In the pathogenesis of acute myocardial infarction, which of the following directly leads to thrombus formation in the coronary artery?

(A) a fissure or fracture in the fibrous cap of an atherosclerotic plaque(B) loss of endothelial cells over areas of calcification in an atherosclerotic plaque(C) microaneurysm formation in a segment involved by atherosclerosis(D) stasis of blood flow proximal to an atherosclerotic plaque

A middle-aged man had several episodes of chest pain during the last two years. He was admitted to the hospital following a very severe attack which ended in shock. The pain began about an hour before he was admitted. The most likely outcome in this case is (A) cerebral embolism from a mural thrombosis (B) death due to congestive heart failure in the third week (C) pulmonary embolism (D) rupture of the myocardium (E) survival with reduced cardiac reserve

As a cause of infarction, the major segment of the coronary vasculature most frequently occluded is

(A) left main coronary artery (B) left anterior descending branch (C) left circumflex branch (D) right coronary artery (E) right circumflex branch

The most common cause of sudden death from myocardial infarction is

(A) angina pectoris (B) arrhythmia (C) cardiac tamponade (D) cardiogenic shock (E) ventricular aneurysm

A 67-year-old man with a known history of stable angina presents to the emergency room after a 6-hour history of chest pain. Both an initial test for troponin-I and a subsequent test done 6 hours later are negative. The most important feature of using this test to exclude a myocardial infarction in this patient is that it has

(A) maximum sensitivity(B) maximum specificity(C) minimal false positives(D) minimal pre-test probability

On an overseas vacation, a 62-year-old woman experienced an episode of severe substernal chest pain and shortness of breath. On her return to the U.S. four days later, she sees her primary physician and relates this episode to her. Suspecting possible myocardial injury, which is the most appropriate laboratory test for the physician to order? (A) cardiac troponin I (cTnI)(B) creatine kinase, total(C) creatine kinase, MB fraction (D) lactate dehydrogenase, total(E) lactate dehydrogenase, LD1 fraction

Which of the following is a cause of high output heart failure? (A) pulmonary emphysema (B) mitral stenosis (C) ventricular aneurysm (D) hypothyroidism (E) arterio-venous fistula

The most frequent cause of pure right-sided heart failure is (A) congenital heart disease (B) ischemic heart disease (C) pulmonary disease (D) liver disease (E) renal disease

A 50-year-old man is admitted for congestive heart failure. He has no history of chest pain or ethanol abuse. On physical examination he has a blood pressure of 190/120 mm Hg, mild hepatosplenomegaly, and no cardiac murmur. The heart failure is most likely due to (A) aortic stenosis (B) cardiomyopathy (C) hypertension (D) myocardial infarct (E) pulmonary emboli

Left-sided heart failure frequently leads to right-sided heart failure because (A) the basic underlying disease usually affects both chambers of the heart (B) poor perfusion of the right coronary artery results from left ventricular failure (C) enlargement of the left ventricle partially obstructs pulmonary outflow (D) increased pulmonary arterial pressure strains the right ventricle

Heart failure cells are (A) atrophic myocytes (B) hypertrophied myocytes(C) macrophages containing ceroid (D) macrophages containing hemosiderin (E) macrophages containing lipofuscin

Chronic passive congestion of the liver most often results from (A) right heart failure (B) liver cirrhosis (C) hepato-renal failure (D) left heart failure (E) portal hypertension

The most conspicuous feature of right-sided heart failure is (A) brown induration of the lung (B) lower extremity edema (C) mitral stenosis (D) pulmonary edema (E) hypertension

Of the following the most common cause of cardiac tamponade is

(A) aortic root dissection(B) congestive heart failure (C) metastatic carcinoma (D) pericarditis (E) rheumatic fever

The mechanism of death in cardiac tamponade is (A) acute right heart failure (B) anemia due to acute blood loss (C) myocardial infarct (D) obstruction to outflow from the aorta (E) pulmonary edema complicated by pneumonia

The most frequent site of myocardial infarction is (A) anterior septal (B) anterior lateral (C) posterior lateral (D) posterior (E) posterior septal

Cerebral embolization occurring as a complication of a myocardial infarct would most probably be indicative of (A) disseminated intravascular coagulation (B) mural thrombus in the left ventricle (C) lack of collateral circulation (D) post-myocardial injury syndrome (E) phlebothrombosis

Death within the first 24 hours following an acute myocardial infarction is most often due to (A) pericardial tamponade (B) mitral insufficiency (C) cerebrovascular accident (D) arrhythmia (E) congestive heart failure

Syphilitic heart disease most commonly involves (A) myocardium (B) mitral valve (C) pulmonic valve (D) tricuspid valve (E) aortic valve

The most frequent cause of mitral stenosis is (A) atherosclerotic valvular disease (B) infective endocarditis (C) congenital malformation (D) rheumatic heart disease (E) hypertensive vascular disease

The cardiac lesion associated with lupus erythematosus is (A) MacCallum's patch (B) tricuspid atresia (C) Libman-Sacks endocarditis (D) shortening and thickening of the chordae tendineae (E) tricuspid insufficiency

On her first prenatal physical exam, a 24-year-old woman was noted by her obstetrician to have a mid-systolic click on auscultation of the heart. The most likely reason for this physical finding would be

(A) calcific aortic stenosis(B) hyperdynamic cardiac output(C) mitral valve prolapse(D) patent ductus arteriosus(E) ventricular septal defect

A 12 year old girls is admitted to the hospital because of marked shortness of breath, and erythematous rash and painful, swollen hip and knee joints Antistreptolysin O titre is abnormally high x ray film of the chest shows an enlarged heart she develops intractable congestive herat failure and dies on the second hospital day. Whcih of rthe following cardiac abnormalities is mnost likely to be see at the autopsy ?

a.-granulomatous pericarditis with caseous necrosis b.-multiple microabscesses in the myocardium c.-myocardial edema with aschoff bodies *d.-stenosis of the aortic valve e.-stenosis of the mitral valve