random

Question 1

T/F: Picornavirus (rhinovirus), coronavirus, paramyxovirus (parainfluenza and respiratory syncytial virus), and orthomyxovirus (influenza) all have a persistent replication pattern

Answer 1

False, they have an acute infection pattern with replicaiton confined to respiratory mucosal surface.

Persistent replication on respiratory mucosal surface is characteristic of adenovirus

Question 2

Paramyxovirus (mumps, measles) Herpesviruses (EBV, VZV, HHV6, CMV) Rubella, Picornavirus
(polio) all belong to which pattern of infeciton?

Answer 2

Systemic replication (dissemination) after primary replication in respiratory tract

Question 3

Picornavirus (rhinovirus) Coronavirus
Paramyxovirus (parainfluenza and respiratory syncytial virus) Orthomyxovirus (Influenza) all belong to what pattern of infection?

Answer 3

Acute infection with replication confined to respiratory mucosal surface

Question 4

T/F: Coronavirus, paramyxovirus, and orthomyxovirus are all (+) ssRNA virus?

Answer 4

False
Coronavirus is (+)ssRNA

Paramyxo and orthoxmyxo are both (-) ssRNA

MERS/SARS

Question 5

Where does orthomyxovirus and paramyxovirus replication?

Answer 5

Ortho - Nuclear

Para-cytoplasm

Both are enveloped

Question 6

Respiratory syncytial virus, measles and mumps all belong to which virus?

Answer 6

paramyxovirus

Question 7

croup is caused by which 2 viruses?

Answer 7

(paramyxovirus= (-)ssRNA replicates in cytoplasm)
parainfluenza and RSV

croup+ laryngotracheobronchitis
peak incidence in winter
barking cough in infants

Question 8

Which respiratory virus is being described: Pharyngoconjunctivial fever, pneumonia, febrile upper tract infection, double stranded DNA virus

Answer 8

Adenovirus

Think close quarters: boot camp…under stress, younger peiople)
Military has vaccine, but not in widespread use

Question 9

What virus is being described?
Symptoms: inspiratory stridor, cough hoarseness
•Peak incidence in winter
•Starts like a cold in adults and infants
•Infants may develop a distinctive barking cough, called croup
•Commonly treated at home with steam and humidifiers
•Complications: pneumonia and respiratory distress

Answer 9

Croup
paramyxovirus= (-)ssRNA replicates in cytoplasm)
parainfluenza and RSV

Question 10

________ is a technique that allows for separation of blood components by centrifugation for removal and/or exchange

Answer 10

Apheresis

Question 11

______ is a technique that allows for the alteration and/or removal of plasma via diffusion and/or convection

Answer 11

Dialysis

Question 12

Anticoaguation is necessary in both apheresis and dialysis….what anticoag agents are used for both?

Answer 12

Apheresis: Citrate (local)
Dialysis: Heparin (Systemic)

Question 13

Who needs dialysis? (AEIOU)

Answer 13

A: Acid-base problems
E: Electrolyte problems
I: Intoxications
O: Overload of fluids
U: Uremic symptoms

Question 14

Who needs apheresis?

Answer 14

Autoantibodies, leukocytes, abnormal RBCs, leukemias, parasitemia, circulating immune complexes, hypercholesterolemia, malaria, systemic vasculitis

Question 15

Fibrinoid necrosis is characteristic of what type of hypertenstion? What is the range of BP in this type of HTN>

Answer 15

Malignant HTN >180/120mmHg

This typically presents with acute end organ damange and is a medical emergency

Question 16

Elevated anti-streptolysin O titer is seen in which cardiac condition involving s. pyogenes?

Answer 16

Suggest acute rheumatic fever which has small nondestructive verrucous vegetations

Question 17

name the cardiomyopathy:
Gross Appearance: Asymmetric hypertrophy of the interventricular septum (bulges into the left ventricular outflow tract)
Histologic Appearance: Myofiber disarray

Answer 17

Hypertrophic cardiomyopathy

Question 18

Which 2 cardiomyopathies produces diastolic dysfunction?

Answer 18

Diastolic dysfucntion- ventricles cant fill
Hypertrophic cardiomyopathy- ventricles cant fill due to LV hypertrophy-decrease CO
Restrictuve cardiomyopathy- decreased compliance of ventricle that restricts filling during diastole

Question 19

Which cardiomyopathy produces a systolic dysfunction?

Answer 19

Dilated cariomyopathy

Results in systolic dysfunction wher ethe ventricles cannot pump, leading to biventricular CHF

Question 20

Histology of fibrosis seen between cardiac myocytes and dilation of all 4 chambers occurs in which cardimyopathy?

Answer 20

Dilated cardiomyopathy

Biventricular CHF that can lead to tricuspid and mitral valve regurg because the area is spread out

Question 21

Genetic mutations in sarcomere proteins and myofiber hypertrophy with disarray, box car nuclei and “replacement fibrosis” is seen in which cardiomyopathy?

