Clinical Quiz 1

Answer the following quiz by commenting below with question number and your choices.

Q1. Cyanosis is a typical feature of which of the following conditions?

  1. Atrial septal defect (ASD)
  2. Mitral atresia
  3. Patent ductus arteriosus (PDA)
  4. Total anomalous pulmonary venous drainage
  5. Ventricular septal defect (VSD)
Q2.Which of the following is the most likely mechanism by which aspirin exerts its beneficial effects in patients with coronary artery disease?

  1. Anti-inflammatory action
  2. Cyclo-oxygenase (COX) inhibitition
  3. Glycoprotein IIB/IIIA receptor inhibitition
  4. Inhibitition of binding of adenosine diphosphonate (ADP) to its platelet receptor
  5. Structural changes in platelets
Q3.A 50-year-old man is admitted with cardiogenic shock due to an acute myocardial infarction.His urine output drops over the next few days. His serum urea increases to 18 mmol/l (2.5 – 7.5), with creatinine of 300 µmol/l (60 – 110). Urinalysis reveals no protein or glucose, a trace blood, and numerous hyaline casts.Several days later he develops polyuria and his serum urea and creatinine fall.Which of the following pathologic findings is most likely to be seen in his kidneys?

  1. Fusion of podocyte foot processes
  2. Glomerular crescents
  3. Hyperplastic arteriolosclerosis
  4. Mesangial immune complex deposition
  5. Patchy tubular necrosis
Q4.A 65-year-old man is referred with abnormal liver function and undergoes a liver biopsy.Which of the following count against hepatic cirrhosis?

  1. Fibrous septa formation
  2. Granuloma formation
  3. Liver cell necrosis
  4. Nodular regeneration
  5. Subendothelial fibrosis
Q5.Which of the following is true regarding mitral stenosis?

  1. Doppler U/S is usually inaccurate in determining severity
  2. In AF, the opening snap disappears
  3. It is tolerated well in pregnancy
  4. The opening snap is not heard when the mitral valve is heavily calcified
  5. There is characteristically a low wedge pressure

Answers

Answer 1:

Total anomalous pulmonary venous connection (TAPVC) is associated with cyanosis in the newborn.

TAPVC consists of an abnormality of blood flow in which all four pulmonary veins drain into systemic veins or the right atrium with or without pulmonary venous obstruction.

Systemic and pulmonary venous blood mix in the right atrium.

PDA, ASD and VSD are left to right shunts.

Tricuspid atresia is typically associated with cyanosis rather than mitral.
Answer 2:
Cyclo-oxygenase (COX) inhibitition

It inhibits platelet aggregation through inhibition on both COX I and II. Clopidogrel inhibits ADP binding to platelet receptors.

Answer 3:

Patchy tubular necrosis

He would have findings of ischaemic acute tubular necrosis from cardiogenic shock.Fusion of podocyte foot processes is seen in minimal change glomerulonephritis.Glomerular crescents can complicate any glomerulopathy but, along with mesangial immune complex deposition, is usually an immune-mediated process.Hyperplastic arteriolosclerosis is the ‘onion skin’ appearance of arterioles in malignant hypertension.

Answer 4:

Granuloma formation is not classically seen in cirrhosis, which can be micro- or macronodular in type.In the micronodular form, the nodules are less than 3 mm across with uniform liver involvement – seen in alcohol or biliary disease.In the macronodular form, there are larger nodules, classically seen in chronic viral hepatitis.

Answer 5:
The opening snap is not heard when the mitral valve is heavily calcified

Mitral stenosis is typically a consequence of childhood rheumatic fever, but congenital disease is well recognised.It is associated with a tapping apex beat, a loud S1, opening snap and mid-diastolic rumble with pre-systolic accentuation in those in sinus rhythm.The opening snap is characteristically lost with heavy valvular calcification.In particular mitral stenosis is poorly tolerated in pregnancy due to volume overload.It is well characterised by Doppler echocardiography.

 

3 Comments

  1. Vipin v says:

    Q5. 4.. Q4. 2.. Q2. 4

  2. bmenon says:

    q1-total anamolous venous drainage
    q2-cyclooxygenase inhibition
    q3-patchy tubular necrosis
    q4-granuloma formation
    q5-opening snap is not heard when valve is heavely calcified1

  3. Dr.Bijoy says:

    Answers published! Click the answer tab below the questions box to read them.

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