Atherosclerosis Thrombosis - Part 2

26 Questions | Total Attempts: 95

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Atherosclerosis Thrombosis - Part 2

So, you managed to squeeze past our first quiz on the topics of atherosclerosis and thrombosis – two life-threatening conditions that involve build-ups in the arteries or veins – but can you get passed the second edition of our quizzes on the topic? Let’s take a look right now!


Questions and Answers
  • 1. 
    At autopsy, the kidneys of a 44-year-old woman who died suddenly are found to be of normal size. Their surfaces appear finely granular. There are small hemorrhages noted. The cortices appear pale. Microscopically, many small renal arteries and arterioles demonstrate concentric intimal thickening with marked luminal narrowing. These findings are most likely to be present as a result of which of the following underlying diseases?
    • A. 

      Amyloidosis

    • B. 

      Systemic lupus erythematosus

    • C. 

      Scleroderma

    • D. 

      Rheumatoid arthritis

    • E. 

      Viral hepatitis

    • F. 

      Diabetes mellitus

  • 2. 
    A 35-year-old previously healthy woman notes that she has bruises form on her arms and legs with just minor trauma. Physical examination reveals areas of purpura from 1 to 3 cm in size over her trunk and extremities, but no swelling, warmth, or erythema. Peripheral pulses are all palpable and full. Her blood pressure is 110/70 mm Hg. An ultrasound examination of her lower extremities with Doppler flow measurement reveals no evidence for thrombosis. Laboratory findings include serum urea nitrogen of 20 mg/dL, LDH 300 U/L, total protein 6.9 g/dL, albumin 5.3 g/dL, alkaline phosphatase 50 U/L, AST 40 U/L, and ALT 20 U/L. Which of the following additional laboratory findings is most likely to be present in this patient?
    • A. 

      Hyperglycemia

    • B. 

      Hypercholesterolemia

    • C. 

      Lactic acidosis

    • D. 

      Thrombocytopenia

    • E. 

      Hypoprothrombinemia

    • F. 

      Anemia

  • 3. 
    Grandma falls down the steps leading to the entrance of the house of a relative hosting a family reunion, who is heard to remark, "I've been meaning to get that loose step fixed." Grandma is hospitalized for surgery to replace the broken hip she sustains and is then moved to a nursing home, but she is unable to ambulate until about a month later, when she dies suddenly. Which of the following is most likely to be the immediate cause of death found at autopsy?
    • A. 

      Squamous cell carcinoma of lung

    • B. 

      Tuberculosis

    • C. 

      Pulmonary embolism

    • D. 

      Pneumonia with pneumococcus

    • E. 

      Congestive heart failure

  • 4. 
    A 53-year-old woman is found on a routine physical examination to have vital signs with T 36.9 C, P 77/minute, R 15/minute, and BP 165/110 mm Hg. There are no other significant findings. She has an abdominal ultrasound examination that shows the right kidney to be atrophic. Angiography reveals markedly reduced blood flow to the right renal artery from an occlusion at the orifice in the abdominal aorta. Which of the following laboratory findings is she most likely to have?
    • A. 

      Serum sodium of 161 mmol/L

    • B. 

      Serologic evidence of anti-cardiolipin antibody

    • C. 

      Prothrombin time of 25 seconds

    • D. 

      Plasma renin activity of 4.8 ng/mL/hr supine

    • E. 

      Serum lactic acid of 5.5 mmol/L

  • 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 is most likely to occur as a consequence of insulitis?
    • A. 

      Neoplasia

    • B. 

      Malabsorption

    • C. 

      Ketoacidosis

    • D. 

      Obesity

    • E. 

      Sepsis

  • 6. 
    A 20-year-old man incurs blunt trauma to his upper outer arm. On physical examination, there is a 2 x 3 cm contusion. The initial soft tissue bleeding stops in a few minutes and the size of the bruise does not increase. Which of the following chemical mediators is most important in this episode of hemostasis?
    • A. 

      Leukotriene

    • B. 

      Prostaglandin

    • C. 

      Prostacyclin

    • D. 

      Plasminogen

    • E. 

      Thromboxane

  • 7. 
    • A. 

      Total white blood cell count

    • B. 

      Glucose

    • C. 

      Platelet count

    • D. 

      Creatine kinase

    • E. 

      Amylase

  • 8. 
    A 68-year-old woman has survived multiple episodes of pulmonary thromboembolism during the past three months. Which of the following is the most likely underlying condition leading to this patient's recurrent pulmonary thromboembolism?
    • A. 

      Micronodular cirrhosis of the liver

    • B. 

      Adenocarcinoma of the pancreas

    • C. 

      Thrombocytopenia

    • D. 

      Familial hypercholesterolemia

    • E. 

      Mitral valve endocarditis

    • F. 

