Myocarditis, Lyme; Cardiac, Vascular Tumors

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Myocarditis, Lyme; Cardiac, Vascular Tumors

Hello everyone and welcome back to another quiz in our long line of medical examinations. Today we’ll be taking a close look at some terrible illnesses and conditions including myocarditis, Lyme disease, as well as cardiac and vascular tumours. What do you know about them?


Questions and Answers
  • 1. 
    A 35-year-old female from Argentina complained for 3 months of shortness of breath, ankle swelling and palpitations. An X-ray showed cardiomegaly and a serological test showed antibodies to Trypanosoma cruzi. Before the serological result was available, the doctor suspected Chagas’ disease because of which clue?
    • A. 

      Pancytopenia due to splenomegaly

    • B. 

      Common reports of sandfly bites in his community

    • C. 

      Earlier presence of skin ulcer and eye swelling

    • D. 

      Blood smear showing amastigotes of T. cruzi

  • 2. 
    A 37-year-old female from Columbia complained for a month of palpitations, intermittent chest pain, dyspnea on exertion, and swollen ankles. The x-ray showed cardiomegaly and the EKG showed ST-wave abnormalities. What was a preceding event in his disease?
    • A. 

      Blood smear that showed amastigotes of Trypanosoma cruzi

    • B. 

      Transmission by infected feces of reduvid bug after its bite

    • C. 

      Cardiac muscle cells contained trypomastigotes of Trypanosoma cruzi

    • D. 

      Severe anemia causing high-output heart failure

  • 3. 
    An eleven year old boy presents with a two-days of severe headache, fever, and malaise followed yesterday by a macular rash on his extremities that appeared to be spreading inward. In taking his history, you find he had been tent camping with the family in South Carolina and had several "large" ticks removed first 14 days ago and for the next 4 days.  Your thorough exam shows some edema of the extremities and a petechial rash largely on his extremities. You realize this might be serious and start him immediately on doxycycline. What is the pathophysiology of this disease?
    • A. 

      Multiplication of the causative agent in the skin with subsequent damage

    • B. 

      Immune-mediated rash

    • C. 

      Endothelial cell invasion and cellular destruction

    • D. 

      Adhesion of an organism to endothelial cells with damage from the outside

  • 4. 
    A 24-year-old man from New Jersey with fever and myalgias for a week develops shortness of breath and palpitations. In the clinic his pulse is irregular, there is no heart murmur, and the x-ray shows an enlarged heart. The doctor suspects myocarditis. What microbial etiology is the likely cause of his illness?
    • A. 

      Lyme disease

    • B. 

      Diphtheria

    • C. 

      Coxsackievirus

    • D. 

      Streptococcus pyogenes evoking acute rheumatic fever

  • 5. 
    Your patient has been hiking along the Appalachian Trail for three weeks. While hiking he wore shorts and did not use insect repellant. He admitted that he appeared to get bitten quite frequently. Upon his return he noticed that he developed a fever along with severe headaches. Upon examination you notice a distinct macular rash upon his wrists, with obvious signs of myalgia. The patient asks why he feels so sick and you reply that this is partly due to his immune response. Which aspect of the patient’s immune response is considered to be crucial to his immune defense against the pathogen that is most likely causing his infection?
    • A. 

      CD8+ T cells

    • B. 

      Neutrophils

    • C. 

      MAC of complement

    • D. 

      CD4+ T cells

  • 6. 
    Four days after a camping trip in Oklahoma, a 24-year-old man presents with fever, headache, myalgia, and red, macular rash on his palms, soles, and arms. The causative organism infected primarily which cells and cell compartment?
    • A. 

      Granulocytes and vacuole

    • B. 

      Endothelial cells and cytoplasm

    • C. 

      Monocytes and cytoplasm

    • D. 

      Endothelial cells and vacuole

  • 7. 
    A 17-year old "street kid" is brought in from a free clinic because he had been sick with a fever and malaise for several days and when he presented to the free clinic, he was febrile and complaining of exertional fatigue. On exam had a heart murmur which he doesn't think he had when he ran away from his upper middle class home. He uses intravenous drugs. Imaging revealed a tricuspid vegetation. What is the most likely causative agent?
    • A. 

      Bartonella spp

    • B. 

      Candida albicans

    • C. 

      Enterococcus faecalis

    • D. 

      Staphylococcus aureus

    • E. 

