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1. Which of the following events initiates the process of atherosclerosis?

D. Endothelial injury and release of cytokines

Endothelial injury and the subsequent release of cytokines are the events that initiate atherosclerosis.

2. The most common consequence of atherosclerosis is:

D. obstruction of the blood vessel lumen.

Smooth muscle proliferations, fibrosis, and calcification in atherosclerosis all reduce the size of the blood vessel lumen.

3. Factors associated with endothelial injury in atherosclerosis include all of the following except:

B. anemia.

Although anemia can lead to hypoxia in the peripheral tissues, it is not associated with endothelial injury and the development of atherosclerosis

4. Which of the following white blood cells play a role in the development of the fatty streak in atherosclerosis?

C. Macrophages

Macrophages phagocytose lipids in the tunica media of the vessel wall and accumulate, forming the fatty streak.

5. Which of the following forms of hyperdyslipidemia is associated with the development of the fatty streak in atherosclerosis?

A. High LDL

In atherosclerosis, LDL adheres to the injured endothelium and is oxidized by macrophages to form the fatty streak. High serum LDL is a risk factor for atherosclerosis.

6. Mitogens, such as angiotensin II, contribute to the development of atherosclerosis by stimulating which of the following events?

A. Smooth muscle proliferation

In atherosclerosis, mitogens stimulate smooth muscle proliferation around the fatty streak.

7. An unstable plaque in the coronary arteries can result in which of the following complications?

A. Myocardial infarction

An unstable plaque can rupture, and the resulting thrombus can obstruct the lumen, causing an abrupt halt to myocardial blood flow. This event is called a myocardial infarction.

8. According to the Joint National Commission Seventh Report (JNC VII), normal blood pressure is defined as:

C. systolic pressure less than 120 mm Hg and diastolic pressure less than 80 mm Hg.

According to JNC VII, normal blood pressure is a systolic pressure less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg.

9. In the development of primary hypertension, increased sympathetic nervous system (SNS) activity causes:

C. peripheral vasoconstriction.

A major factor in the development of primary hypertension is vasoconstriction and increased peripheral resistance caused by abnormal SNS activity.

10. Dysfunction in the normal secretion of natriuretic hormones affects renal reabsorption of:

C. sodium.

Natriuretic hormones affect renal reabsorption of sodium.

11. A risk factor that is associated with atherosclerosis and primary hypertension is:

B. advanced age.

12. Over time, sustained hypertension can result in which of the following problems?

B. Vascular remodeling

Over time, prolonged vasoconstriction can result in permanent remodeling of blood vessel walls.

13. Complications of sustained hypertension include which of the following?

A. Retinal damage
B. Stroke
C. Renal disease
D. All of the above

High pressures in the vasculature cause damage to many organs, including the eye (retinal injury), kidneys (nephrosclerosis), and brain (aneurysm resulting in stroke).
Correct Answer: D

14. Malignant hypertension can result in which of the following life-threatening complications?

A. Cerebrovascular accident
B. Encephalopathy
C. Cardiac failure
D. All of the above

Malignant hypertension can cause cerebrovascular accident, encephalopathy, and cardiac failure caused by high systolic and diastolic pressures and the resulting high hydrostatic pressures in the capillaries.

Correct Answer: D

15. Atherosclerosis of the aorta can cause isolated systolic hypertension by:

C. decreasing arterial distensibility.

Atherosclerosis of the aorta results in calcification and decreased distensibility. The result is increased arterial pressures during systole.

16. An individual with secondary hypertension has an abnormal blood pressure caused by:

D. a systemic disease.

Secondary hypertension is caused by altered hemodynamics associated with a primary disease such as atherosclerosis or renal failure.

17. Orthostatic hypotension refers to a decrease in both systolic and diastolic blood pressure when an individual:

D. stands up.

Orthostatic hypotension refers to a decrease in blood pressure upon standing and is caused by the gravitational changes on the circulation that are inadequately compensated for.