      Type II diabetes mellitus

  • 9. 
    A 77-year-old woman has experienced abdominal pain for the past month. On physical examination, she has a pulsatile lower abdominal mass. An abdominal CT scan reveals an abdominal aorta dilated to 7 cm in diameter, with calcification of the aortic wall. While awaiting surgery, she has an episode of severe abdominal pain and a repeat CT scan shows marked retroperitoneal hemorrhage. Which of the following laboratory test findings is she most likely to have?
    • A. 

      Factor V Leiden mutation

    • B. 

      Factor VIII deficiency

    • C. 

      Increased carcinoembryonic antigen

    • D. 

      Homocystinemia

    • E. 

      Increased HDL cholesterol

  • 10. 
    A 70-year-old man has noted coldness and numbness of his lower left leg, increasing over the past 4 months. He also experiences pain in this extremity when he tries walking more than the distance of half a city block. On physical examination, his dorsalis pedis, posterior tibial, and popliteal artery pulses are not palpable. Which of the following laboratory test findings is he most likely to have?
    • A. 

      Protein S deficiency

    • B. 

      Blood culture with Staphylococcus aureus

    • C. 

      Decreased arterial oxygen saturation

    • D. 

      Hyperglycemia

    • E. 

      Hypercalcemia

  • 11. 
    A 72-year-old man suffered a myocardial infarction involving half the left ventricular free wall 3 months ago. He now has increasing dyspnea and orthopnea. On echocardiography his ejection fraction is 29%. On examination he has poor capillary filling in hands and feet. A chest x-ray shows pulmonary edema. Which of the following laboratory test analytes is most likely to be increased in this man at this point in time?
    • A. 

      Sodium

    • B. 

      Creatine kinase

    • C. 

      Lactic acid

    • D. 

      Hematocrit

    • E. 

      Sedimentation rate

  • 12. 
    A 44-year-old African-American man has had elevated blood pressure for years which has not been treated. He now has severe headaches. On physical examination his blood pressure is 275/150 mm Hg. Laboratory studies show Hgb 13.8 g/dL, serum glucose 76 mg/dL, and creatinine 3.5 mg/dL. These findings are most likely to be associated with which of the following pathologic lesions involving his kidneys?
    • A. 

      Hyperplastic arteriolosclerosis

    • B. 

      Hyaline arteriolosclerosis

    • C. 

      Monckeberg medial calcific sclerosis

    • D. 

      Atherosclerosis

    • E. 

      Thrombophlebitis

  • 13. 
    A 60-year-old woman has become increasingly obtunded over the past day. She was found by her daughter in a stuporous condition and brought to the emergency department. On physical examination, she has poor skin turgor. She is afebrile. Her vital signs reveal a blood pressure of 90/40 mm Hg, respirations 15 and shallow, pulse 95, and temperature 36 C. Laboratory studies show a hemoglobin A1C of 10%. Her serum electrolytes show sodium 144 mmol/L, potassium 5 mmol/L, chloride 95 mmol/L, CO2 22 mmol/L, and glucose 940 mg/dL. Which of the following is the most likely diagnosis?
    • A. 

      Insulin overdose

    • B. 

      Hyperosmolar coma

    • C. 

      Hyperlipidemia

    • D. 

      Ketoacidosis

    • E. 

      Overeating

  • 14. 
    A study is performed involving persons who have a history of diabetes mellitus type 1 or type 2. These patients are found to have cellular injury that results from glycosylation end products and from sorbitol accumulation within cells. The same patients are also shown to have ischemic tissue damage from accelerated and advanced atherosclerosis. Which of the following complications is most likely to result from atherosclerosis in these patients?
    • A. 

      Chronic renal failure

    • B. 

      Impotence

    • C. 

      Stroke

    • D. 

      Cataracts

    • E. 

      Retinopathy

  • 15. 
    A 30-year-old man goes to his physician for a routine health checkup. On physical examination there are no abnormal findings. Laboratory test findings include serum glucose 80 mg/dL, hemoglobin A1C 4%, total cholesterol 240 mg/dL, LDL cholesterol 180 mg/dL, and HDL cholesterol 20 mg/dL. Through which of the following mechanisms is endothelial vascular injury in this patient most likely to occur?
    • A. 

      Accumulation of sorbitol

    • B. 

      Insudation of lipid in foam cells

    • C. 

      Inflammation with neutrophils

    • D. 

      Genetic mutation

    • E. 

      Activation of complement

  • 16. 
    A 65-year-old man has had increasing lower leg swelling along with reduced exercise tolerance for the past 5 years. He sometimes has chest pain on exertion. He has not experienced dyspnea. He has experienced 4 episodes of transient ischemic attacks in the past year. He has experienced abdominal pain in the past 2 months. Vital signs show T 36.9 C, P 82/min, RR 15/min, and BP 130/85 mm Hg. He has pitting edema to the knees bilaterally. The lower extremities have palpable pulses, no tenderness, and no erythema. An abdominal CT scan shows dilation of the abdominal aorta to 5 cm, filled with mural thrombus. Other family members have had similar problems. Which of the following underlying conditions is most likely to produce these findings:
    • A. 

