What is the initiating event that leads to the development of atherosclerosis?
B.
What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
D.
Oxidized LDLs are toxic to endothelial cells, cause smooth muscle proliferation, and
activate further immune and inflammatory responses
Which inflammatory cytokines are released when endothelial cells are injured?
a. Granulocyte-macrophage colony-stimulating factor (GM-CSF)
b. Interferon-beta, interleukin 6 (IL-6), and granulocyte colony-stimulating
factor (G-CSF)
c. Tumor necrosis factor–alpha, interferon-gamma, and interleukin 1 (IL-1)
d. Interferon-alpha, interleukin-12 (IL-12), and macrophage colony-stimulating factor (M-CSF)
C.
Numerous inflammatory cytokines are released, including TNF-alpha, IFN-gamma, IL-1, toxic
oxygen radicals, and heat shock proteins
When endothelia cells are injured, what alteration contributes to atherosclerosis?
A.
Injured endothelial cells become inflamed and cannot make normal amounts of antithrombotic and vasodilating cytokines.
Which factor is responsible for the hypertrophy of the myocardium associated with
hypertension?
B.
What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?
A.
In the kidney, vasoconstriction and resultant decreased renal perfusion cause tubular ischemia and preglomerular arteriopathy.
What effect does atherosclerosis have on the development of an aneurysm?
B.
Atherosclerosis is a common cause of aneurysms because plaque formation erodes the
vessel wall.
Regarding the endothelium, what is the difference between healthy vessel walls and those
that promote clot formation?
C.
Invasion of the tunica intima by an infectious agent also roughens the normally smooth lining of the artery, causing platelets to adhere readily.
Which factor can trigger an immune response in the bloodstream that may result in an
embolus?
B.
Of the options available, only amniotic fluid displaces blood, thereby reducing oxygen,
nutrients, and waste exchange
Which statement best describes thromboangiitis obliterans (Buerger disease)?
C.
Which statement best describes Raynaud disease?
C.
Attacks of vasospasm in the small arteries and arterioles of the fingers and, less commonly, of the toes characterize Raynaud phenomenon
What change in a vein supports the development of varicose veins?
B.
If a valve is damaged, permitting backflow, then a section of the vein is subjected to the pressure exerted by a larger volume of blood under the influence of gravity
Superior vena cava syndrome is a result of a progressive increase of which process?
A.
Superior vena cava syndrome (SVCS) is a progressive occlusion of the superior vena cava
(SVC) that leads to venous distention in the upper extremities and head.
What term is used to identify when a cell is temporarily deprived of blood supply?
A.
Coronary artery disease (CAD) can diminish the myocardial blood supply until deprivation
impairs myocardial metabolism enough to cause ischemia, a local state in which the cells
are temporarily deprived of blood supply
The risk of developing coronary artery disease is increased up to threefold by which
factor?
C.
Hypertension is the only factor responsible for a twofold-to-threefold increased risk of
atherosclerotic cardiovascular disease.
Which risk factor is associated with coronary artery disease (CAD) because of its
relationship with the alteration of hepatic lipoprotein?
D.
Of the available options, only diabetes mellitus is associated with CAD because of the
resulting alteration of hepatic lipoprotein synthesis; it increases triglyceride levels and is
involved in low-density lipoprotein oxidation.
Nicotine increases atherosclerosis by the release of which neurotransmitter?
D.
Nicotine stimulates the release of catecholamines (e.g., epinephrine, norepinephrine), which increases the heart rate and causes peripheral vascular constriction
Which substance is manufactured by the liver and primarily contains cholesterol and protein?
A.
Which substance is manufactured by the liver and primarily contains triglycerides and protein?
B.
Which substance is manufactured by the liver and primarily contains phospholipids and protein?
B.
Which laboratory test is an indirect measure of atherosclerotic plaque?
A.
Highly sensitive CRP (hs-CRP) is an acute phase reactant or protein mostly synthesized in
the liver and, of the available options, is an indirect measure of atherosclerotic plaque-related inflammation.