      Streptococcus pyogenes

  • 8. 
    A 37-year-old unemployed man without health insurance had not been to a dentist for a long time. He came to the ER with a 2-week history of fever and fatigue. He had several carious teeth, an aortic diastolic murmur, and sore red nodules on the tips of his fingers. Bacteria grown in blood cultures would have which characteristics?
    • A. 

      Catalase-positive, coagulase-positive, beta hemolytic

    • B. 

      Catalase-positive, coagulase-negative, nonhemolytic

    • C. 

      Catalase-negative, alpha hemolytic, optochin resistant

    • D. 

      Catalase-negative, resistant to bile, resistant to high salt

  • 9. 
    A 58-year-old male complains of a 2-week history of fever and fatigue. A month ago he had 3 carious teeth extracted. You notice tender red nodules on his finger tips, splinter hemorrhages in fingernail beds, a Roth spot in a fundus, and a grade II/VI diastolic decrescendo murmur over the aortic and pulmonic areas. Two blood cultures grow Streptococcus mutans. What was the likely order of events in his illness?
    • A. 

      Bacteria in the blood attached to the endothelium of his aortic valve, a bacterial vegetation formed, emboli caused infarcts in his finger and eye

    • B. 

      Endothelial injury on his aortic valve led to nonbacterial thrombi, pieces of nonbacterial thrombi broke off and caused infarcts in his fingers and eye, bacteria in the blood attached to nonbacterial thrombi

    • C. 

      Nonbacterial thrombi formed on his aortic valve, bacteria in blood attached to the nonbacterial thrombi, antibodies formed antigen-antibody complexes that caused vascular damage in his fingers and eye

    • D. 

      Nonbacterial thrombi formed on his aortic valve, bacteria in blood attached to the nonbacterial thrombi, emboli caused infarcts in his fingers and eye

  • 10. 
    Which of these agents of endocarditis would not show up in two days on routine cultures?
    • A. 

      Bartonella spp

    • B. 

      Candida albicans

    • C. 

      Enterococcus faecalis

    • D. 

      Staphylococcus aureus

    • E. 

      Streptococcus pyogenes

    • F. 

      Viridans Streptococci

  • 11. 
    Which of the following test would be most helpful in confirming the diagnosis of the gross and microscopic lesion shown in images 1A & 1B?
    • A. 

      HHV 8 antibody test

    • B. 

      ANCA

    • C. 

      P-ANCA

    • D. 

      HIV antibody test

    • E. 

      CD 31 markers

  • 12. 
    A 44-year-old Hispanic female is brought to the emergency room with syncope, dizziness, and left-sided hemiplegia. After admission she developed intense chest pain and died. Postmortem examination reveals a cerebral infarction in the area of the middle cerebral artery and the left atrial lesion presented in the picture below. Which of the following is the most likely histologic findings in this case?
    • A. 

      Myxoid matrix with sparse stellate cells

    • B. 

      Hemorrhagic apipose tissue

    • C. 

      Bundles of spindle-shaped cells and vascular channels

    • D. 

      Pleomorphic rhabdomyocytes

  • 13. 
    A 36-year-old man in Texas with fever, headache, myalgia, and tick exposure had a serological test that showed antibodies against Ehrlichia chafeeensis. What is a feature of Ehrlichia that differs from other Rickettsia?
    • A. 

      Invasion of mononuclear leukocytes

    • B. 

      Invasion of vascular endothelium

    • C. 

      Cell wall that contains peptidoglycan

    • D. 

      Cell wall that contains lipopolysaccharide

    • E. 

      Invasion of polymorphonuclear leukocytes

  • 14. 
     An outbreak of murine (endemic) typhus occurred in the US in 2008.  Affected patients experienced fever, headache, chills, vomiting, nausea, myalgia, and rash.  Of the 53 cases, 62% had a four-fold rise in antibody titer to Rickettsia typhi antigens.  What is the vector associated with transmission of this organism?
    • A. 

      Mosquito

    • B. 

      Body louse

    • C. 

      Tick

    • D. 

      Flea

    • E. 

      Sand fly

  • 15. 
    How are the obligate intracellular pathogens of the genera Rickettsia, Ehrlichia, and Anaplasma transmitted by vectors?
    • A. 

      All are transmitted by ticks except for Rickettsia typhi, which is transmitted by lice

    • B. 

      Rocky Mountain spotted fever is transmitted mainly by Amblyoma ticks found in Texas

    • C. 

      Anaplasma is transmitted mainly by Ixodes ticks, which can be co-infected with Babesia or agent of Lyme disease

    • D. 

      Epidemic typhus is transmitted mainly by rodent fleas