Hypertensive disease

#

A 25-year-old man experiences chest pain on exercise when he attempts to climb three flights of stairs. This pain is relieved by sublingual nitroglycerin. Laboratory studies show a total serum cholesterol of 550 mg/dL with an HDL cholesterol component of 25 mg/dL. He is worried about these findings because his brother died of a myocardial infarction at age 34. Which of the following conditions is this man most likely to have?

Diabetes mellitus, type II

Malignant hypertension

Familial hypercholesterolemia

Gushing syndrome

Morbid obesity

#

A 70 year old man is ill with vascular atherosclerosis of lower extremities and coronary heart disease. Examination revealed disturbance of lipidic blood composition. The main factor of atherosclerosis pathogenesis is the excess of the following lipoproteins:

@Low-density lipoproteins

Intermediate density lipoproteins

Cholesterol

High-density lipoproteins

Chylomicrons

#

A 56-year-old has not received any medical care nor seen a physician for years. He reports reduced exercise tolerance over the past 5 years. On occasion in the past year he has noted chest pain after ascending a flight of stairs. He smokes 2 packs of cigarettes per day. He is found to have a blood pressure of 155/95 mm Hg. His body mass index is 30. Laboratory findings include a total serum cholesterol of 245 mg/dL with an HDL cholesterol that is 22 mg/dL. Which of the following vascular abnormalities is most likely to be his most serious health risk?

Hyperplastic arteriolosclerosis

Lymphedema

Medial calcific sclerosis

@Atherosclerosis

Deep venous thrombosis

Plexiform arteriopathy

#

An autopsy study reveals that evidence for atheroma formation can begin even in children. The gross appearances of the aortas are recorded and compared with microscopic findings of atheroma formation. Which of the following is most likely to be the first visible gross evidence for the formation of an atheroma?

Thrombus

@Fatty streak

Calcification

Hemorrhage

Ulceration

#

An aorta at autopsy that demonstrated a mild degree of atherosclerosis with only lipid streake and just a few atheromatous plaques would be most consistent with which of the following histories from patients:

A 62-year-old man with familial hypercholesterolemia

@A 48-year-old man who exercises regularly

A 45-year-old woman with nodular glomerulosclerosis

A l0-year-old child killer in a motor vehicle accident.

A 56-year-old man with angina

#

A 45-year-old male died in a traffic accident. A histological investigation of his aorta revealed a lipid infiltration of its intima with fats accumulation in myocytes and macrophages of aortal medial layer. Name the stage of atherosclerosis?

@Lipoidosis

Liposclerosis

Atheromatosis

Pre-lipoidosis

Atherocalcification

#

A post-mortem of a 65-year-old male revealed yellowish streaks and spots in the abdominal aorta's intima, which did not rise above endothelial surface. These areas were stained by Sudan III in orange color. What stage of atherosclerosis such changes are characteristic for?

@Lipidosis

Liposclerosis

Atheromatosis

Ulceration

Atherocalcification

#

At autopsy of 52-year-old male revealed yellowish areas at his aorta's intima, this did not bulge above its surface. Histological investigation showed the accumulation of cells with foamy cytoplasm, stained by Sudan III in yellow color. Name the most likely stage of atherosclerosis in aorta?

@Lipidosis

Liposclerosis

Atheromatosis

Pre-lipoidosis

Atherocalcification

#

A 46-year-old male suddenly died after developing a heart failure. An autopsy revealed in abdominal aorta the yellow color areas, which did not rise over its surface. Histological investigation of aorta showed the aggregations of cells with a foamy cytoplasm among smooth mussels and macrophages. These cells had a motley-orange coloring, when stained by a Sudan III. For what stage of an atherosclerosis such picture is characteristic?

@Lipoidosis

Liposclerosis

Atheromatosis

Ulceration

Atherocalcification

#

At autopsy of an elderly female an aorta tissue sample collected for histology. Microscopic investigation revealed in aorta's intima the accumulation of xanthoma's cells. At what disease such morphological picture is possible?

@Atherosclerosis

Hypertension

Syphilitic mesaortitis

Nonspecific aortoarteritis

Nodular periarteritis

#

The first visible gross evidence for the formation of an atheroma in an artery such as the aorta, even in a young person, is a(an):

Thrombus

@ Fatty streak

Calcification

Hemorrhage

Inflammatory infiitra.tr;

#

A 53-year-old female died from acute myocardial infarction. An autopsy revealed multiple whitish dense plaques in her coronal arteries' intimae, which bulged in and narrowed the vessel's lumen. Name the most likely stage of a coronary atherosclerosis?