18. Older adults with chronic orthostatic hypotension are at risk for:

C. falls.

Orthostatic hypotension is often accompanied by dizziness and fainting, which can lead to head injuries or bone fractures from falls.

19. A ruptured cerebral aneurysm often will result in:

A. stroke.

When a cerebral artery ruptures, there is hemorrhage into the brain, leading to a hemorrhagic stroke. In addition, blood flow to the corresponding area of the brain is interrupted. The resulting ischemia and tissue death is called a cerebral infarct, or stroke.

20. The pathophysiology of deep venous thrombosis (DVT) can be described though three processes, known as Virchow's triad. Which of the following is not a component of Virchow's triad?

B. LDL accumulation

LDL accumulation occurs in atherosclerosis.

21. Clinical manifestations of a deep vein thrombosis (DVT) in the lower leg include:

A. pain and edema in the affected limb.

Pain and edema from inflammation and reduced venous return are the hallmark signs of a DVT.

22. Which of the following patients should be monitored for superior vena cava syndrome?

B. A 56-year-old woman with bronchogenic (lung) cancer

Tumors in the mediastinum can compress the superior vena cava, resulting in obstruction of venous return to the heart. This is a serious complication of cancers involving solid tumors in the thorax.

23. Individuals with Raynaud disease experience vasospasm in the small arteries of the fingers under which of the following conditions?

B. Cold exposure

Individuals with Raynaud disease experience vasospasm in the small arteries of the fingers during cold exposure or emotional stress.

24. Standing for long periods of time causes blood to pool in superficial veins. The result is the development of:

B. varicose veins.

Varicose veins are distended, tortuous, and palpable vessels that are caused by blood pooling in the legs.

25. The most common cause of coronary artery disease is:

C. atherosclerosis.

The most common cause of coronary artery disease is atherosclerosis, which results in decreased blood flow to the myocardium.

26. Symptoms of stable angina include all of the following except:

A. severe substernal pain that lasts more than a few hours.

Severe substernal pain lasting more than a few hours is a symptom of a myocardial infarction. Stable angina manifests with chest tightness or discomfort that goes away with rest.

27. Prinzmetal angina is caused by:

C. vasospasm.

Prinzmetal angina is a special type of chest pain that occurs transiently at rest because of vasospasm.

28. Which of the following chronic diseases places an individual at high risk for silent myocardial ischemia caused by dysfunction of the autonomic nerves carrying sensory information to the brain?

B. Diabetes mellitus

Neuropathies associated with diabetes can diminish sensory impulses carrying pain signals from an ischemic heart. The result is silent myocardial ischemia, a condition in which hypoxic injury to the myocardium is occurring without visceral sensation.

29. Why is myocardial ischemia usually reversible within 20 minutes of interruption of coronary blood flow?

D. Anaerobic metabolism maintains cellular integrity for approximately 20 minutes.

Anaerobic metabolism maintains basic cellular integrity for approximately 20 minutes, although cardiac output during this time can be dramatically reduced.

30. The most important component in the development of acute coronary syndromes is a decrease in supply or an increase in demand for:

D. oxygen.

The heart is highly dependent on oxygen and will cease to function if the demand for oxygen exceeds the available supply.

31. Unstable angina is considered a precursor to:

B. myocardial infarction.

The concern with unstable angina is that a clot may form in the diseased coronary artery and cause occlusion of the vessel and a myocardial infarction.

32. Elevated levels of which of the following markers are indicative of an acute myocardial infarction?

C. Isoenzyme of creatine phosphate (CK-MB) and Troponin 1

Elevations of CK-MB and Troponin 1 are markers for myocardial infarction.

33. When a myocardial infarction occurs, the myocardial cells surrounding the infarct undergo structural and functional changes. Which one of the following changes can be observed in these tissues following a myocardial infarction?

