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1.

A 67-year old male has a persistent headache and difficulty chewing; arterial biopsy shows multinuclear giant cells and internal elastic membrane fragmentation. Immediate prednisone therapy is initiated to prevent which of the following?
A. B. C. D. E. F. Renal failure Blindness Myocardial infarction Hemoptysis Pulmonary hypertension Hepatic necrosis

2. A 3-month-old male is brought to your office with a slowly growing skin lesion on his buttock. Physical examination findings are shown on the slide below. Which of the following is the most likely diagnosis in this patient?
A. B. C. D. E. Strawberry (capillary) hemangioma Cherry hemangioma Spider angioma Cavernous hemangioma Cystic hygroma

3. Over the past few months, a 54-year old male has experienced several episodes of thrombophlebitis involving various sites in both his arms and legs. The patients symptoms may indicate the presence of which of the following? A. Hyperthyroidism B. Celiac sprue C. Polycystic kidneys D. Visceral cancer E. Chlamydial infection

4. A 42-year old woman presents to your office for a routine check-up. She has no complaints at present, and there is no significant past medical history. On physical examination, he note the lesions on her eye lids are Xanthelsma. Which of the following is the best next step in the management of this patient? a. ECG and serum cardiac enzymes b. Serum lipids and blood glucose level c. Liver function tests and abdominal ultrasonography d. Complete blood count and stool guaiac test e. Slit lamp exam and ophthalmoscopy f. Lesion biopsy and surgeon referral

5. A cross-section of the right coronary artery of a 34year old male who died in cardiac intensive care unit is shown on the slide below. His father died of a heart attack at the age of 40. Assuming this patients disease had a genetic basis, poor receptor expression in which of the following organs is most likely responsible for his condition?
a. b. c. d. e. f. Small intestine Kidney Liver Heart Lung Pancreas

6. A 67-year old male with a past medical history significant for severe, ongoing drug-resistant hypertension, dies of intracranial hemorrhage. At autopsy, the right kidney is significantly shrunken, though the left kidney appears grossly normal. Which of the following mechanisms most likely explains the renal morphology in this patient? a. Congenital hypoplasia b. Lack of trophic hormones c. Denervation d. Oxygen and nutrient deprivation e. Senile changes

7. A 46-year old male who presented with abdominal pain is diagnosed with a rare vascular tumor. This type of tumor is often times associated with past arsenic or polyvinyl chloride exposure. Immunohistochemical staining of the tumor cells is positive for the CD 31 cell marker. The patient most likely has which of the following conditions?
a. b. c. d. e. f. g. h. i. Cavernous hemangioma Pyogenic granuloma Cystic hygroma Port-wine stain Kaposis sarcoma Lymphangiosarcoma Liver angiosarcoma Vascular ectasia Glomus tumor

8. A 43yr old male presents to your office complaining of heaviness in his legs. Physical examination reveals varicose veins. Which of the following is most likely abnormal in this patient?
a. b. c. d. e. Arterial intima Capillary permeability Venous valves Lymphoid capillaries Plasma oncotic pressure

9. Autopsy of a 65-year old Caucasian male demonstrates widespread narrowing of the renal arterioles. The arteriolar walls are homogenously thickened and stain pink with hematoxylin-eosin. The patient most likely suffered from
a. b. c. d. e. Malignant hypertension Chronic heart failure Rapidly progressive glomerulonephritis Hyperthyroidism Diabetes mellitus

10. A 62-yr old female presents with dialted and tortuous superficial viens in her lower legs. She says that her mother and grandmother had the same problem. The most likely complication of her condition would be which of the following? a. Myocardial infarction b. Skin ulcerations c. Pulmonary embolism d. Intermittent claudication e. Ischemic stroke f. Phlegmasia alba dolens

11. A 56 yr old male comes to the emergency room with

acute chest pain and dyspnea. Lung scanning reveals a large perfusion defect that does not match any ventilation abnormality. This patients condition is most likely the initial presentation of which of the following? a. Myocardial infarction b. Deep vein thrombosis c. Abdominal aorta aneurysm d. Malignant hypertension e. Exudative pleuritis f. Fibrinous pericarditis

12. A 50 yr old female with history of breast cancer treated by radical mastectomy and radiation several years ago, now presents with persistent right arm swelling. This patient is at increased risk of developing which of the following? a. Cavernous hemagioma b. Pyogenic granuloma c. Cystic hygroma d. Port-wine stain e. Kaposis sarcoma f. Lymphangiosarcoma g. Liver hemangiosarcoma

13. An infant presents with unexplained fever lasting five

days. Examination reveals conjunctival injection, strawberry tongue, peripheral edema, and a polymorphous rash. Which of the following is most likely? a) Takayasu arteritis b) Temporal arteritis c) Polyarteritis nodosa d) Wegener granulomatosis e) Thromboangiitis obliterans (Beurger) f) Mucocutanous lymph node syndrome (Kawasaki) g) Leukocytoclastic vasculitis (hypersensitive angiitis)

14. A male smoker presents with color changes to the

hands in a cold or stressful environment. Which of the following is most likely? a) Takayasu arteritis b) Temporal arteritis c) Polyarteritis nodosa d) Wegener granulomatosis e) Thromboangiitis obliterans (Beurger) f) Mucocutanous lymph node syndrome (Kawasaki) g) Leukocytoclastic vasculitis (hypersensitive angiitis)