@Liposclerosis

Lipoidosis

Atheromatosis

Atherocalcification

Ulceration

#

During the section of a 69-year-old woman with overweight, who died of acute myocardial infarction, were revealed multiple whitish solid formations in the tunica intima of coronary arteries. They bulge into the lumen and constrict it. What stage of atherosclerosis is described?

Stage of a creation of an atheromatous ulcer

Lipoidosis

Atheromatosis

Atherocalcinosis

@Liposclerosis

#

A post-mortem of an elderly male revealed microscopic alteration of his coronary artery. There was narrowing of vessel's lumen due to a fibrous plaque with some admixture of lipids. Name the stage of atherosclerosis:

@Liposclerosis

Lipoidosis

Pre-lipoidosis

Atheromatosis

Atherocalcification

#

A 54-year-old male died after developing a heart failure. An autopsy revealed a chronic venous hyperemia of the internal organs, hypertrophy of the left ventricle of a heart and focal cardiosclerosis. Gross investigation of aorta showed yellow-white plaques in the intima with fine-grained masses in their centers, which infiltrated the aortal wall. Give the name of this pathological process.

@Atheromatosis

Lipoidosis

Liposclerosis

Arteriolosclerosis

Calcinosis.

#

A 73-year-old woman who exercises regularly falls down the stairs and injures her right hip. A radiograph is taken of the pelvis. There is no fracture but the radiograph reveals calcification of the small muscular arteries in the region of the pelvis. What is the probable vascular lesion which accounts for this calcification?

@Ulcerative atherosclerosis

Calcific medial sclerosis

Metastatic calcification

Trauma

Dystrophic calcification

#

If the coronary arteries on dissection at autopsy show severe atherosclerosis in a patient who had clinically acute (60-h) myocardial infarction, you would expect to find

Gross evidence of myocardial scarring

Coronary thrombosis in 90 percent of cases

Coronary thrombosis in 65 percent of cases

@A plaque with ulceration, fissure, or hemorrhage

Rupture of a papillary muscle

#

Which of the following complications is LEAST likely to occur in a 49-year-old woman who has developed severe generalized atherosclerosis over the past 20 years:

Sudden death

Gangrene of the right big toe

@Pulmonary artery atherosclerosis

Remote (healed) myocardial infarction

Retinopathy with blindness

#

A 63-year-old man has had insulin dependent diabetes mellitus for over two decades. The degree of control of his disease is characterized by the laboratory finding of a hemoglobinAIC of 10.1%. He has noted episodes of abdominal pain following meals, these episodes have worsened over the past year. On physical examination, there are no masses and no organomegaly of the abdomen, and he has no tenderness to palpation. Which of the following pathologic findings is most likely to be present in this man?

Ruptured aortic aneurysm

Hepatic infarction

@Mesenteric artery occlusion

Acute pancreatitis

Chronic renal failure

#

A 70-year-old man has noted coldness and numbness of his lower left leg, increasing over the past 4 months. He also experiences pain in this extremity when he tries walking more than the distance of half a city block. On physical examination, his dorsalis pedis, posterior tibial, and popliteal artery pulses are not palpable. Which diagnosis is he most likely to have?

General atherosclerosis

Trombophlebitis

Atheromatosis

Atherocalcinosis

@Atherosclerosis of a. femoralis

#

A patient has tissue ischemia lower the knee joint, accompanied with "intermittent claudication". Which artery is occluded in this case?

Posterior tibial

Proximal part of the femoral

Anterior tibial

@Popliteal

Fibial

#

The gross appearance an aorta with severe ulcerative atherosclerosis is associated with each of the following additional findings EXCEPT:

Mural thrombosis

Diabetes mellitus, type I

Hypercholester-olemia

@Neopiasia

Aneurysm formation

#

A 66-year-old male suddenly died on his way to operation room. An autopsy revealed a hemorrhage into retroperitoneal fat, a saccular dilatation of the abdominal aorta wall with rupture in arterial wall. The aorta's defect had uneven edges and stony hardening of surrounding tissues. Name the disease, resulted in described complication?

@Atherosclerosis

Hypertension

Systemic vasculitis

Visceral Syphilis

-

#

A 56-year-old man present with the sudden onset of excruciating pain. He describes the pain as beginning in the anterior chest, radiating to the back, and then moving downward into the abdomen. His blood pressure is found to be 160/115. Your differential diagnosis includes myocardial infarction; however, no changes are seen on ECG, and you consider this to be less of a possibility. You obtain an x-ray of this patient’s abdomen and discover a “double-barrel” aorta. Which of the following is the basic cause of this abnormality?

