Heart Failure And Inflammation Quiz: Trivia!

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Heart Failure And Inflammation Quiz: Trivia! - Quiz

The heart is what many consider to be the single most important organ in the body, as it pumps blood to every other organ which allows our bodies to tick away like normal. But as such an important organ, there is a lot of serious complications that can come about with it, such as cardiomyopathy, heart failure, and heart disease. What do you know about them?


Questions and Answers
  • 1. 

    This 48-year-old woman presents with shortness of breath and a non-productive cough which has been worsening over the last 6 months.  The most likely cause of her chest x-ray would be:

    • A.

      Low output failure associated with seeing a really scary movie

    • B.

      Volume depletion resulting in low output failure

    • C.

      Decreased cardiac output secondary to cardiomyopathy

    • D.

      High output heart failure

    Correct Answer
    D. High output heart failure
    Explanation
    CAUSES OF HIGH-OUTPUT FAILURE — The disorders contributing to high-output heart failure include: ■Systemic arteriovenous fistulas ■Hyperthyroidism ■Anemia, including the anemia of chronic kidney disease ■Beriberi (vitamin B1 or thiamine deficiency) ■Dermatologic disorders (eg, psoriasis) ■Renal disease ■Hepatic disease ■Skeletal disorders (eg, Paget disease, multiple myeloma) Other potential causes of high-output HF include obesity and carcinoid syndrome

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  • 2. 

    You attend an autopsy of a 65-year-old man who died suddenly at home.  The pathologist shows you the heart and describes "cardiomegaly with concentric left ventricular hypertrophy".  He tells you the kidneys have "arteriolonephrosclerosis".  What is the patient's cause of death?

    • A.

      Hypertensive cardiovascular disease

    • B.

      Coronary atherosclerosis

    • C.

      Hypertrophic cardiomyopathy

    • D.

      Aortic stenosis

    • E.

      Mitral valve prolapse

    Correct Answer
    A. Hypertensive cardiovascular disease
    Explanation
    ARTERIOLOSCLEROSIS A. Narrowing of small arterioles; divided into hyaline and hyperplastic types B. Hyaline arteriolosclerosis is caused by proteins leaking into the vessel wall, producing vascular thickening; proteins are seen as pink hyaline on microscopy (Fig. 7.7). 1. Consequence of long-standing benign hypertension or diabetes 2. Results in reduced vessel caliber with end-organ ischemia; classically produces glomerular scarring (arteriolonephrosclerosis) that slowly progresses to chronic renal failure C. Hyperplastic arteriolosclerosis involves thickening of the vessel wall by hyperplasia of smooth muscle ('onion-skin' appearance, Fig. 7.9). l. Consequence of malignant hypertension 2. Results in reduced vessel caliber with end-organ ischemia 3. May lead to fibrinoid necrosis of the vessel wall with hemorrhage; classically causes acute renal failure with a characteristic 'flea-bitten' appearance

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  • 3. 

    A 24-year-old man, marathon runner, and endurance athlete, suddenly develops an illness characterized by cough, high fever, and severe muscle aches.  Within a day he is developing signs of heart failure.  Due to the severe nature of his illness a myocardial biopsy is performed, a photomicrograph of which is shown below.  What is the diagnosis?

    • A.

      Rheumatic heart disease

    • B.

      Hypertrophic cardiomyopathy

    • C.

      Dilated cardiomyopathy

    • D.

      Viral myocarditis

    • E.

      Cardiac angiosarcoma

    Correct Answer
    D. Viral myocarditis
    Explanation
    The correct answer is viral myocarditis. This diagnosis is supported by the patient's symptoms of cough, high fever, and severe muscle aches, as well as the development of signs of heart failure within a day. The myocardial biopsy reveals characteristic features of viral myocarditis, confirming the diagnosis. Rheumatic heart disease, hypertrophic cardiomyopathy, dilated cardiomyopathy, and cardiac angiosarcoma are less likely based on the clinical presentation and biopsy findings.

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  • 4. 

    A 21-year-old NCAA basketball player dies during a game.  He has no known medical problems or previous history of illness. Which of the following is most likely?