15. A patient presents with ulcerations and

gangrene of the left fingertips. History reveals recurrent inflammation and pain of the hand. Thromboangiitis obliterans (Buergers disease) is suspected. Which of the following is the most effective treatment for this patient? a) Exercise thereapy b) Low molecular weight heparin c) Aspirin regimen d) Atorvastatin (Lipitor) e) Smoking cessation

16. A 65-year-old man has had fasting blood glucose

measurements in the range of 140 to 180 mg/dL for over 20 years. He presents with the sudden onset of severe abdominal pain. His heart rate is 110/minute, respirations 25, blood pressure 145/100 mmHg, and temperature 37 C. Physical examination reveals diminished pulses in the lower extremities. There is a pulsatile abdominal mass. His serum creatine kinase is not elevated. Which of the following conditions is he most likely to have A. Superior mesenteric artery thrombosis B. Atherosclerotic aortic aneurysm C. Polyarteritis nodosa D. Septic embolization E. Monkeberg's medial calcific sclerosis

17. A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged heart with predominantly left ventricular hypertrophy. Her kidneys are small, with cortical scarring, and microscopically they demonstrate small renal arterioles that have lumenal narrowing from concentric intimal thickening. These findings are most characteristic for A. Dominant polycystic kidney disease B. Arterial changes with diabetes mellitus C. Vascular disease with hyperlipidemia D. Malignant hypertension E. Monckeberg's sclerosis

18. A 74-year-old man has had increasingly severe, throbbing headaches for several months, centered on the right. He sees his physician, who records vital signs of T 36.1 R 22 P 82 and BP 130/85 mm Hg. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities. A biopsy of this lesion is obtained next, and histologic examination reveals a muscular artery with lumenal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy. Which of the following laboratory test findings is most likely to be present with this disease A. Erythrocyte sedimentation rate of 110 mm/hr B. Rheumatoid factor titer of 80 IU/mL C. HDL cholesterol of 15 mg/dL D. Anti-double stranded DNA titer of 1:1024 E. pANCA titer of 1:160

19. The sudden onset of chest pain in a 40-

year-old man is associated with a tear in the aortic intima. An inherited condition that is most likely to be associated with this finding is
a.Turner syndrome b.Neurofibromatosis c.Familial hypercholesterolemia d.Marfan syndrome e.Dilated cardiomyopathy

20. A 69-year-old man has a positive serum

serologic test for syphilis. A chest radiograph reveals prominence of the aortic knob. A chest CT scan reveals a thoracic aortic aneurysm? a. Cystic medial necrosis b. Aschoff nodules c. Small platelet and fibrin vegetations d. Inflammation with giant cells e. Obliterative endarteritis

21. A 45-year-old woman has been treated for

hypertension in the past, but her blood pressure is now recorded at 250/150 mm Hg, and she has a serum urea nitrogen of 4.5 mg/dL with creatinine of 49 mg/dL. Which of the following lesions involving the arterial circulation is most likely to accompany these findings: a. Monckeberg's arteriosclerosis b. Hyperplastic arteriolosclerosis c. Fibromuscular dysplasia d. Renal artery thrombosis e. Benign nephrosclerosis

22. A 31-year-old woman comes to see you because of

low back pain. After an extensive analysis of the situation, you recommend regular exercise, such as walking. To encourage the patient, you tell her that exercise might increase her HDL levels. Higher HDL levels are beneficial because they: a. Lower LDL cholesterol levels b. Inhibit lipoprotein lipase activity c. Slow apolipoprotein B transfer to LDL d. Accelerate receptor-mediated LDL uptake e. Promote cholesterol transport from arteries to the liver

23. For the past 3 weeks a 70-year old woman has been

bed ridden while recuperating from a bout of viral pneumonia complicated by bacterial pneumonia. Physical examination now shows some swelling and tenderness of the right leg, which worsens when she raises or moves the leg. Which of the following terms best describes the condition involving the patients right leg? a. Lymphedema b. Disseminated intravascular coagulopathy c. Thrombophlebitis d. Thromboangiitis obliterans e. Varicose veins

24. 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. Oxidized LDL d. Platelet-derived growth factor e. VLDL

25. A 46-yr 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 arrayof 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 1.1mg/dL, total protein of 5.8g/dL, and albumin of 3.4g/dL. Which of the following underlying disease is most likely to be present in this patient? a. Wegener granulomatosis b. Micronodular cirrhosis c. Marfan syndrome d. AIDS e. Diabetes mellitus

26. 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 angiogram 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 catechlamines

27. A 3 year old child from osaka ,japan , developed a fever

and a rash and swelling of her hands and feet over 2 days. On physical examination , her temperature is 37 degrees centigrade. There is a desquamative rash, oral erythema , erythema of palms and soles , edema of hands and feet and cervical lymphadenopathy. The child improves after a course of intra venous immunoglobulin therapy. Which of the following is most likely to be a complication of this childs disease if it is untreated? a) asthma b) Glomerulonephritis c) Intra cranial hemorhage d) Myocardial infarction e) Pulmonary hypertension

28. A cohort study is performed involving healthy adult men and women born 20years ago. They are followed to assess development of atherosclerotic cardiovascular disease. Multiple lab tests are performed yearly during this study . An elevation of which of the following test results is most likely to indicate the greatest relative risk for development of one of these diseases? a) anti proteinase 3 b) C- reactive protein c) Cryoglobulin d) Erythrocyte sedimentation rate e) Platelet count