ch 30 patho

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Atherosclerosis is an inflammatory disease.

T

Decreasing low-density lipoproteins (LDLs) can cause regression of atherosclerotic lesions and improve endothelial function.

T

Once fatty streaks accumulate, they form foam cells that cause immunologic changes that damage the endothelium.

F foam cells then fatty streaks

Even though air is lighter than blood, it can form an embolism and cause the occlusion of a blood vessel.

T

Raynaud disease is characterized by vasospasms of large peripheral arteries.

F small peripheral arteries

Many people with type 2 diabetes mellitus, who were treated with drugs that increased insulin sensitivity, experienced a decline in their blood pressure without taking antihypertensive drugs.

T

Chronic venous insufficiency can progress to varicose veins and valvular incompetence.

F

Most body cells are also capable of synthesizing cholesterol.

T

In high output failure, the heart increases its output, but the body's metabolic needs are still not met.

T

Angina pectoris is chest pain caused by myocardial ischemia.

T

When fluid collects gradually in a pericardial effusion, the pericardium stretches to accommodate the fluid without compressing the heart

T

Acute rheumatic fever can develop only as a sequel to pharyngeal infection by group A beta-streptococcus.

T

An increase in left ventricular end-diastolic volume (LVEDV) in diastolic heart failure may lead to pulmonary edema.

F

Many cases of mitral valve prolapse are completely asymptomatic.

T

Chorea or St. Vitus dance is the most definitive sign of rheumatic fever.

F

Atrial and brain natriuretic peptides are increased in congestive heart failure and may have some protective effect in decreasing preload.

T

What is the primary mechanism of atherogenesis?
a.
The release of the inflammatory cytokines tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ), and interleukin-1 (IL-1)
b.
The release of the growth factor granulocyte-macrophage colony-stimulating factor (GM-CSF)
c.
The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs)
d.
The release of the inflammatory cytokines interferon-beta (IFN-β), interleukin-6 (IL-6), and granulocyte colony-stimulating factor (G-CSF)

c.
The release of toxic oxygen radicals that oxidize low-density lipoproteins (LDLs

2. What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
a.
It causes smooth muscle proliferation.
b.
It causes regression of atherosclerotic plaques.
c.
It increases levels of inflammatory cytokines.
d.
It directs macrophages to the site within the endothelium.

a.
It causes smooth muscle proliferation.

3. Which inflammatory cytokines are released when endothelial cells are injured?
a.
Granulocyte-macrophage colony-stimulating factor (GM-CSF)
b.
Interferon-beta (IFN-β), interleukin-6 (IL-6), and granulocyte colony-stimulating factor (G-CSF)
c.
Tumor necrosis factor-alpha (TNF-α), interferon-gamma (γ-IFN), and interleukin-1 (IL-1)
d.
Interferon-alpha (IFN-α), interleukin-12 (Il-12), and macrophage colony-stimulating factor (M-CSF)

c.
Tumor necrosis factor-alpha (TNF-α), interferon-gamma (γ-IFN), and interleukin-1 (IL-1)

4. What alteration occurs in injured endothelial cells that contributes to atherosclerosis?
a.
They release toxic oxygen radicals that oxidize low-density lipoproteins (LDLs).
b.
They are unable to make the normal amount of vasodilating cytokines.
c.
They produce an increased amount of antithrombotic cytokines.
d.
They develop a hypersensitivity to homocysteine and lipids.

b.
They are unable to make the normal amount of vasodilating cytokines

5. What factor is responsible for the hypertrophy of the myocardium associated with hypertension?
a.
Increased norepinephrine
b.
Adducin
c.
Angiotensin II
d.
Insulin resistance

c.
Angiotensin II

6. What pathologic change occurs to the kidney's glomeruli as a result of hypertension?
a.
Compression of the renal tubules
b.
Ischemia of the tubule
c.
Increased pressure from within the tubule

b.
Ischemia of the tubule

7. Atherosclerosis causes an aneurysm by:
a.
causing ischemia of the intima.
b.
increasing nitric oxide.
c.
eroding the vessel wall.
d.
obstructing the vessel.

eroding the vessel wall.

8. The differences between healthy vessel walls and those that promote clot formation is that there is _____ of the endothelium of the vein.
a.
inflammation of the endothelium of the artery and roughing
b.
vasoconstriction of the endothelium of the artery and hypertrophy
c.
excessive clot formation of the endothelium of the artery and lipid accumulation
d.
roughening of the endothelium of the artery and inflammation

roughening of the endothelium of the artery and inflammation

9. What is the usual source of pulmonary emboli?
a.
Deep venous thrombosis
b.
Endocarditis
c.
Valvular disease
d.
Left heart failure

Deep venous thrombosis
b.