    • A.

      Dilated cardiomyopathy

    • B.

      Restrictive cardiomyopathy

    • C.

      Viral cardiomyopathy

    • D.

      Arrhythmogenic right ventricular cardiomyopathy

    • E.

      Hypertrophic cardiomyopathy

    Correct Answer
    E. Hypertrophic cardiomyopathy
    Explanation
    Hypertrophic cardiomyopathy is the most likely cause of the 21-year-old NCAA basketball player's death during a game. This condition is characterized by the thickening of the heart muscle, which can disrupt the normal flow of blood and cause various complications, including sudden cardiac arrest. It is often hereditary and can go undiagnosed until a tragic event occurs, as in this case. Given the player's young age, lack of known medical problems or previous history of illness, and the sudden nature of his death, hypertrophic cardiomyopathy is a plausible explanation.

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  • 5. 

    This 49-year old obese Afro-Caribbean female presents to the emergency room with shortness of breath. She complains that ordinary activity can leave her slightly fatigued and short of breath. Her past history is significant for type 2 diabetes, hypertension, and a long history of alcohol abuse.   Her blood pressure is 150/88. On physical exam, she has bilateral lung crackles and an S3 gallop and 3+ pitting edema. Which of the following is the best predictor of her prognosis?

    • A.

      History of obesity and type 2 diabetes

    • B.

      An elevated creatine phosphokinase

    • C.

      Hypertension

    • D.

      An elevated brain naturetic peptide

    Correct Answer
    D. An elevated brain naturetic peptide
    Explanation
    Diagnostic significance The main clinical utility of either BNP or NT-BNP is that a normal level rules out heart failure.[2] Either marker can also be used for screening and prognosis of heart failure.[3] Both are also typically increased in patients with left ventricular dysfunction, with or without symptoms (BNP accurately reflects current ventricular status, as its half-life is 20 minutes, as opposed to 1–2 hours for NT-ProBNP).[4] BNP less than 100 pg per milliliter sensitivity = 90% specificity = 76% BNP less than 50 pg per milliliter sensitivity = 97% specificity = 62% some laboratories report in units ng per Litre (ng/L) which is equivalent to pg/ml For patients with congestive heart failure, BNP values will generally be above 100 pg/ml. FUN FACT: BNP is also one of the reasons why people will feel the need to urinate after getting into the bathtub or pool. The increased pressure on the body drives more fluid back into systemic circulation which in turn leads to a slight increase in preload. The left ventricle, and to a small degree the left atrium, secrete BNP in response. The natriuretic effect of BNP leads to an increase in urine production

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  • 6. 

    A 27-year-old Caucasian male, a professional basketball player develops severe chest pain during a game. Echocardiography reveals an asymmetrically thickened interventricular septum along with a decreased end-diastolic volume. Which of the following is the most likely diagnosis?

    • A.

      Hypertrophic cardiomyopathy

    • B.

      Endomyocardial fibrosis

    • C.

      Heart amyloidosis

    • D.

      Physiologic heart hypertrophy

    Correct Answer
    A. Hypertrophic cardiomyopathy
    Explanation
    The most likely diagnosis in this case is hypertrophic cardiomyopathy. This condition is characterized by the thickening of the interventricular septum, which can lead to decreased end-diastolic volume. It is commonly seen in young athletes and can cause symptoms such as chest pain during physical activity. Endomyocardial fibrosis, heart amyloidosis, and physiologic heart hypertrophy are not consistent with the findings described in the question.

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  • 7. 

    The pictures shown below represent the gross and microscopic changes of the heart of a 60 –year- an old Caucasian male who died with multiple symptoms of left-sided heart failure including cough and dyspnea. What laboratory test finding is most likely to be found in the patient’s medical record?

    • A.

      High anti-double-stranded DNA antibody titer

    • B.

      Elevated serum p-ANCA titer

    • C.

      Hyperlipidemia

    • D.

