Artherosclerosis — Past Paper Questions & Answers

Question 1

A study of atherogenesis is performed. There is a propensity for atheromas to form at muscular arterial branch points, such as the carotid and aortic bifurcations. Which of the following events in the arteries at these locations is most likely to initiate atherogenesis?

Accepted Answer

Endothelial dysfunction — A variety of stressors may affect endothelial cells, including the shear stress from turbulent flow at arterial branch points. Endothelial dysfunction is the initiating event that allows insudation of lipids to promote atherogenesis. ---

Question 2

An autopsy study reveals that evidence for atheroma formation can begin even in children. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence for the formation of an atheroma?

Accepted Answer

Fatty streak — A fatty streak on the arterial intimal surface is the first grossly visible sign of atheroma formation. It is benign and reversible, but it may be the precursor to more severe plaques. ---

Question 3

A 57-year-old woman has had episodes of abdominal pain following meals for the past year. Her BMI is 31 kg/m2. She her blood pressure is 165/110 mg Hg. Her total serum cholesterol is 256 mg/dL. Which of the following types of blood vessel is the most likely location for the pathologic abnormality causing her pain?

Accepted Answer

Artery — She has abdominal angina from vascular insufficiency. She has multiple risk factors for atherosclerosis. Atherosclerosis occurs in muscular arteries, because the level of blood pressure in arteries predisposes to endothelial dysfunction. ---

Question 4

A 58-year-old woman has the sudden onset of severe dyspnea with chest pain and diaphoresis. A chest CT scan shows areas of decreased attenuation within the main pulmonary arteries. Her D-dimer assay is elevated. Her acute event is most likely to be a consequence of which of the following?

Accepted Answer

Placement of a hip prosthesis — Immobilization is a major risk for the development of venous thrombosis and subsequent pulmonary embolization (the areas of diminished attenuation). Immobilization occurs following surgery. The postoperative goal: get the patient mobile as soon as possible, and meanwhile employ methods to reduce the risk for thrombosis. ---

Question 5

A study of pathologic findings in the islets of Langerhans is performed. It is observed that insulitis may occur in the islets. The inflammatory infiltrate is predominantly composed of T lymphocytes. Which of the following complications is most likely to occur as a consequence of insulitis?

Accepted Answer

Ketoacidosis — An insulitis can precede the development of type I diabetes mellitus. Actually, it is rare to see it because by the time the patients present with overt diabetes mellitus, the islets are long gone. The presence of the T lymphocytes suggests an autoimmune component to the pathogenesis. ---

Question 6

A 57-year-old man has had blood pressure measurements in the range of 160/95 to 180/110 mm Hg for many years. He has taken no medications. A renal scan reveals kidneys of normal size for age. These findings with benign nephrosclerosis are most likely to occur with which of the following vascular changes?

Accepted Answer

Hyaline arteriolosclerosis — Hyaline arteriolosclerosis is a feature of long-standing hypertension and is part of benign nephrosclerosis which may go on for many years with no complications. The small arterioles are thickened with pink (hyaline) proteinaceous deposits. ---

Question 7

A 45-year-old man feels some crushing chest pain along with numbness in his left arm after shoveling 15 cm of snow off his driveway. Three hours later he collapses and is taken to the emergency room. Which of the following laboratory tests run on a blood specimen is most useful in this situation?

Accepted Answer

Troponin — Elevations in troponins are going to be seen acutely with myocardial infarction beginning within 3 hours and remaining for up to 14 days. Total creatine kinase (CK) reflects changes in any striated muscle, and is not specific for cardiac muscle. The CK-MB fraction is most specific to myocardium, but remains elevated for up to 3 days. ---

Question 8

A 68-year-old woman has survived multiple episodes of pulmonary thromboembolism during the past three months. On physical examination there are no abnormal findings. Which of the following is the most likely underlying condition leading to this patient's recurrent pulmonary thromboembolism?

Accepted Answer

Adenocarcinoma of the pancreas — The recurrent episodes suggest a hypercoagulable state, and carcinomas can do this (Trousseau syndrome) by releasing substances that act as thromboplastins. Even a small carcinoma difficult to detect can produce thromboplastic substances as a paraneoplastic phenomenon. ---

Question 9

A 57-year-old woman has experienced episodes of altered mental status for the past month. On physical examination, she has bilateral carotid artery bruits. She is given folic acid supplementation. Which of the following laboratory test findings is she most likely to have?

Accepted Answer

Homocysteinemia — An elevated plasma homocysteine level is a risk for atherosclerosis as well as thrombosis. Her findings point to transient ischemic attacks (TIAs) with risk for stroke. The carotid bruits represent arterial narrowing as the result of atherosclerosis. ---

Artherosclerosis — Past Paper Questions & Answers

Questions, Answers & Explanations