10. Which of the following can trigger an immune response within the bloodstream that can result in an embolus?
a.
Amniotic fluid
b.
Fat
c.
Bacteria
d.
Air

Amniotic fluid

11. Which statement best describes thromboangiitis obliterans (Buerger disease)?
a.
An inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands
b.
A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly, the toes
c.
An autoimmune disorder of the large arteries and veins of the upper and lower extremities
d.
A neoplastic disorder of the lining of the arteries and veins of the upper extremities

a.
An inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands

12. Which of the following statements best describes Raynaud disease?
a.
An inflammatory disorder of small and medium-size arteries in the feet and sometimes in the hands
b.
A neoplastic disorder of the lining of the arteries and veins of the upper extremities
c.
A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly, the toes
d.
An autoimmune disorder of the large arteries and veins of the upper and lower extremities

A vasospastic disorder of the small arteries and arterioles of the fingers, and less commonly, the toes
d.

13. What changes in veins occur to create varicose veins?
a.
An increase in osmotic pressure
b.
Damage to the valves within veins
c.
Damage to the venous endothelium
d.
An increase in hydrostatic pressure

Damage to the valves within veins

14. Superior vena cava syndrome is a progressive _____ of the superior vena cava that leads to venous distention of the upper extremities and head.
a.
inflammation
b.
occlusion
c.
distention
d.
sclerosis

occlusion

15. A local state in which cells are temporarily deprived of blood supply is defined as:
a.
infarction.
b.
ischemia.
c.
necrosis.
d.
inflammation

ischemia.

16. The risk of developing coronary artery disease is increased up to threefold by:
a.
diabetes mellitus.
b.
hypertension.
c.
obesity.
d.
high alcohol consumption.

hypertension.

17. Which of the following risk factors NOT is associated with coronary artery disease (CAD)?
a.
Diabetes mellitus
b.
Hypertension
c.
Obesity
d.
High alcohol consumption

High alcohol consumption

18. Nicotine increases atherosclerosis by the release of:
a.
histamine.
b.
nitric oxide.
c.
angiotensin II.
d.
epinephrine.
19.

epinephrine.

19. Which of the following is manufactured by the liver and primarily contains cholesterol and protein?
a.
Very-low-density lipoproteins (VLDLs)
b.
Low-density lipoproteins (LDLs)
c.
High-density lipoproteins (HDLs)
d.
Triglycerides

Low-density lipoproteins (LDLs

20. Which elevated value may be protective of the development of atherosclerosis?
a.
Very-low-density lipoproteins (VLDLs)
b.
Low-density lipoproteins (LDLs)
c.
High-density lipoproteins (HDLs)
d.
Triglycerides (TGs

High-density lipoproteins (HDLs)

21. Which lab test is an indirect measure of atherosclerotic plaque?
a.
Homocysteine
b.
Low-density lipoprotein (LDL)
c.
Erythrocyte sedimentation rate (ESR)
d.
C-reactive protein (CRP

C-reactive protein (CRP

22. Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes?
a.
10
b.
15
c.
20
d.
25

20

23. Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary arteries?
a.
Unstable
b.
Stable
c.
Silent
d.
Prinzmetal
24. The

Prinzmetal

24. The scar tissue that is formed after a myocardial infarction (MI) is most vulnerable to injury between days:
a.
5 to 9.
b.
10 to 14.
c.
15 to 20.
d.
20 to 30.

10 to 14.

25. An individual who is demonstrating elevated levels of troponin, creatine kinase (CK), and lactic dehydrogenase (LDH) is exhibiting indicators associated with:
a.
myocardial ischemia.
b.
hypertension.
c.
myocardial infarction (MI).
d.
coronary artery disease.

myocardial infarction (MI).

26. What is the expected electrocardiogram pattern for a person when a thrombus in a coronary artery lodges permanently in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium?
a.
Prolonged QT interval
b.
ST elevation (STEMI)
c.
ST depression (STDMI)
d.
Non-ST elevation (non-STEMI

ST elevation (STEMI)

27. Angiotensin II increases the workload of the heart after a myocardial infarction by:
a.
increasing the peripheral vascular resistance.
b.
causing dysrhythmias as a result of hyperkalemia.
c.
reducing the contractility of the myocardium.
d.
stimulating the sympathetic nervous system.

reducing the contractility of the myocardium.

