Atherosclerosis — Past Paper OmpathStudy

Artherosclerosis — Questions and Answers Complete review bank: 50 questions recovered from all 31 source pages. 1. A 56-year-old man reports reduced exercise tolerance over the past 5 years. In the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. On examination he has a blood pressure of 155/95 mm Hg. His body mass index is 30 kg/m2. Laboratory findings include a total serum cholesterol of 245 mg/dL with HDL cholesterol of 22 mg/dL. Which of the following vascular abnormalities is he most likely to have? A. Hyperplastic arteriolosclerosis B. Lymphedema C. Medial calcific sclerosis D. Atherosclerosis E. Deep venous thrombosis F. Plexiform arteriopathy Answer: D. He has multiple risk factors for atherosclerosis, including his weight, smoking, hypertension, and high total cholesterol with low 'good' HDL cholesterol. His findings suggest coronary artery disease with risk for an acute coronary syndrome. 2. A 54-year-old previously healthy woman is hospitalized for pneumonia. On the 10th hospital day she is found to have swelling and tenderness of her right leg, which has developed over the past 48 hours. Raising the leg elicits pain. An ultrasound examination reveals findings suggestive of femoral vein thrombosis. Which of the following conditions is most likely to have contributed the most to the appearance of these findings? A. Trousseau syndrome B. Protein C deficiency C. Immobilization D. Pregnancy E. Chronic alcohol abuse F. Hypertension Answer: C. The immobilization while in hopsital would predispose to thrombosis of leg veins. This is the most common cause for deep venous thrombosis. 3. A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is indicated by the laboratory finding of hemoglobin A1C 10.1%. He has noted episodes of abdominal pain following meals. These episodes have worsened over the past year. On physical examination, there are no masses and no organomegaly of the abdomen, and he has no tenderness to palpation. Which of the following pathologic findings is most likely to be present in this man? A. Ruptured aortic aneurysm B. Hepatic infarction C. Mesenteric artery occlusion D. Acute pancreatitis E. Chronic renal failure Answer: C. He has 'abdominal angina' from diminished blood flow to the bowel as a consequence of severe atherosclerosis. Persons with diabetes mellitus may have this finding, because all branches of major arteries to the bowel are affected by atherosclerosis. 4. A 62-year-old man has experienced substernal chest pain upon exertion with increasing frequency over the past 6 months. An electrocardiogram shows features consistent with ischemic heart disease. He has a total serum cholesterol of 262 mg/dL. By angiography, there is 75% narrowing of two major coronary arteries. In which of the following locations is a mural thrombus most likely to occur in this man? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle E. Aorta F. Vena cava Answer: B. The left ventricle is the major user of oxygen and nutrients and requires a good blood supply. A complication of ischemic heart disease with infarction is development of overlying mural thrombus. Such mural thrombi are likely to result from damage to the left ventricle from ischemic heart disease, either acutely with an underlying myocardial infarction, or with a left ventricular aneurysm formed following resolution of a large myocardial infarction 5. A 66-year-old man with Parkinson disease develops pleuritic chest pain. On exam, he has guarding over the right lower lung with dullness to percussion. A chest CT scan shows a focal, wedge-shaped pleural based area of hemorrhage in the right lower lobe. Which of the following is the most likely cause for his pulmonary lesion? A. Embolism B. Atherosclerosis C. Vasculitis D. Arteriolosclerosis E. Thrombosis Answer: A. A pulmonary infarction is described. A thromboembolus from the venous circulation, usually arising in large leg veins, has lodged in a peripheral pulmonary arterial branch. The bronchial arterial supply to the lung does not provide enough oxygenation to prevent infarction, but does provide blood to make the infarct hemorrhagic. His neurodegenerative disorder with reduced movement is a risk for immobilization as a risk for phlebothrombosis. 6. A 44-year-old woman has a family history of heart disease. Her father and mother both developed myocardial infarction and congestive heart failure as a result of occlusive coronary atherosclerosis. A dietary modification to include consumption of which of the following is most likely to reduce her risk for ischemic heart disease? A. 40% of total caloric intake as fat B. Increased saturated fat C. Foods with cholesterol D. Cold water fish oil E. Fat found in beef products F. Hydrogenated oils with trans-fats Answer: D. Fish oils diminish arachidonic acid metabolites and reduce platelet aggregation. 7.