Cardiac cells can withstand ischemic conditions and still return to a viable state for how
many minutes?
C.
Cardiac cells remain viable for approximately 20 minutes under ischemic conditions. If
blood flow is restored, then aerobic metabolism resumes, contractility is restored, and
cellular repair begins. If the coronary artery occlusion persists beyond 20 minutes, then
myocardial infarction (MI) occurs
Which form of angina occurs most often during sleep as a result of vasospasms of one or
more coronary arteries?
C.
Of the options available, only Prinzmetal angina (also called variant angina) is chest pain
attributable to transient ischemia of the myocardium that occurs unpredictably and almost
exclusively at rest.
When is the scar tissue that is formed after a myocardial infarction (MI) most vulnerable to
injury?
A.
During the recovery period (10 to 14 days after infarction), individuals feel more capable
of increasing activities and thus may stress the newly formed scar tissue
An individual who is demonstrating elevated levels of troponin, creatine
kinase–isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators
associated with which condition?
B.
Cardiac troponins (troponin I and troponin T) are the most specific indicators of MI. Other
biomarkers released by myocardial cells include CK-MB and LDH
What is the expected electrocardiogram (ECG) pattern when a thrombus in a coronary
artery permanently lodges in the vessel and the infarction extends through the myocardium
from the endocardium to the epicardium?
A.
How does angiotensin II increase the workload of the heart after a myocardial infarction
(MI)?
D.
The pulsus paradoxus that occurs as a result of pericardial effusion is caused by a
dysfunction in which mechanism?
D.
Pulsus paradoxus means that the arterial blood pressure during expiration exceeds arterial
pressure during inspiration by more than 10 mm Hg
A patient reports sudden onset of severe chest pain that radiates to the back and worsens
with respiratory movement and when lying down. These clinical manifestations describe:
C.
Most individuals with acute pericarditis describe several days of fever, myalgias, and
malaise, followed by the sudden onset of severe chest pain that worsens with respiratory
movements and with lying down. Although the pain may radiate to the back, it is generally
felt in the anterior chest and may be initially confused with the pain of an acute MI.
Individuals with acute pericarditis also may report dysphagia, restlessness, irritability,
anxiety, and weakness
Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure,
characterize which form of cardiomyopathy?
C.
A disproportionate thickening of the interventricular septum is the hallmark of which form
of cardiomyopathy?
B.
Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of
cardiomyopathy?
D.
Restrictive cardiomyopathy may occur idiopathically or as a cardiac manifestation of systemic diseases, such as scleroderma, amyloidosis, sarcoidosis, lymphoma, and
hemochromatosis, or a number of inherited storage diseases.
Which condition is a cause of acquired aortic regurgitation?
disorders (e.g., Marfan syndrome, ankylosing spondylitis), appetite suppressing medications, trauma, or atherosclerosis can cause acquired aortic regurgitation
Which predominantly female valvular disorder is thought to have an autosomal dominant
inheritance pattern, as well as being associated with connective tissue disease?
A.
Mitral valve prolapse tends to be most prevalent in young women. Studies suggest an autosomal dominant and X-linked inheritance pattern. Because mitral valve prolapse often is associated with other inherited connective tissue disorders (e.g., Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta), it is thought to result from a genetic or environmental disruption of valvular development during the fifth or sixth week of gestation
Which disorder causes a transitory truncal rash that is nonpruritic and pink with
erythematous macules that may fade in the center, making them appear as a ringworm?
A.
Erythema marginatum is a distinctive truncal rash that often accompanies acute rheumatic
fever. It consists of nonpruritic, pink erythematous macules that never occur on the face or
hands.
What is the most common cause of infective endocarditis?
B.
Infective endocarditis is a general term used to describe infection and inflammation of the
endocardium—especially the cardiac valves. Bacteria are the most common cause of
infective endocarditis, especially streptococci, staphylococci, or enterococci.
What is the most common cardiac disorder associated with acquired immunodeficiency
syndrome (AIDS)
C.
