Disorders of Blood Vessels & Ischemic Heart Disease

1. A 49-year-old woman has had a long history of high-grade hypertension which has not been
under good control. She has no history of any other heart or lung disease. The pressures
within her pulmonary arteries and right side of the heart are within normal limits. Except for
frequent headaches, she is asymptomatic. Which of the following conditions would you
expect to be present in this patient?
a. Jugular vein distension
b. Left atrial dilation
c. Hyperplastic nephrosclerosis
d. Pulmonary vascular congestion
e. Right ventricular hypertrophy
2. Following injury produced by cutting the toe nail too short, a 70 year-old diabetic woman
developed infection that progressed to gangrene of the left great toe. The most likely
vascular disease process is
a. Infectious arteritis
b. Thrombophlebitis
c. Atherosclerosis
d. Phlebosclerosis
e. Thromboangiitis obliterans
3. A 54-year-old man is brought to the emergency room with a blood pressure of 70/40 mmHg,
pulse of 160/min and cold, clammy skin. Chest x-rays reveal an ascending aorta 2 to 3 times
normal diameter with a normal abdominal aorta. An early diastolic murmur is present.
Based upon this information, the most likely diagnosis is
a. Acute aortic dissection
b. Acute myocardial infarction
c. Essential hypertension
d. Polyarteritis nodosa
e. Ruptured berry aneurysm
f. Tertiary syphilis
4. A 67-year-old man with a history of poorly controlled hypertension develops a sudden
tearing pain in this chest. He is immediately taken to the emergency room where he is
observed to develop signs of cardiac tamponade. The most likely diagnosis is
a. Aortic dissection
b. Mycotic aneurysm
c. Myocardial infarction
d. Tertiary syphilis
5. Slow, progressive narrowing of a distributing artery most often results in:
a. Widespread necrosis
b. Infarction of related muscles
c. Diffuse interstitial fibrosis
d. Hypertrophy of related muscles
e. Amyloidosis
6. Which of the following is most often associated with infarction secondary to ischemia?
a. Fibrinoid
 b. Coagulative
c. Liquefactive
d. Gummatous
e. Caseous
7. The elevation of lysosomal enzymes in the blood is most appropriately associated with:
a. Myocardial infarction
b. Ischemic heart disease
c. Congenital heart disease
d. Cyanosis
e. Cardiac rhabdomyosarcoma
8. Which of the following is the most immediate response to the necrotic tissue resulting from
an infarction?
a. Granulation tissue
b. Fibroblastic proliferation
c. Angioblastic proliferation
d. Neutrophilic infiltration
e. Lymphocytic infiltration
9. The newly formed, highly vascularized connective tissue with a component of acute
inflammatory exudation is known as
a. Angioma
b. Scar
c. Granulation tissue
d. Granuloma
e. Purulent exudate
10. The earliest change in atherosclerosis is seen in the
a. Intima
b. Elastica
c. Media
d. Adventitia
11. Which of the following cell types plays little or no role in the initiation of atherosclerosis
a. Blood monocytes
b. Blood platelets
c. Endothelial cells
d. Medial smooth muscle cells
12. When a person dies suddenly from a "heart attack", the most likely event that led to the
sudden death is
a. Rupture of the heart
b. Congestive heart failure
c. Angina pectoris
d. Coronary artery thrombosis
e. Cardiac arrhythmia
13. An 84-year-old nursing home resident with a known history of stable angina has recently
complained of increasing dyspnea while performing everyday tasks. One morning, she is
found dead in bed. At autopsy, her heart has several scattered grey-white scars in the left
 ventricular myocardium. Microscopically, she has diffuse myocardial atrophy, diffuse
interstitial and patchy fibrous tissue as well as the grossly observed scars. This patient's
condition is best designated as
a. Chronic ischemic heart disease
b. Cor pulmonale
c. Restrictive cardiomyopathy
d. Rheumatic heart disease
e. Acute myocardial Infarction
14. Microscopic examination of a myocardial infarct in a man who died 36 hours following the
occlusion of his left coronary artery would most likely show
a. Extensive infiltration with mononuclear cells
b. Fibroblast proliferation
c. Infiltration with neutrophils
d. Plasma cell infiltrates
e. Well developed granulation tissue
15. In the healing of a myocardial infarct, granulation tissue first becomes prominent at the
margins of the infarct at about
a. 1 day
b. 3 days
c. 1 week
d. 2 weeks
e. 1 month
16. A 57-year-old man presents to the emergency room with diaphoresis and chest pain of 3
hours duration. A diagnosis of acute myocardial infarct is made on the basis of EKG. Which of
the following developments would be most ominous?
a. Appearance of a new systolic murmur
b. Elevation of serum creatine kinase levels
c. Fever
d. Leukocytosis
e. Pericardial friction rub
17. Of the following, the most frequent cause of death in the first week following a myocardial
infarct is
a. Embolism
b. Myocardial rupture
c. Congestive failure
d. Cardiogenic shock
e. Rupture of a papillary muscle
18. A 44-year-old man dies within one hour of onset of severe chest pain. At autopsy which of
the following findings is much more likely to be present than the others listed?
a. Morphologic evidence of myocardial infarct
b. Rupture of the heart
c. Atherosclerosis of coronary arteries
d. Thrombosis of a coronary artery
e. Mural thrombosis
19. Cerebral embolization occurring as a complication of a myocardial infarct would most
probably be indicative of
a. Disseminated intravascular coagulation
b. Mural thrombus in the left ventricle
c. Lack of collateral circulation
d. Post-myocardial injury syndrome
e. Phlebothrombosis
20. Eight days following a documented myocardial infarction, which of the following serum
enzymes would be most useful to evaluate recurrence of chest pain and equivocal
electrocardiographic changes?
a. Alanine aminotransferase
b. Alkaline phosphatase
c. Aspartate aminotransferase
d. Creatine kinase
e. Lactic dehydrogenase
21. Which of the following best describes the gross appearance of a myocardial infarct one week
after infarction?
a. Pale brown center without distinct margin
b. Soft yellow center, no hyperemic margin
c. Pale brown center, normal consistency, hyperemic margin
d. Soft yellow center with red, hyperemic margin
e. Discrete gray-white center, no hyperemic margin