteritis Polyarteritis nodosa Temporal arteritis Henoch-Schonlein purpura Wegener granulomatosis 25. A. 58 -year-old Principal of a medical college known hypertensive with a sedentary lifestyle experiences severe choking substernal chest pain that lasts for about 10 minutes. What degree of stenosis in his coronary arteries would have caused his symptoms? 90% 50% 10% 20% <1%

KEY FOR SEQs: Q. No 1: Stable Angina / Typical Unstable Angina / Crescendo Prinzmetal Angina / Variant At rest Prolonged duration Disruption of stable atheroma thrombosis Embolization, vasospasm Q. No 2: CPK , CK MB AST LDH Troponins I & T II , CRP Homocysteine levels BNP Troponin I & T is the best because it is the most sensitive and specific marker of myocardial damage. Their levels begin to rise after 2-4 hours and peak at 48 hours. Their levels remain elevated for 7-10 days Q. No 3: a. rheumatic fever b.Major criteria: Migratory polyarthritis Carditis Subcutaneous nodules Erythema marginatum Sydenham chorea Minor criteria: Fever Pain right upper quadrant abdomen Raised ESR Raised CRP Elevated ASO titers EKG changes Presence of 2 major or 1 major + 2 minor criteria is diagnostic of RF Q. No 4: ACUTE IE SUBACUTE IE Develop on healthy valves Develop on diseased valves / prosthesis By organisms of low virulence

Caused by highly virulent organisms Acute & severe Insidious 50% mortality Recovery common Destructive necrotizing Less destructive Q. No 5: Complication of MI: 1. Contractile dysfunction crdiogenic shock 2. Arrhythmias 3. MC rupture 4 cardiac rupture syndrome 5 Pericarditis 6. Right ventricular infarction 7. Extension 8. Mural thrombosis 9. Ventricular aneurysm 10 Papillary muscle dysfunction 11. Progressive late heart failure Left sided heart failure: Causes:IHDn HTN Aortic, mitral valvular disease Non ischemic MC disease (myocarditis, cardiomyopathy) Pericarditis Thyroid disease Pregnancy Septic shock Q. No 6: a. kaposis sarcoma b. chronic c. lymphadenopathci d transplant associated kaposis sarcom e. AIDS-associated Kaposi sarcoma c.patch,plaque and nodule Reference ROBINS page 535,chapter 12

Q. No 7:

a. takayasu arteritis b.irregular thickening of aortic or branch vessel wall with intimal wrinkling adventitial mononuclear infiltration with perivascular cuffing granulomatous changes with patchy necrosis and giant cells c.large vessel vasculitis(giant cell arteritis,takayasu arteritis) medium sized vasculitis(PAN,kawasaki) small vessel vasculitis(wegeners granulomatosis,churg strauss) Reference ROBBINS page 519,page 517-chapter 12

Q no 8 Pathologic Basis of Disease 6th edition, Chapter 12, page 531,532 a. Gross----few mm to several cm, bright red to blue, slightly elevated intact covering epithelium. Microscopic-----lobulated, unencapusalted aggregates of closely packed thin walled capillaries, blood filled, lined by flattened endothelium, scant CT. b. Benign Neoplasm----Hemangioma, Lymphangioma, glomus tumor, vascular ectasias, reactive vascular proliferations. Intermediate Grade Neoplasm----Kaposi sacrcoma, Hemangioendothelioma. Malignant neoplasm----Angiosarcoma, Hemangiopericytoma Q.NO.9 a..haemorrhage into artheroma,rupture,fissuring,erosion,ulceration b. which has a thin fibrous cap and is vulnerable to these changes. Q.N.10 KEY Q 10 Robbins and Cotran Pathologic Basis of Disease 7th Ed. 520, Table 11-2 Major Risk factors: Non-modifiable: Increasing age, Male gender, Family history Potentially controllable: Hyperlipidemia, Hypertension, cigarette smoking Minor risk factors: Obesity, Physical inactivity, High carbohydrate intake, alcohol