      Antibodies against Treponema pallidum

    Correct Answer
    D. Antibodies against Treponema pallidum
    Explanation
    THORACIC ANEURYSM A. Balloon-like dilation of the thoracic aorta B. Due to weakness in the aortic wall. Classically seen in tertiary syphilis; endarteritis of the vasa vasorum results in luminal narrowing decreased flow and atrophy of the vessel wall. Results in a 'tree-bark' appearance of the aorta (Fig. 7.12) C. Major complication is dilation of the aortic valve root, resulting in aortic valve insufficiency. 1. Other complications include compression of mediastinal structures (e.g., airway or esophagus) and thrombosis/embolism.

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  • 8. 

    A 25-year-old Hispanic female dies after 5 days of an acute coxsackievirus infection.  Autopsy reveals a widely distended pericardial sac filled with serous fluid. The heart is of normal weight. Both ventricular walls are of normal thickness and all chambers are of normal size.  There is no history of cardiac abnormalities prior to infection and a heart monitor during the course of the illness shows no evidence of fatal arrhythmia.  Which of the following is the most likely mechanism for heart failure?  

    • A.

      Reduced preload

    • B.

      Increased preload

    • C.

      Increased afterload

    • D.

      Decreased afterload

    Correct Answer
    A. Reduced preload
    Explanation
    The most likely mechanism for heart failure in this case is reduced preload. Preload refers to the amount of blood that fills the ventricles of the heart during diastole, and reduced preload means that there is a decreased amount of blood filling the ventricles. In this case, the widely distended pericardial sac filled with serous fluid suggests the presence of pericardial effusion, which can compress the heart and reduce the amount of blood that can fill the ventricles. This can lead to decreased cardiac output and heart failure.

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  • 9. 

    This 45-year-old patient presents with shortness of breath and a non-productive cough which has worsened over several months. Based on this x-ray, the most likely diagnosis is

    • A.

      Congestive heart failure

    • B.

      Right-sided heart failure

    • C.

      Hypertension

    • D.

      Pulmonary edema

    Correct Answer
    D. Pulmonary edema
    Explanation
    The x-ray shows a pattern consistent with pulmonary edema, which is a condition characterized by the accumulation of fluid in the lungs. This is supported by the patient's symptoms of shortness of breath and non-productive cough, which are commonly seen in pulmonary edema. Congestive heart failure and right-sided heart failure can both lead to pulmonary edema, but the x-ray alone does not provide enough information to differentiate between the two. Hypertension alone would not typically cause the findings seen on the x-ray. Therefore, pulmonary edema is the most likely diagnosis based on the information provided.

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  • 10. 

    A 42-year-old African female with a history of rheumatic fever presents to the outpatient clinic with dyspnea, fatigue, lower leg edema, dry cough with scanty amount of rusty sputum, and abdominal distension. Physical examination reveals cyanosis, pedal edema, ascites, and rales in both lower lung fields. A chest X-ray reveals left atrial enlargement and pulmonary edema. Which of the following is the most likely type of heart failure seen in this patient?

    • A.

      Chronic combine LSHF and RSHF

    • B.

      Chronic LSHF

    • C.

      Acute RSHF

    • D.

      Acute LSHF

    Correct Answer
    A. Chronic combine LSHF and RSHF
    Explanation
    The patient's symptoms and physical examination findings suggest a diagnosis of congestive heart failure (CHF). The presence of dyspnea, fatigue, lower leg edema, dry cough with rusty sputum, and abdominal distension are all consistent with CHF. The physical examination findings of cyanosis, pedal edema, ascites, and rales in both lower lung fields further support this diagnosis. The chest X-ray revealing left atrial enlargement and pulmonary edema indicate chronic left-sided heart failure (LSHF). However, the combination of symptoms and findings, including the presence of rales in both lower lung fields, suggests the involvement of both sides of the heart, indicating chronic combined LSHF and RSHF.

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  • 11. 

    A 42-year-old African female with a history of rheumatic fever presents to the outpatient clinic with dyspnea, fatigue, lower leg edema, dry cough with scanty amount of rusty sputum, and abdominal distension. Physical examination reveals cyanosis, pedal edema, ascites, and rales in both lower lung field. A chest X-ray reveals left atrial enlargement and pulmonary edema. Which of the following is the most likely type of heart failure seen in this patient?     Clinical scenario from the previous question  Which of the following is the most likely mechanism of heart (LV) failure in this patient?