Pericardial effusion and left heart failure are the most common complications of human
immunodeficiency virus (HIV) infection
A patient is diagnosed with pulmonary disease and elevated pulmonary vascular
resistance. Which form of heart failure may result from pulmonary disease and elevated
pulmonary vascular resistance?
A.
Right heart failure is defined as the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation at a normal central venous pressure
What cardiac pathologic condition contributes to ventricular remodeling?
A.
Of the options available, myocardial ischemia contributes to inflammatory, immune, and
neurohumoral changes that mediate a process called ventricular remodeling
In systolic heart failure, what effect does the renin-angiotensin-aldosterone system
(RAAS) have on stroke volume?
D.
Activation of the RAAS not only causes an increase in preload and afterload, but it also
causes direct toxicity to the myocardium.
What is the cause of the dyspnea resulting from a thoracic aneurysm?
a. Pressure on surrounding organs
b. Poor oxygenation
c. Formation of atherosclerotic lesions
d. Impaired blood flow
A.
Clinical manifestations depend on the location of the aneurysm. Pressure of a thoracic
aneurysm on surrounding organs cause symptoms of dysphagia (difficulty in swallowing)
and dyspnea (breathlessness).
Which statement is true concerning the cells’ ability to synthesize cholesterol?
A.
What is the trigger for angina pectoris?
D.
Angina pectoris is chest pain caused by myocardial ischemia
Individuals being effectively managed for type 2 diabetes mellitus often experience a
healthy decline in blood pressure as a result of what intervention?
A.
Many people with type 2 diabetes mellitus, who are treated with drugs that increase insulin
sensitivity, experience a decline in their blood pressure without taking antihypertensive drugs.
Which statements is false regarding fatty streaks?
D.
The oxidized LDLs penetrate the intima of the arterial wall and are engulfed by macrophages. Macrophages filled with oxidized LDLs are called foam. Once these lipid-laden foam cells accumulate in significant amounts, they form a lesion called a fatty streak.
What factor does not contribute to the development of orthostatic hypotension?
B.
Which assessment findings are clinical manifestations of aortic stenosis?
A.
The classic manifestations of aortic stenosis are angina, syncope, and heart failure.
Which risk factor is NOT associated with infective endocarditis?
B.
Aortic stenosis
B.
Aortic regurgitation
A.
Mitral stenosis
B.
Tricuspid regurgitation
D.
Mitral regurgitation
B.
Within the walls of arteries and arterioles, smooth muscle cells undergo hypertrophy and hyperplasia in a process called _______ ________
vascular remodeling
An increase in CAD-related ischemic events can occur within weeks of beginning ______ use
NSAID
This infarction usually presents with ST depression and T-wave inversion and is termed ______.
non-STEMI
________ causes increased venous pressure, systemic venous congestion, and signs and symptoms of right heart failure
tamponade
Individuals with cardiac tamponade most often present with dyspnea, tachycardia, jugular venous distention, cardiomegaly, and _______ ________
pulsus paradoxus
In _____ stenosis, outflow obstruction increases pressure within the left ventricle as it tries to eject blood through the narrowed opening.
aortic
______ stenosis impairs the flow of blood from the left atrium to the left ventricle.
Mitral
______ regurgitation permits backflow of blood from the left ventricle into the left atrium during ventricular systole, giving rise to a loud pansystolic murmur heard best at the apex
Mitral
______ regurgitation is associated with failure of the right ventricle secondary to pulmonary hypertension.
Tricuspid
Mitral valve ________ syndrome is a condition in which the anterior and posterior cusps of the mitral valve billow upward into the atrium during systole
prolapse
_______ heart failure is defined as an ejection fraction of <40% and an inability of the heart to generate an adequate cardiac output to perfuse vital tissues.
systolic
________ _______ causes abnormal myocyte fatty acid metabolism and generation of ATP, which contributes to decreased myocardial contractility and remodeling
Insulin resistance
________ heart failure is defined as pulmonary congestion despite a normal stroke volume and cardiac output.
diastolic
When this happens, pressure will rise in the systemic venous circulation, resulting in jugular venous distention, peripheral edema, and hepatosplenomegaly