C. Myocardial remodeling

Areas surrounding the infarct experience a temporary loss of contractile activity (myocardial stunning), decrease their metabolic needs (hibernation), and begin to remodel through the process of hypertrophy.

34. Which of the following conditions is caused by the collection of fluid in the pericardial sac, resulting in tamponade?

B. Pericardial effusion

Pericardial effusions are caused by transudate, exudate, or serosanguinous fluid collection that can compress the heart (tamponade).

35. Aortic stenosis results in the incomplete emptying of the:

D. left ventricle.

Blood from the left ventricle is pumped through the aortic valve into the aorta. Aortic stenosis results in the incomplete emptying of the left ventricle.

36. Which of the following valve disorders is most likely to result in left ventricular failure?

D. All of the above

Increased volumes in the left ventricle resulting from all three valve disorders can progress to left heart failure.

37. The most common cardiac valve disease in the United States, which tends to be most prevalent in young women, is:

A. mitral valve prolapse.

The most common valve disorder, mitral valve prolapse, has been found to have an autosomal dominant pattern of inheritance and occurs most often in young women.

38. In the elderly, aortic stenosis usually results from which of the following conditions?

C. degeneration and calcification of the valve.

Aging changes to the valves include degeneration and calcification (from atherosclerosis) that can result in aortic stenosis.

39. Many valvular stenosis and regurgitation disorders in adults have a common etiology. Which of the following can result in both types of valve dysfunction?

A. Rheumatic heart disease

Inflammatory damage from rheumatic heart disease can cause calcification leading to valvular stenosis or leaflet destruction, which leads to valvular regurgitation.

40. Infective endocarditis is most often caused by:

B. bacteria.

Infective endocarditis is generally caused by bacterial infection with microorganisms such as Staphylococcus aureus.

41. Congestive heart failure (CHF) results in which of the following intraventricular hemodynamic changes?

A. Increased left ventricular preload

CHF occurs when the left ventricle fails to pump adequate volumes of blood to the systemic circulation, resulting in an increase in left ventricular end-diastolic pressure that is also referred to as left ventricular preload.

42. A patient is diagnosed with chronic pulmonary disease and elevated pulmonary vascular resistance. Which of the following heart failures generally results from this condition?

A. Right heart failure

Elevated right ventricular afterload related to pulmonary artery vasoconstriction from chronic pulmonary disease can result in right heart failure, also known as cor pulmonale.

43. Of the following diseases, which is the most common cause of right heart failure?

C. Left heart failure

Left heart failure causes pressure to back up into the pulmonary circulation, causing increased right ventricular afterload and the potential for right heart failure.

44. Manifestations of increased left atrial and pulmonary venous pressures in left (congestive) heart failure include:

D. dyspnea and cough.

Increased left atrial and pulmonary venous pressures result in pulmonary edema. The resulting hypoxemia causes dyspnea, and the accumulation of fluid in the lung tissue stimulates coughing.

45. Which problem is a pathophysiological consequence common to all shock states?

A. Hypoperfusion

A lack of perfusion to the peripheral tissues is common to all shock states.

46. A consequence of switching from aerobic to anaerobic cellular metabolism during shock states is:

C. lactic acidosis.

Anaerobic metabolism under hypoxic conditions results in decreased ATP production and the formation of lactic acid.

47. In shock, how does the body maintain blood glucose levels once available glucose and glycogen stores are used up?

B. By breaking down protein to fuel gluconeogenesis

During shock, the body breaks down protein from muscle tissue to make new glucose.

48. Which of the following conditions is not a potential cause of cardiogenic shock?

B. Spinal cord injury

Since the cardiac conduction system has autorhythmicity, the heart can maintain its rate of contraction in absence of neuronal stimulation. Spinal cord injury results in a form of distributive shock.

49. Which of the following shock states manifests with tachycardia, vasoconstriction, and movement of large volumes of interstitial fluid to the vascular compartment?

