blood vessles

A 23-year-old man experiences sudden onset of severe, sharp chest pain. On physical examination, his temperature is 36.9°C, and his lungs are clear on auscultation. A chest radiograph shows a widened mediastinum. Transesophageal echocardiography shows a dilated aortic root and arch, with a tear in the aortic intima 2 cm distal to the great vessels. The
representative microscopic appearance of the aorta with elastic stain is shown in the figure. Which of the following is the most likely cause of these findings?
□ (A) Scleroderma
□ (B) Diabetes mellitus
□ (C) Systemic hypertension
□ (D) Marfan syndrome
□ (E) Wegener granulomatosis
□ (F) Takayasu arteritis
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A 23-year-old man experiences sudden onset of severe, sharp chest pain. On physical examination, his temperature is 36.9°C, and his lungs are clear on auscultation. A chest radiograph shows a widened mediastinum. Transesophageal echocardiography shows a dilated aortic root and arch, with a tear in the aortic intima 2 cm distal to the great vessels. The
representative microscopic appearance of the aorta with elastic stain is shown in the figure. Which of the following is the most likely cause of these findings?
□ (A) Scleroderma
□ (B) Diabetes mellitus
□ (C) Systemic hypertension
□ (D) Marfan syndrome
□ (E) Wegener granulomatosis
□ (F) Takayasu arteritis
D
A 40-year-old man with a history of diabetes mellitus has had worsening abdominal pain for the past week. On physical examination, his vital signs are temperature, 36.9°C; pulse, 77/min; respirations, 16/min; and blood pressure, 140/90 mm Hg. An abdominal CT scan shows the findings in the figure. Laboratory studies show his hemoglobin A1C is 10.5%. Which of the following is the most likely underlying disease process in this patient?
□ (A) Polyarteritis nodosa
□ (B) Obesity
□ (C) Diabetes mellitus
□ (D) Systemic lupus erythematosus
□ (E) Syphilis
C
A 55-year-old woman has noted the increasing prominence of unsightly dilated superficial veins over both lower legs for the past 5 years. Physical examination shows temperature of 37°C, pulse of 70/min, respirations of 14/min, and blood pressure of 125/85 mm Hg. There is no pain, swelling, or tenderness in either lower leg. Which of the following complications is most likely to occur as a consequence of this condition?
□ (A) Stasis dermatitis
□ (B) Gangrenous necrosis of the lower legs
□ (C) Pulmonary thromboembolism
□ (D) Disseminated intravascular coagulation
□ (E) Atrophy of the lower leg muscles
A
An experiment studies early atheromas. Lipid streaks on arterial walls are examined microscopically and biochemically to determine their cellular and chemical constituents and the factors promoting their formation. Early lesions show increased attachment of monocytes to endothelium. The monocytes migrate subendothelially and become macrophages; these macrophages transform themselves into foam cells. Which of the following is most likely to produce these effects?
□ (A) C-reactive protein
□ (B) Homocysteine
□ (C) Lp(a)
□ (D) Oxidized LDL
□ (E) Platelet-derived growth factor
□ (F) VLDL
D
A 12-year-old boy died of complications of acute lymphocytic leukemia. The gross appearance of the aorta at autopsy is shown in the figure. Histologic examination of the linear pale marking is most likely to show which of the following features?
□ (A) Cap of smooth muscle cells overlying a core of lipid debris
□ (B) Collection of foam cells with necrosis and calcification
□ (C) Granulation tissue with a lipid core and areas of hemorrhage
□ (D) Lipid-filled foam cells and small numbers of T lymphocytes
□ (E) Cholesterol clefts surrounded by proliferating smooth muscle cells and foam cells
D
After falling down a flight of stairs, a 59-year-old woman experiences mild intermittent right hip pain. Physical examination shows a 3-cm contusion over the right hip. The area is tender to palpation, but she has full range of motion of the right leg. A radiograph of the pelvis and right upper leg shows no fractures, but does show calcified, medium-sized arterial branches in the pelvis. This radiographic finding is most likely to represent which of the following?