28. The pulsus paradoxus that occurs as a result of pericardial effusion is significant because it reflects the impairment of the:
a.
diastolic filling pressures of the right ventricle and reduction of blood volume in both ventricles.
b.
blood ejected from the right atria and reduction of blood volume in the right ventricle.
c.
blood ejected from the left atria and reduction of blood volume in the left ventricle.
d.
diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.

diastolic filling pressures of the left ventricle and reduction of blood volume in all four heart chambers.

29. A patient complains of sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:
a.
myocardial infarction.
b.
pericardial effusion.
c.
restrictive pericarditis.
d.
acute pericarditis.

d.
acute pericarditis

30. Biventricular dilation is the result of which form of cardiomyopathy?
a.
Hypertrophic
b.
Restrictive
c.
Dilated
d.
Inflammatory

DILATED

31. Which form of cardiomyopathy is characterized by ventricular dilation and grossly impaired systolic function, leading to dilated heart failure?
a.
Dilated
b.
Hypertrophic
c.
Septal
d.
Dystrophic

Dilated

32. The hallmark of which form of cardiomyopathy is a disproportionate thickening of the interventricular septum?
a.
Dystrophic
b.
Hypertrophic
c.
Restrictive
d.
Dilated

Hypertrophic

33. Which form of cardiomyopathy is usually caused by an infiltrative disease of the myocardium, such as amyloidosis, hemochromatosis, or glycogen storage disease?
a.
Infiltrative
b.
Restrictive
c.
Septal
d.
Hypertrophic

Restrictive

34. Which of the following is a clinical manifestation of aortic stenosis?
a.
Jugular vein distention
b.
Bounding pulses
c.
Peripheral edema
d.
Angina

Angina

35. Aortic and mitral regurgitation as well as mitral stenosis are caused by:
a.
congenital malformation.
b.
cardiac failure.
c.
rheumatic fever.
d.
coronary artery disease

rheumatic fever.

36. 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
b.
Tricuspid stenosis
c.
Tricuspid valve prolapse

Mitral valve prolapse

37. 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.
Fat emboli
b.
Rheumatic fever
c.
Bacterial endocarditis
d.
Myocarditis of acquired immunodeficiency syndrome

Rheumatic fever

38. Infective endocarditis is most often caused by:
a.
a virus.
b.
a fungus.
c.
a bacterium.
d.
rickettsiae.

a bacterium.
d.

39. Genitourinary instrumentation, male gender, and intravenous drug use are risk factors for which of the following?
a.
Rheumatic fever
b.
Infective endocarditis
c.
Mitral regurgitation
d.
Aortic regurgitation

Infective endocarditis

40. What is the most common cardiac disorder associated with acquired immunodeficiency syndrome (AIDS) resulting from myocarditis and infective endocarditis?
a.
Inflammatory cardiomyopathy
b.
Hypertrophic cardiomyopathy
c.
Dilated cardiomyopathy
d.
Restrictive cardiomyopathy

Dilated cardiomyopathy
d.

41. A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures may result from this condition?
a.
Right heart failure
b.
Left heart failure
c.
Low-output failure
d.
High-output failure

Right heart failure

42. Ventricular remodeling is a result of:
a.
left ventricular hypertrophy.
b.
right ventricular failure.
c.
myocardial ischemia.
d.
contractile dysfunction.

myocardial ischemia.
d.

43. In systolic heart failure, what effect does angiotensin II have on stroke volume?
a.
Increases preload and decreases afterload
b.
Increases preload and increases afterload
c.
Decreases preload and increases afterload
d.
Decreases preload and decreases afterload

Increases preload and decreases afterload

1. Aortic stenosis

.
Impairs flow from the left ventricle

Aortic regurgitation

e.
Backflow into left ventricle

Mitral stenosis

a.
Impairs flow from left atrium to left ventricle

Tricuspid regurgitation

d.
Backflow into right atrium

Mitral regurgitation

c.
Backflow into left atrium

6. Usually caused by infiltrative disease, such as amyloidosis

Restrictive cardiomyopathy

Usually caused by ischemic or valvular heart disease
8.

c.
Dilated cardiomyopathy

Results in muscular subaortic stenosis

b.
Hypertrophic cardiomyopathy

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