B. Hypovolemic

In response to hypovolemia, sympathetic nervous system activation causes tachycardia and vasoconstriction, while fluid shifts from the tissues into the blood stream in an attempt to preserve blood volume and pressure.

50. Which of the following shock states is (are) characterized by vasodilation of the systemic arteries?

C. Distributive

The hallmark of distributive shock is vasodilation and low peripheral vascular resistance.

51. Which of the following shock states is (are) characterized by acute, severe bronchoconstriction?

B. Anaphylactic

Acute onset, severe bronchoconstriction occurs with anaphylactic shock.

52. Causes of hypovolemic shock include all of the following except:

C. brainstem injury.

Injury to the CNS causes a form of distributive shock. Hypovolemic shock is caused by the loss of intravascular volume and can be caused by dehydration, blood loss, or diuresis.

53. Clinical manifestations of hypovolemic shock include all of the following except:

A. pulmonary edema.

Pulmonary edema is not seen in hypovolemic shock because hydrostatic pressure in the pulmonary capillaries is low. Clinical manifestations of hypovolemic shock include tachycardia in response to hypotension and oliguria due to renal reabsorption of water to conserve blood volume.

54. Neurogenic shock is caused by:

D. a lack of sympathetic activity.

Neurogenic shock is caused by injuries or medications that inhibit sympathetic nervous system activity to the heart and blood vessels.

55. Which of the following pathophysiological events causes the severe hypotension observed in neurogenic shock?

C. Decreased peripheral vascular resistance

Increased capillary permeability and diuresis do not occur in neurogenic shock. Severe hypotension in neurogenic shock is caused by profound vasodilation leading to decreased peripheral vascular resistance and in some cases bradycardia.

56. Anaphylactic shock occurs in response to severe:

B. allergic reactions.

Anaphylactic shock occurs when high levels of IgE are produced during severe allergic reactions.

57. Anaphylactic shock manifests with the rapid onset of which set of symptoms?

B. Dyspnea, hypotension, and urticaria

The release of cytokines during anaphylactic shock causes vasodilation resulting in hypotension, bronchoconstriction and airway edema causing dyspnea, and urticaria.

58. Which of the following conditions presents the most significant risk factor for developing septic shock?

A. Use of immunosuppressant medications

Since septic shock is caused by bacterial infections, individuals who are immunosuppressed are at high risk since they are unable to mount an adequate immune or inflammatory response.

59. What is the primary cause of hypotension in early stages of septic shock?

B. Arterial vasodilation

The release of vasodilatory mediators during septic shock results in decreased peripheral vascular resistance and decreased blood pressure.

60. Which set of clinical manifestations is highly characteristic of a septic shock state?

A. Tachycardia, generalized edema, and warm skin

The set of symptoms that all manifest with septic shock consists of tachycardia in response to hypotension, generalized edema from increased capillary permeability, and warm skin due to peripheral vasodilation.

61. Low levels of which molecule contributes to the pathophysiology of septic shock?

C. Activated protein C
Decreased amounts of activated protein C during a systemic inflammatory response leads to increased clotting, causing tissue ischemia.

62. The most common cause of multiple organ dysfunction syndrome (MODS) is:

B. septic shock.

Activation of the system inflammatory response in septic shock will rapidly lead to MODS if resuscitation and treatment strategies are inadequate.

63. Secondary MODS is defined as the progressive dysfunction of two or more organ systems resulting from:

C. an uncontrolled inflammatory response.

Secondary MODS is caused by an uncontrolled inflammatory response.

64. In MODS, which of the following events contribute to organ failure?

A. Microvascular clotting
B. Interstitial edema
C. Exhaustion of fuel supply
D. All of the above

Organ failure in MODS is caused by a wide variety of factors, including ischemia from microvascular clotting, gas diffusion abnormalities from edema, and exhaustion of fuel supply from hypoperfusion and hypermetabolism.

Correct Answer: D

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