□ (A) Long-standing diabetes mellitus
□ (B) Benign essential hypertension
□ (C) An incidental observation
□ (D) Increased risk for gangrenous necrosis
□ (E) Unsuspected hyperparathyroidism
C
A study is conducted to investigate the pathogenesis of atherosclerosis. The investigators have developed genetically modified mice that have hypercholesterolemia and spontaneously develop atherosclerosis. Next, the investigators
selectively delete individual genes to determine the factors that are crucial to the development of atherosclerosis. Deletion of the gene encoding for which of the following is most likely to reduce the experimentally observed atherosclerosis in these modified mice?
□ (A) Von Willebrand factor
□ (B) Homocysteine
□ (C) T-cell receptor
□ (D) Endothelin
□ (E) Fibrillin
□ (F) LDL receptor
□ (G) Factor VIII
□ (H) Apolipoprotein
C
A 40-year-old man has experienced malaise, fever, and a 4-kg weight loss over the past month. On physical examination, his blood pressure is 145/90 mm Hg, and he has mild diffuse abdominal pain, but no masses or hepatosplenomegaly. Laboratory studies include a serum urea nitrogen concentration of 58 mg/dL and a serum creatinine level of 6.7 mg/dL. Renal angiography shows right renal arterial thrombosis, and the left renal artery and branches show segmental luminal narrowing with focal aneurysmal dilation. During hemodialysis 1 week later, the patient experiences
abdominal pain and diarrhea and is found to have melena. Which of the following serologic laboratory findings is most likely to be positive in this patient?
□ (A) C-ANCA
□ (B) ANA
□ (C) HIV
□ (D) HBsAg
□ (E) Scl-70
□ (F) RPR
D
A 30-year-old schoolteacher is known to be a strict disciplinarian in the classroom. She has angina pectoris of 6 months' duration. On physical examination, her blood pressure is 135/85 mm Hg. She is 168 cm (5 ft 5 in) tall and weighs 82 kg (BMI 29). Coronary angiography shows 75% narrowing of the anterior descending branch of the left coronary artery. Angioplasty with stent placement is performed. Which of the following is the major risk factor associated with these findings?
□ (A) Obesity
□ (B) Type A personality
□ (C) Diabetes mellitus
□ (D) Sedentary lifestyle
□ (E) Age
C
A 46-year-old man visits his physician because he has noted increasing abdominal enlargement over the past 15 months. Physical examination shows several skin lesions on the upper chest that have central pulsatile cores. Pressing on a core causes a radially arranged array of subcutaneous arterioles to blanch. The size of the lesions, from core to periphery, is 0.5 to 1.5 cm. Laboratory studies show serum glucose of 119 mg/dL, creatinine of 1.1 mg/dL, total protein of 5.8 g/dL, and albumin of 3.4 g/dL. Which of the following underlying diseases is most likely to be present in this patient?
□ (A) Wegener granulomatosis
□ (B) Micronodular cirrhosis
□ (C) Marfan syndrome
□ (D) AIDS
□ (E) Diabetes mellitus
B
A clinical study is performed that includes a group of subjects whose systemic blood pressure measurements are consistently between 145/95 mm Hg and 165/105 mm Hg. They are found to have increased cardiac output and increased peripheral vascular resistance. Renal angiograms show no abnormal findings, and CT scans of the abdomen show no masses. Laboratory studies show normal levels of serum creatinine and urea nitrogen. The subjects take no medications. Which of the following laboratory findings is most likely to be present in this group of subjects? □ (A) Lack of angiotensin-converting enzyme □ (B) Decreased urinary sodium □ (C) Elevated plasma renin □ (D) Hypokalemia □ (E) Increased urinary catecholaminesBAn epidemiologic study seeking to determine possible risk factors for neoplasia is reviewing patient cases of neoplasms reported to tumor registries. Analysis of the data shows that one type of neoplasm is seen in two widely disparate situations: (1) the liver of individuals exposed to polyvinyl chloride and (2) the soft tissue of the arm ipsilateral to a prior radical mastectomy. The pathology reports about the neoplasms in these two groups of patients show a similar gross appearance—an irregular, infiltrative, soft reddish mass—and a similar microscopic appearance—pleomorphic spindle cells positive for CD31. Which of the following neoplasms is most likely to be described by these findings? □ (A) Angiosarcoma □ (B) Hemangioendothelioma □ (C) Hemangioma □ (D) Hemangiopericytoma □ (E) Kaposi sarcoma □ (F) LymphangiomaA