Atherosclerosis Thrombosis - Part 1

26 Questions | Total Attempts: 700

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Atherosclerosis Thrombosis - Part 1

In today’s dip into the world of medicine, we’ll be looking at two conditions; atherosclerosis – a disease that involves the build-up of plaque in the arteries – and thrombosis, which refers to blood clots that form in the veins or arteries that can have life-threatening effects. What do you know about them?


Questions and Answers
  • 1. 
    A 56-year-old has not received any medical care nor seen a physician for years. He reports reduced exercise tolerance over the past 5 years. On occasion in the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. He is found to have a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include a total serum cholesterol of 245 mg/dL with an HDL cholesterol that is 22 mg/dL. Which of the following vascular abnormalities is most likely to be his most serious health risk?
    • A. 

      Hyperplastic arteriolosclerosis

    • B. 

      Lymphedema

    • C. 

      Medial calcific sclerosis

    • D. 

      Atherosclerosis

    • E. 

      Deep venous thrombosis

    • F. 

      Plexiform arteriopathy

  • 2. 
    A 55-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 apparently 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. 

      Prolonged immobilization

    • D. 

      Pregnancy

    • E. 

      Chronic alcoholism

    • F. 

      Hypertension

  • 3. 
    A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is characterized by the laboratory finding of a hemoglobin A1C of 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

  • 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 the left anterior descending artery. Which of the following vascular complications is most likely to occur in this patient?
    • A. 

      A systemic artery embolus from thrombosis in a peripheral vein.

    • B. 

      A systemic artery embolus from a left atrial mural thrombus.

    • C. 

      Pulmonary embolism from a left ventricular mural thrombus.

    • D. 

      A systemic artery embolus from a left ventricular mural thrombus.

    • E. 

      Pulmonary embolism from thrombosis in a peripheral vein.

  • 5. 
    On sectioning of an organ from a 60-year-old man at the time of autopsy, a focal, wedge-shaped area that is firm is accompanied by extensive hemorrhage, giving it a red appearance. The lesion has a base on the surface of the organ. In which of the following situations will this lesion most likely occur?
    • A. 

      Lung with pulmonary thromboembolism

    • B. 

      Heart with coronary thrombosis

    • C. 

      Liver with hypovolemic shock

    • D. 

      Kidney with septic embolus

    • E. 

      Spleen with embolized mural thrombus

    • F. 

      Brain with cerebral arterial aneurysm

  • 6. 
    A 44-year-old woman has a family history of heart disease. Her father and mother both developed congestive heart failure and myocardial infarction as a result of extensive 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. 

      A diet high in saturated fat

    • C. 

      Foods with cholesterol

    • D. 

      Fish oil

    • E. 

      Fat found in beef products

    • F. 

      Trans-fats

  • 7. 
    An 81-year-old woman has the sudden onset of dyspnea and palpitations with chest pain. A pulmonary ventilation-perfusion scan is performed and indicates a high probability for a perfusion defect involving right segmental pulmonary arterial branch. Of the following findings or conditions, which is the most important factor favoring development of these findings?
    • A. 

      An increased white blood cell count

    • B. 

      Cirrhosis of the liver

    • C. 

      Altered blood flow with stasis

    • D. 

      An increased platelet count

    • E. 

      Generalized atherosclerosis

  • 8. 
    A 66-year-old woman has the sudden loss of movement on part of the left side of her body. She has smoked a pack of cigarettes a day for the past 45 years. She has vital signs including T 37.1 C, P 80/minute, RR 16/minute, and BP 160/100 mm Hg. A cerebral angiogram reveals occlusion of a branch of her middle cerebral artery. Laboratory findings include a hemoglobin A1C of 9%. Which of the following components of blood lipids is most important in contributing to her disease?
    • A. 

      Chylomicrons

    • B. 

      Lipoprotein lipase

    • C. 

      Oxidized LDL

    • D. 

      VLDL

    • E. 

      HDL cholesterol

  • 9. 
    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?
    • A. 

      Thrombus

    • B. 

      Fatty streak

    • C. 

      Calcification

    • D. 

      Hemorrhage

    • E. 

      Exudate

    • F. 

      Ulceration

  • 10. 
    A 63-year-old man has had increasing exercise intolerance for the past 5 years so that he now becomes short of breath upon climbing a single flight of stairs. Laboratory studies have shown fasting blood glucose measurements from 145 to 210 mg/dL for the past 25 years, but he has not sought medical treatment. If he dies suddenly, which of the following is most likely to be the immediate cause of death?
    • A. 

      Myocardial infarction

    • B. 

      Nodular glomerulosclerosis

    • C. 

