USMLE题库Cardiology(二)1-10.pptx

Cardiology 2 题库 Q 1 A 35-year-old obese Caucasian female presents to your office with progressive dyspnea and dizziness on exertion. She has no significant past medical history, but admits following several strict weight-reduction diets and consuming appetite suppressant medications in the past. Her blood pressure is 110/80 mmHg and her heart rate is 90 beats per minute. The patient dies suddenly six months after the initial visit. Which of the following pathologic findings would you expect most based on the patients history? Berry aneurysms of the cerebral arteries Upper pulmonary lobe fibrosis Right ventricular hypertrophy Significant aortic dilation Renal vascular sclerosis Vascular medial calcification A 1 Correct answer: C The key clue in this patients history is the past use of appetite suppressants. Ingestion of fenfluramine, dexfenfluramine, and phentermine for more than three months duration has been associated with the development of secondary pulmonary hypertension. Patients with pulmonary hypertension generally present with exertional dyspnea (and possible exertional pre-syncope), due to an inability of the right heart to adequately increase cardiac output against increased pulmonary vascular resistance during exercise. For this reason, systemic blood pressure may fall during exercise. Chronic pulmonary hypertension results in right ventricular hypertrophy and cor pulmonale. Cor pulmonale may lead to sudden death from a lethal cardiac arrhythmia. (Choice A) Cerebral berry aneurysms are associated with genetic disorders such as autosomal dominant polycystic kidney disease and Ehlers-Danlos syndrome. Risk factors include hypertension and smoking. This patients past medical history does not suggest any of these conditions. (Choice B) Bilateral upper lobe pulmonary fibrosis may be caused by progressive massive fibrosis (as in coal workers pneumoconiosis and silicosis), tuberculosis, histoplasmosis, sarcoidosis, allergic bronchopulmonary aspergillosis, a