      Factor V Leiden mutation

    • B. 

      Adenocarcinoma of the colon

    • C. 

      Multiple blunt trauma

    • D. 

      Vasculitis

    • E. 

      Diabetes mellitus

  • 17. 
    A 45-year-old woman who has been bedridden for several weeks has the onset of left sided chest pain along with dyspnea. She has some tenderness in her left leg, which has a slightly greater circumference in the thigh than the right. A ventilation/perfusion scan shows evidence for a left lower lobe perfusion defect. Which of the following vascular diseases is most likely to cause these findings
    • A. 

      Hyaline arteriolosclerosis

    • B. 

      Monckeberg's medial calcific sclerosis

    • C. 

      Complex calcified coronary atherosclerosis

    • D. 

      Arterial mural thrombosis

    • E. 

      Phlebothrombosis

  • 18. 
    A 27-year-old woman had a hemoglobin A1C of 7.9% noted during a prenatal visit. She gives birth to a 4350 gm baby at 37 weeks gestation. Just after the delivery, the baby becomes irritable and displays seizure activity. Which of the following laboratory findings is most likely to be found in the baby:
    • A. 

      Decreased hemoglobin A1C

    • B. 

      Markedly increased serum osmolality

    • C. 

      Inflammation of islets of Langerhans

    • D. 

      Blood glucose of 20 mg/dl

    • E. 

      Ketoacidosis

  • 19. 
    Which of the following chemical components of the blood is mainly responsible for transporting exogenous (dietary) triglyceride from the intestine following a meal.
    • A. 

      Apoprotein (apolipoprotein)

    • B. 

      Chylomicron

    • C. 

      Lipoprotein lipase

    • D. 

      Oxidized low density lipoprotein

    • E. 

      High density lipoprotein

  • 20. 
    Some cells demonstrate glucose uptake regardless of the plasma insulin level. In a person who has had persistent hyperglycemia for years, cellular injury can occur. Which of the following cell types is most likely to show injury from hyperglycemia:
    • A. 

      Cardiac muscle cells

    • B. 

      Fibroblasts

    • C. 

      Steatocytes

    • D. 

      Neurons

    • E. 

      Smooth muscle cells

  • 21. 
    During hospitalization, a 40-year-old woman develops thrombophlebitis. She recovers and is discharged. She returns to her job as an electrician. A couple of months later, which of the following terms would best describe the process seen in a femoral vein after recovery from her thrombophlebitis:
    • A. 

      Acute inflammation

    • B. 

      Rupture

    • C. 

      Embolization

    • D. 

      Organization

    • E. 

      Propagation

  • 22. 
    A 52-year-old man has an ulcerated area on the sole of his foot that has not healed for 2 months. He is 180 cm tall, weighs 126 kg, and has continued to gain weight gradually. He has not had any major illnesses. His blood pressure is normal. Which of the following laboratory tests performed on serum from a blood sample would be most useful in elucidating the underlying cause for his problem:
    • A. 

      Antithrombin III

    • B. 

      Cortisol

    • C. 

      Creatine kinase

    • D. 

      Glucose

    • E. 

      Carcinoembryonic antigen

  • 23. 
    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:
    • A. 

      Hyaline arteriolosclerosis

    • B. 

      Monckeberg's medial calcific sclerosis

    • C. 

      Complex calcified atherosclerosis

    • D. 

      Arterial mural thrombosis

    • E. 

      Hyperplastic arteriolosclerosis

  • 24. 
    A 70-year-old woman with a history of type II diabetes mellitus is found comatose at her home. There are no external signs of trauma. When seen a week ago she was depressed, but in no apparent distress. She had not been ingesting much food or drinking much water for several days. Vital signs show T 35.8 C, P 85, R 16, and BP 100/65 mm Hg. Which of the following laboratory test findings is most likely to be present:
    • A. 

      Decreased hemoglobin A1C

    • B. 

      Markedly increased serum osmolality

    • C. 

      Lactic acidosis

    • D. 

      Blood glucose of 20 mg/dl

    • E. 

      Ketoacidosis

  • 25. 
    A 20-year-old woman was diagnosed last year with pulmonary thromboembolism. In her 6th month of her first pregnancy, she delivered a stillborn baby. Laboratory testing revealed the presence of a normal prothrombin time, normal partial thromboplastin time, platelet count of 250,000/microliter, and presence of lupus anticoagulant. These findings are most characteristic for which of the following hypercoagulable states:
    • A. 

      Antiphospholipid syndrome

    • B. 

      Factor V Leiden mutation

    • C. 

      Paraneoplastic syndrome

    • D. 

      Elevated factor VIII

    • E. 

      Protein C deficiency