      Cerebral hemorrhage

    • D. 

      Hyperosmolar coma

    • E. 

      Right lower leg gangrene

  • 11. 
    A 45-year-old man dies suddenly and unexpectedly. The immediate cause of death is found to be a hemorrhage in the right basal ganglia region. On microscopic examination his renal artery branches have concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage of the renal parenchyma. An elevation in which of the following substances in his blood is most likely to be associated with these findings?
    • A. 

      Ammonia

    • B. 

      Calcium

    • C. 

      Cholesterol

    • D. 

      Renin

    • E. 

      Troponin I

    • F. 

      Triglyceride

    • G. 

      C-reactive protein

  • 12. 
    A 10-year-old previously healthy child has been noted by her parents to be constantly thirsty. She is consuming large amounts of soft drinks. She is urinating often. Her diet and exercise patterns have not changed, except for an increased appetite, yet she appears cachectic and has lost 7 kg over the past 4 months. On physical examination there are no abnormal findings, other than peripheral muscle wasting and weakness. Which of the following laboratory findings would you most strongly suspect is present in this girl?
    • A. 

      Increased blood insulin

    • B. 

      Decreased blood glucagon

    • C. 

      Ketonuria

    • D. 

      Markedly increased serum osmolality

    • E. 

      Decreased plasma hydrogen ion (alkalosis)

    • F. 

      Decreased plasma cortisol

  • 13. 
    A 73-year-old woman who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries lateral to her uterus. What is the probable vascular lesion which accounts for this calcification?
    • A. 

      Ulcerative atherosclerosis

    • B. 

      Calcific medial sclerosis

    • C. 

      Metastatic calcification

    • D. 

      Trauma

    • E. 

      Dystrophic calcification

  • 14. 
    A 55-year-old woman has been treated in the hospital for pancreatitis for the past three weeks. She is examined one morning on rounds and found to have a swollen right leg. It is tender to palpation posteriorly but is not warm. This condition is most likely to be the result of which of the following vascular complications?
    • A. 

      Venous thrombosis

    • B. 

      Septic embolization

    • C. 

      Congestive heart failure

    • D. 

      Cellulitis

    • E. 

      Infarction

  • 15. 
    A 29-year-old woman is involved in a motor vehicle accident that results in severe lacerations to her lower extremities, along with blunt abdominal trauma. In the emergency room she is noted to have cool, pallid skin. She has vital signs showing T 36.9 C, P 103/minute, RR 18/minute, and BP 70/30 mm Hg. She has decreased urine output. Which of the following laboratory findings on a blood sample from this patient is most likely to be present?
    • A. 

      Hematocrit of 54%

    • B. 

      Glucose of 181 mg/dL

    • C. 

      PaO2 of 20 mm Hg

    • D. 

      Lactic acid of 4.8 mmol/L

    • E. 

      Troponin I of 4 ng/mL

  • 16. 
    A 61-year-old man has the sudden onset of severe chest pain. Vital signs include T 37 C, P 101/minute, RR 20/minute, and BP 80/40 mm Hg. An electrocardiogram demonstrates changes that are consistent with myocardial ischemia involving the left lateral ventricular free wall. He is given thrombolytic therapy with tissue plasminogen activator (tPA). However his serum creatinine kinase is found to be 450 U/L 3 hours after this therapy. Which of the following cellular events has most likely occurred?
    • A. 

      Cellular regeneration

    • B. 

      Drug-induced necrosis

    • C. 

      Reperfusion injury

    • D. 

      Increased synthesis of creatine kinase

    • E. 

      Myofiber atrophy

  • 17. 
    A 52-year-old woman has experienced marked substernal, crushing chest pain for the past 6 hours. Her vital signs show T 36.9 C, P 80/minute, RR 16/minute, and BP 100/60 mm Hg. Laboratory studies include a serum creatine kinase MB fraction of 10 microgm/L as well as a serum troponin I of 4.5 ng/mL. Which of the following findings is the best evidence for the presence of a coronary arterial thrombus as the etiology for her chest pain?
    • A. 

      Total serum cholesterol of 300 mg/dL

    • B. 

      Large size of the infarction by scintigraphic scanning

    • C. 

      80% coronary occlusion by angiography

    • D. 

      Response to thrombolytic therapy

    • E. 

      Hemoglobin A1C of 10.1%

  • 18. 
    In an experiment, a glass bead is embolized to a branch of the renal artery. A day later there is a focal area in which the renal parenchymal cells in the distribution of the occluded artery show karyolysis and karyorrhexis. The outlines of the cells are still visible, but the nuclei have lost basophilic staining and the cytoplasm is eosinophilic but pale. Which of the following types of cellular necrosis is most likely present?
    • A. 

