Pathophysiology Module 15 Exam Review

Which of the following events initiates the process of atherosclerosis?

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

The most common consequence of atherosclerosis is:

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

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

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

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

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

Which of the following forms of dyslipidemia is associated with the development of the fatty streak in atherosclerosis?

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.

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

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

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

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.

According to the Joint National Commission Seventh Report (JNCVII), normal blood pressure is defined as:

Systolic pressure less that 120 mm Hg and diastolic pressure less than 80 mm Hg
According to JNCVII, normal blood pressure is a systolic pressure less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg.

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

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

Dysfuntion in the normal secretion of natriuretic hormones affects renal absorption of:

Sodium
Natriuretic hormones affect renal reabsorption of sodium.

How is insulin resistance related to the development of primary hypertension?

Insulin resistance activates the sympathetic nervous system, contributes to the development of diabetes, dyslipidemia, and eventually atherosclerosis, and promotes thrombus formation
Insulin resistance contributes to increases in SNS activity, peripheral

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

Advanced age
Older adults are more likely than younger individuals to develop atherosclerosis and primary hypertension.

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

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

Complications of sustained hypertension include which of the following?

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

Sustained uncontrolled hypertension can result in which of the following life-threatening complications?

Cardiac failure, cerebrovascular accident and encephalopathy
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

Atherosclerosis of the aorta can cause isolated systolic hypertension by:

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

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

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

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

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.

Older adults with chronic orthostatic hypotension are at risk for:

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

A ruptured cerebral aneurysm often will result in:

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 infarct, or strok

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

LDL accumulation
LDL accumulation occurs in atherosclerosis.

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

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

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

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.

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

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

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

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

The most common cause of coronary artery disease is:

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

Symptoms of stable angina include all of the following except:

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 infarctioin. Stable angina manifests with chest tightness or discomfort that goes away with rest.

Prinzmetal angina is caused by:

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

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?

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 viscer

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

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

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

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

Unstable angina is considered a precursor to:

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.

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

Isoenzyme of creatine phosphate (CK-MB) and troponin I
Elevations of CK-MB and troponin I are markers for myocardial infarction.

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?

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.

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

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

Aortic stenosis results in the incomplete emptying of the:

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.

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

Aortic stenosis, aortic regurgitation, and mitral regurgitation
Increased volumes in the left ventricle resulting from all three valve disorders can progress to left heart failure.

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

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.

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

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

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

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

Infective endocarditis is most often caused by:

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

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

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 pre

In left ventricular failure, decreased perfusion to the kidneys stimulates the renin-angiotensin-aldosterone system, which may ultimately result in:

Increased blood volume
Activation of the renin-angiotensin-aldosterone system results in sodium and water retention through the release of aldosterone, which in turn increases blood volume and ventricular preload.

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

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 Pumonale.

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

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.

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

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.