PA26.1-10 | Cardiovascular System — Practice Quiz

A 58-year-old man with a 30-pack-year smoking history and poorly controlled hypertension undergoes carotid endarterectomy. The specimen shows intimal thickening composed of smooth-muscle cells, collagen, and lipid deposits with a necrotic lipid core and overlying fibrous cap. Which pathological process BEST describes this lesion?

During the early stages of atherogenesis, oxidised LDL is taken up by macrophages via scavenger receptors, producing lipid-laden cells that accumulate in the intima. What is the term for these cells, and what is their collective lesion?

A 72-year-old hypertensive man presents with a pulsatile, non-tender abdominal mass at the umbilical level. CT reveals a fusiform dilation of the infrarenal aorta measuring 6.2 cm. Histology of the resected specimen shows destruction of the elastic media with lymphoplasmacytic infiltration in the adventitia. What is the MOST LIKELY diagnosis and its strongest risk factor?

A 45-year-old man with Marfan syndrome (tall, arachnodactyly, ectopia lentis) develops sudden severe chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 140/90 in the left. CXR shows widened mediastinum. Histology of the aorta would MOST LIKELY show:

A 62-year-old diabetic man presents with 4 hours of crushing substernal chest pain radiating to the jaw, with ST elevation in leads II, III, aVF. Troponin-I is 8.2 ng/mL (normal <0.04). Emergent angiography reveals 100% occlusion of the right coronary artery. If untreated, which histological change would be expected at 18–24 hours after infarct onset?

A 55-year-old man with NSTEMI is managed medically. On day 10 post-infarct he develops pleuritic chest pain, fever, and a pericardial friction rub. ECG shows diffuse ST elevation in all leads. This is BEST explained by:

A 68-year-old woman with longstanding rheumatic mitral stenosis presents with progressive dyspnoea and orthopnoea. On examination she has crackles at both lung bases, S3 gallop, and bilateral pitting ankle oedema. Chest X-ray shows cardiomegaly and Kerley B lines. Serum BNP is markedly elevated. Which chamber pathology and haemodynamic sequence BEST explains her Kerley B lines?

A 16-year-old boy presents with fever, migratory polyarthritis (affecting knees and ankles in sequence), a carditis with a new apical holosystolic murmur, skin nodules over the extensor surfaces, and an erythematous annular rash on the trunk. A throat swab 3 weeks ago was positive for group A Streptococcus. Which microscopic finding would MOST LIKELY be seen in the myocardium on biopsy?

A 35-year-old intravenous drug user presents with high-grade fever, rigors, and a new loud pansystolic murmur at the left lower sternal border (tricuspid area), along with multiple septic pulmonary emboli on CT. Blood cultures grow Staphylococcus aureus. Echocardiography reveals large, irregular vegetations on the tricuspid valve. This presentation BEST fits:

A 6-month-old boy is brought with increasing dyspnoea and failure to thrive. On examination there is a harsh pansystolic murmur loudest at the left sternal border. Echocardiography shows a 12 mm defect in the membranous interventricular septum with left-to-right shunt. Without correction, which long-term complication is MOST feared?

A 30-year-old man with progressive dyspnoea and a family history of sudden cardiac death presents. Echocardiography shows asymmetric septal hypertrophy (IVS 20 mm) with systolic anterior motion of the mitral valve and dynamic left ventricular outflow tract obstruction. His ECG shows left ventricular hypertrophy and deep Q waves in lateral leads. This BEST describes:

A 50-year-old man with a 10-year history of hypertension and type 2 diabetes develops an extensive anterior STEMI and is thrombolysed at 3 hours. Serial serum cardiac markers are measured post-thrombolysis. Which enzyme kinetic profile BEST characterises the marker used for BOTH confirming successful reperfusion AND detecting re-infarction if it occurs?

A 70-year-old woman with a previous anterior MI and dilated left ventricle (EF 25%) develops a right-sided pleural effusion, ascites, and tender hepatomegaly. Liver biopsy shows centrilobular sinusoidal dilation, hepatocyte dropout, and pericentral fibrosis producing a 'nutmeg' pattern. What is the MOST LIKELY primary cardiac mechanism driving her hepatic pathology?

A 65-year-old woman presents with progressive dyspnoea and a positional left atrial mass is found on echocardiography — a pedunculated, gelatinous, myxoid mass attached to the fossa ovalis of the interatrial septum, causing intermittent mitral valve obstruction and 'ball-valve' symptoms. Which statement about this lesion is MOST ACCURATE?