    • A.

      Increased pressure overload

    • B.

      Reduced preload

    • C.

      Increased volume overload

    • D.

      Impaired contractility

    Correct Answer
    A. Increased pressure overload
    Explanation
    The most likely mechanism of heart failure in this patient is increased pressure overload. This is indicated by the presence of left atrial enlargement and pulmonary edema on the chest X-ray, as well as the physical examination findings of cyanosis, pedal edema, ascites, and rales in both lower lung fields. Increased pressure overload occurs when there is an increased resistance to blood flow out of the left ventricle, leading to increased pressure within the ventricle and ultimately causing heart failure.

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  • 12. 

    A 60-year-old hypertensive businessman, on therapy over the past 10 years, woke his wife (who slept in the same bed) at about 2 AM - 3 AM on three occasions over the last week, complaining of shortness of breath, cough, and palpitations.  He sat up on each occasion breathing deeply, went to the open window “to get some fresh air” then returned to bed after settling down in half an hour or so. 

    • A.

      He needs to see his doctor for hospitalization, because he is developing an acute myocardial infarction

    • B.

      He needs to consult his doctor for and ECG, chest X-ray and ECHO because he may be going into left ventricular failure.

    • C.

      His clinician told him that he was showing evidence of right-sided heart failure and would start him on therapy

    • D.

      His wife was worried about an allergic reaction to his evening medication (for cholesterol lowering) and his doctor agreed to change this

    Correct Answer
    B. He needs to consult his doctor for and ECG, chest X-ray and ECHO because he may be going into left ventricular failure.
    Explanation
    The patient's symptoms of shortness of breath, cough, and palpitations, along with his history of hypertension and the fact that his symptoms occur at night, suggest that he may be experiencing left ventricular failure. Left ventricular failure can cause fluid to accumulate in the lungs, leading to symptoms such as shortness of breath and cough. An ECG, chest X-ray, and ECHO can help assess the function of the heart and identify any abnormalities that may be causing the symptoms. Therefore, consulting his doctor for these tests is necessary to evaluate his condition and determine the appropriate treatment.

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  • 13. 

    Examination of the endomyocardial biopsy obtained from a 14-year-old African girl reveals the changes shown below. What is the most likely diagnosis?

    • A.

      Viral myocarditis

    • B.

      Giant cell myocarditis

    • C.

      Rheumatic myocarditis

    • D.

      Dilated cardiomyopathy

    Correct Answer
    C. Rheumatic myocarditis
    Explanation
    The given information states that the examination of the endomyocardial biopsy obtained from a 14-year-old African girl reveals certain changes. Based on this information, the most likely diagnosis is rheumatic myocarditis. This is because rheumatic fever, which is caused by a streptococcal infection, can lead to inflammation of the heart muscle (myocarditis) in some cases. The patient's age and the presence of changes in the biopsy support this diagnosis.

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  • 14. 

    An eight-month-old African American male infant develops cardiac failure and dies two months later. At autopsy, the heart does not have any obvious congenital defects, but the heart chambers are small and covered with the thick white endocardium. Histologic examination of the postmortem material reveals regular elastic fibers embedded in the thickened fibrous endocardium. Which of the following is the most likely diagnosis?

    • A.

      Kawasaki disease

    • B.

      Emdomyocardial fibrosis

    • C.

      Loffler endocarditis

    • D.

      Endocardial fibroelastosis

    • E.

      Cardiac amyloidosis

    Correct Answer
    D. Endocardial fibroelastosis
    Explanation
    Endocardial Fibroelastosis: Very rare disease of *infants & young children* Thickening and fibrosis of endocardium Part of HEC syndrome Hydrocephalus Endocardial fibroelastosis Cataracts Pathology Marked thickening and fibrosis of endocardium Clinical findings related to inability of heart to contract and pump blood Treatment is heart transplant

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  • Apr 26, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • Jul 14, 2012
    Quiz Created by
    Chachelly
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