      Caseous

    • B. 

      Coagulative

    • C. 

      Fatty

    • D. 

      Gangrenous

    • E. 

      Liquefactive

  • 19. 
    A 52-year-old man has the sudden onset of chest pain. He is found to have a serum troponin I of 5 ng/mL. A year later he has reduced exercise tolerance. An echocardiogram reveals an akinetic segment of left ventricle, and he has reduced cardiac output, with an ejection fraction of 25%. He then experiences a transient ischemic attack (TIA). His serum troponin I is now <0.5 ng/mL. Thrombus formation involving which of the following locations is most likely to have put him at greatest risk for the TIA?
    • A. 

      Cerebral vein

    • B. 

      Vertebral artery

    • C. 

      Superior vena cava

    • D. 

      Left ventricle

    • E. 

      Coronary artery

    • F. 

      Saphenous vein

  • 20. 
    A 25-year-old previously healthy primigravida is in the first trimester of pregnancy. During two successive prenatal visits, she has fasting serum glucose levels of 127 and 131 mg/dL. Prior to this pregnancy, her fasting serum glucose was 80 mg/dL. A hemoglobin A1C level is 8.1% at the last visit, at 18 weeks gestation. She feels well and has no major health problems. Which of the following problems is most likely to become apparent in the latter part of her pregnancy?
    • A. 

      Intrauterine fetal growth retardation

    • B. 

      Ketoacidosis

    • C. 

      Hyperosmolar coma

    • D. 

      Congenital anomalies

    • E. 

      Placental insufficiency

  • 21. 
    A 54-year-old man with diabetes mellitus has had 3 urinary tract infections during the past year. He now sees the physician for an ulceration on his right big toe which has not healed in 2 months. Laboratory studies on each of his doctor visits over the past year show blood glucose levels below 110 mg/dl. This situation could be best explained by which of the following laboratory findings?
    • A. 

      Elevated hemoglobin A1C level

    • B. 

      Increased urine ketones

    • C. 

      Elevated serum osmolarity

    • D. 

      Decreased plasma insulin

    • E. 

      Elevated titer of anti-insulin antibodies

  • 22. 
    A 25-year-old man experiences chest pain on exercise when he attempts to climb three flights of stairs. This pain is relieved by sublingual nitroglycerin. He is 178 cm tall and weighs 101 kg. Laboratory studies show a total serum cholesterol of 550 mg/dL with an HDL cholesterol component of 25 mg/dL. He is worried about these findings because his brother died of a myocardial infarction at age 34. Which of the following conditions is this man most likely to have?
    • A. 

      Diabetes mellitus, type II

    • B. 

      Malignant hypertension

    • C. 

      Familial hypercholesterolemia

    • D. 

      Cushing syndrome

    • E. 

      Morbid obesity

  • 23. 
    In a clinical study of patients with diabetes mellitus, a group of patients is found who had blood glucose measurements ranging from 140 to 180 mg/dL for at least 10 years. Rectal biopsies from these patients now show that there is a form of osmotic cellular injury present in arterioles. This form of injury is most likely to be manifested by which of the following complications?
    • A. 

      Cerebral infarction

    • B. 

      Colonic adenocarcinoma

    • C. 

      Congestive heart failure

    • D. 

      Impotence

    • E. 

      Pyelonephritis

  • 24. 
    A 49-y/o woman has experienced marked pain in her lower extremities on ambulation more than 300 meters for the past 5 months. On physical examination, her lower extremities are cool and pale, without swelling or erythema. No dorsalis pedis or posterior tibial pulses are palpable. Her BMI is 32. She is a smoker. Which of the following abnormalities of the vasculature is most likely to account for these findings?
    • A. 

      Lymphatic obstruction

    • B. 

      Arteriolosclerosis

    • C. 

      Atherosclerosis

    • D. 

      Medial calcific sclerosis

    • E. 

      Venous thrombosis

  • 25. 
    An autopsy study is conducted involving the gross appearance of the aorta of adults ranging in age from 60 to 90. In some of these patients, the aorta demonstrates atheromatous plaques covering from 70 to 95% of the intimal surface area, mainly in the abdominal portion, with ulceration and calcification. Which of the following contributing causes of death are these patients most likely to have?
    • A. 

      Hyperparathyroidism

    • B. 

      Hypertension

    • C. 

      Marfan syndrome

    • D. 

      Thrombophlebitis

    • E. 

      Vasculitis

    • F. 

      Colonic adenocarcinoma

    • G. 

      Systemic lupus erythematosus

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