Case 3 Flashcards
Component of S1 that in the principal component of S1 and is heard throughout the precordium and is loudest at the cardiac apex.
a. mitral sound
b. tricuspid sound
c. aortic sound
d. pulmonic sound
A
S1: mitral sound and tricuspid sound
S2: A2 and P2
Component of S2 that is relatively soft and is best heard in the 2nd and 3rd left interspaces close to the sternum.
a. M1
b. T1
c. A2
d. P2
D
A2: first sound, left-sided aortic valve closure, normally louder than P2. It reflects high pressure in the aorta, best heard
Type of murmur that is from structural abnormalities or abnormalities in the great vessels
a. Innocent
b. Physiologic
c. Pathologic
d. Intermittent
C
Origin of a murmur that is located in the left 2nd and 3rd interspaces close to the sternum, but also at higher or lower levels
a. aortic valve
b. pulmonic valve
c. tricuspid valve
d. mitral valve
B
a. aortic valve - right 2nd interspace to the apex
c. tricuspid valve - at or near the lower left sternal border
d. mitral valve - at and around the cardiac apex
Grade of murmur described as very loud, with thrill. May be heard with stethoscope entirely off the chest
a. Grade 3
b. Grade 4
c. Grade 5
d. Grade 6
D Grade 1 - very faint Grade 2 - quiet Grade 3 - moderately loud Grade 4 - loud, with palpable thrill Grade 5 -very loud, with thrill, may be heard when the stethoscope is PARTLY OFF the chest
It starts immediately after s2, without gap, fades into silence before the next s1, sometimes usually reflects regurgitant flow across incompetent semilunar valves
a. Early diastolic
b. Mid diastolic
c. Pan systolic
d. Mid systolic
A
Aschoff bodies is the pathologic hallmark of rheumatic heart disease and it is most frequently seen in which of the following tissues?
a. Epicardium
b. Myocardium
c. Endocardium
d. Mitral valve
B. MYOCARDIUM
- Aschoff bodies may be seen in all three layers of the heart (Robbins)
- Two-hit hypothesis: antibody attack of valve
endothelium facilitates extravasation of T cells,
leading to Aschoff bodies formation that is
characteristic in rheumatic myocarditis
(Braunwald’s)
According to Jones Criteria (2015), the major criteria of ARF is high risk populations include/s the following:
a. Polyarthralgia
b. Polyarthritis
c. Monoarthritis
d. Any of the options
D. ANY OF THE OPTIONS
- Major criteria for Moderate and High Risk
Populations: Carditis, Arthritis (polyarthritis,
monoarthritis, or polyarthralgia), Chorea,
Erythema marginatum, Subcutaneous nodules
A 20-year old girl develops subcutaneous nodules over the skin of her arms and torso 3 weeks after a bout of acute pharyngitis. She manifests choreiform movements and begins to complain of pain in her knees and hips, particularly with movement. A friction rub is heard on auscultation of her chest. An abnormality detected by which of the following serum laboratory findings is most characteristic of the disease?
a. Antistreptolysin O antibody fiber
b. Antinuclear antibody titer
c. Creatinine level
d. Troponin level
A. ANTISTREPTOLYSIN O TITER
After 1 year of valvular surgery, prosthetic valve endocarditis is most likely caused by the following microbes.
a. Streptococcus viridans
b. Staphylococcus aureus
c. Coagulase-negative staphylococcus
d. HACEK group
A
B. STAPHYLOCOCCUS AUREUS
- In patients with prosthetic valves, early PVE has been defined as early as 60 days or less up to 1 year after surgery.
- S. aureus is the leading cause of early PVE (35%) followed by CoNS.
Which of these statements about rheumatic heart disease is/are correct?
a. It commonly affects the pre-school children
b. The peak prevalence age is between the age of 20 and 30’s
c. It tends to be more common in males than females
d. Any of the options
B
All of the following statements are true about heart sounds. Which one is the exception?
a. S1 is louder at the apex of the heart
b. S2 is louder at the base of the heart
c. S1 coincides with the pulsation of the heart
d. None of the options
D
The primary mechanism of antibacterial action of the penicillin involves the inhibition of which of the following.
a. Beta lactamases
b. B-acetylmuramic acid synthesis
c. Peptidoglycan cross linking
d. Synthesis of cell membrane
D. Penicillin inhibits cell wall synthesis
The following statement/s is/are TRUE about chronic rheumatic heart disease.
a. Only 10% of patients who experience ARF will develop clinical carditis.
b. Resolution of carditis is seen more in aortic involvement.
c. Younger age of the first episode of ARF is a risk for its development.
d. Any of the options
C
A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2. Which of the following is the most likely diagnosis?
a. Mitral stenosis
b. Mitral insufficiency
c. Aortic stenosis
d. Aortic insufficiency
C
A 12-year-old girl presented with dyspnea and knee pain. She has a history of sore throat 4 weeks prior to the onset of symptoms. Her ASO titer is high/ On PE, she has a systolic murmur at the apex. She eventually died. An autopsy of the heart shows Aschoff bodies in the epicardium, myocardium and endocardium layers.
Which of the following is the most probable underlying cause of death?
a. Acute rheumatic fever
b. Chronic rheumatic fever
c. Scarlet fever
d. Bacterial endocarditis
A
A 12-year-old girl presented with dyspnea and knee pain. She has a history of sore throat 4 weeks prior to the onset of symptoms. Her ASO titer is high/ On PE, she has a systolic murmur at the apex. She eventually died. An autopsy of the heart shows Aschoff bodies in the epicardium, myocardium and endocardium layers. Which of the following is the most probable underlying cause of death?
a. Acute rheumatic fever
b. Chronic rheumatic fever
c. Scarlet fever
d. Bacterial endocarditis
A
Which of the following clinical findings is the most common initial presentation of acute rheumatic fever?
a. Carditis
b. Erythema marginatum
c. Migratory polyarthritis
d. Sydenham chorea
C