Answer 21

Hypertrophic cardiomyopathy

Question 22

A “Machinery-like” murmur is an indication of which fetal cardiac issue?

Answer 22

Patent ductus arteriosus
Associated with maternal rubella infection, may predispose to infective endocarditis
Left ventricular output is shunted into the pulmonary circulation
Increased volume and pressure of blood in the pulmonary circulation eventually leads to pulmonary hypertension

Question 23

Why might you see high pulmonary bp with PDA?

Answer 23

Left ventricular output is shunted into the pulmonary circulation
Increased volume and pressure of blood in the pulmonary circulation eventually leads to pulmonary hypertension

Question 24

_______ Syndrome (507):
Delayed form of pericarditis
Develops 2 to 10 weeks after infarction (or cardiac surgery)
Formation of antibodies to heart muscle

Physical examination finds a friction rub along with increased jugular venous pressure and pulsus paradoxus (excess blood pressure drop with inspiration)

Answer 24

Dressler’s Syndrome

Treatment: Steroids

Question 25

A thrombotic occlusion of the left circumflex artery occurs in a 50-year-old male with severe coronary atherosclerosis. Within an hour after the thrombus forms, which of the following complications is most likely to occur?

Ventricular fibrillation
Autoimmune Pericarditis
Myocardial rupture
Ventricular aneurysm
Thromboembolism

Answer 25

V-fib
Complications of Myocardial Infarction (505):
High yield, good setup for test questions
Virtually all patients who have a myocardial infarct have abnormal cardiac rhythm at some time during their illness
Arrhythmias are the earliest complication of MI

Question 26

Hearing a mid-systolic click is an indication of which type of valvular problem?

Answer 26

Mitral Valve Prolapse (518):
Mitral valve leaflets become enlarged and redundant, billowed leaflets prolapse into the left atrium during systole

Physical Exam: Mid systolic click (due to prolapse of redundant leaflets), late systolic murmur (if mitral regurgitation is present)

Question 27

Name this condition:
A 4 yo child presenting with
(1) Pulmonary stenosis
(2) Ventricular septal defect
(3) Dextroposition of the aorta so that it overrides the ventricular septal defect
(4) Right ventricular hypertrophy
Radiographic Appearance: “Boot shaped” heart (due to hypertrophy)

Answer 27

Tetralogy of Fallot (493):
Clinical Presentation: Retarded development, cyanotic episodes, dyspnea, may be complicated by endocarditis with septic emboli

Question 28

A 32-year-old North American Caucasian female presents with increasingly severe symptoms of congestive heart failure over 2 weeks. She has no previous history of heart disease. An electrocardiogram shows some runs of ventricular tachycardia, and an endomyocardial biopsy shows focal myocyte necrosis along with a lymphocytic infiltrate. She is most likely to have an infection with which of the following organisms?

T. cruzi
S. viridans
Coxsackievirus A
Toxoplasma gondii
S. aureus

Answer 28

Coxsackievirus A

Question 29

The presence of hemorrhage and contraction bands in necrotic myocardial fibers is most likely to be seen in which of the following?

Subendocardial infarct resulting from diffuse narrowing of coronary arteries
Transmural infarct caused by complete thrombotic occlusion of a coronary artery
Transmural infarct complicated by mural thrombosis
Transmural infarct that is reperfused by thrombolytic therapy
A healing transmural myocardial infarct

Answer 29

Transmural infarct that is reperfused by thrombolytic therapy

Reperfusion: contraction band necrosis

Question 30

_________ is an atypical form of angina that occurs at rest
Caused by coronary artery spasm
Treatment: Nitrates or Calcium channel blockers

Answer 30

Prinzmetal Angina

Question 31

Which type of cardiomyopathy is associated with doxorubicin cardiotoxicity?

Answer 31

Dilated cardiomypoathy

Histologic appearance shows vacuoliztion and loss of myofibrils

Question 32

Becks Triad of (1) Hypotension, (2) JVD, (3) Muffled heart sounds, is associated with what cardiac condition?

Answer 32

Tamponade

Question 33

A 4-year-old boy with a history of mental retardation and seizures is brought to the physician with a 3-month history of worsening shortness of breath. During physical examination, the physician notices numerous acne like papules on the patient’s face. Echocardiography shows significant left ventricular outflow obstruction. Which of the following is the most likely diagnosis for this patient’s heart condition?

Coronary artery disease
Dilated cardiomyopathy
Myxoma
Rhabdomyoma 
Transposition of the great vessels

Answer 33

Rhabdomyoma is the most common primary pediatric cardiac tumor…it is a benign harmartoma of cardiac muscle
Occurs in association with tuberous sclerosis

Myxoma is the most common primary adult cardiac tumor

Question 34

Which type of arteriolosclerosis is due to malignant HTN? (hyaline or hyperplastic)

Answer 34

hyperplastic -thickening of wall due to hyperplasia of smooth muscle…may lead to fibrinoid necrosis

Hyaline is caused by benign HTN and diabetes… thickening of vessel wall due to proteins leaking into it