A microbial infection

Loss of elastic tissue in the media

A congenital defect in the wall of the aorta

@Atherosclerosis of the abdominal aorta

Abnormal collagen synthesis

#

Under macroscopic (gross) investigation of aorta yellow patches and stripes, fibrous plaques, ulcers were found out in its intima. What disease is characterized with such changes?

@Atherosclerosis

Rheumatic fever

Tuberculosis

Diphtheria

Typhoid fever

#

A 77-year-old woman has experienced abdominal pain for the past month. On physical examination, she has a pulsatile lower abdominal mass. An abdominal CT scan reveals an abdominal aorta dilated to 7 cm in diameter, with calcification of the aortic wall. While awaiting surgery, she has an episode of severe abdominal pain and a repeat CT scan shows marked retroperitoneal hemorrhage. Which of the following diagnosis is she most likely to have?

Atherosclerosis of aorta

General atherosclerosis

True aneurysm

False aneurysm

Stratified aneurysm

#

Hypertension is most closely related to the formation of which one of the following types of aneurysms?

Berry aneurysm

Atherosclerotic aneurysm

Mycotic aneurysm

@Charcot-Bouchard aneurysm

Saccular aneurysm

#

An autopsy study is conducted involving the gross appearance of the aorta of adults ranging in age from 60 to 90. In some of these patients, the aorta demonstrates atheromatous plaques covering from 70 to 95% of the intimal surface area, mainly in the abdominal portion, with ulceration and calcification. Which of the following contributing causes of death are these patients most likely to have?

Hyperparathyroidis

@Hypertension

Marfan syndrome

Thrombophlebitis

Vasculitis

#

A 49-year-old woman has experienced marked pain in her lower extremities on ambulation more than 300 meters for the past 5 months. On physical examination, her lower extremities are cool and pale, without swelling or erythema. No dorsalis pedis or posterior tibial pulses are palpable. Her body mass index is 32. She is a smoker. Which of the following abnormalities of the vasculature is most likely to account for these findings?

Lymphatic obstruction

@Arteriolosclerosis

Atherosclerosis

Medial calcific sclerosis

Venous thrombosis

#

An elderly woman, with a long history of bronchial asthma, ischemic heart disease and hypertension, presented with hypertrophy of her heart's left ventricle. Name the cause of the heart alteration?

@Arterial hypertension

Pulmonary insufficiency

Chronic ischemia of cardiac muscle

Bronchial asthma

Emphysema of lights

#

A 63-years-old patient, with a history of hypertensive disease, died from cardiac insufficiency. At autopsy, the heart enlargement and dilated ventricular cavities were revealed. Microscopical investigation showed marked hypertrophy of cardiomyocytes, with their fatty dystrophy and hyperchromic barrel-like nucleuses. What pathological process is the most likely in a heart?

@Eccentric hypertrophy

Myocarditis

Concentric hypertrophy

Angiogenic cardiosclerosis

Cardiomyopathy

#

An artery demonstrates concentric endothelial cell proliferation which markedly narrows the lumen, resulting in focal ischemia and hemorrhage. This histologic finding is likely to be found:

Most frequently in the small vessels of the liver

Most commonly in the enderly

@In association with progressive hypertension (diastolic >110 mm Hg)

Accompanying an acute myocardial infarction

As a result of hereditary hypercholesterolemia

#

The form of vascular disease responsible for malignant hypertension is

Medial calcific sclerosis

Arteriosclerosis obliterans

@Hyperplastic arteriolosclerosis

Hyaline arteriolosclerosis

Thromboangiitis obliterans

#

A 41-year-old woman present with recurrent severe headaches and increasing visual problems. Physical examination reveals her blood pressure to be 220/150. Her symptoms are most likely to be associated with which one of the following abnormalities?

Medial calcific sclerosis

Arteriosclerosis obliterans

@Hyperplastic arteriolosclerosis

Hyaline arteriolosclerosis

Tromboangiitis obliterans

#

A 64-years-old male died from uremia. At autopsy revealed reduced in sizes kidneys, with 50.0g weight. Their surfaces were regularly granulated; the cortexes were thin. A microscopic study showed considerably thickened walls of glomerular arterioles due to deposition of homogeneous unstructured pink masses. The lumens of these vessels were markedly narrowed; nephrons were diminished with sclerotic changes, tubules were atrophic. For what disease the described changes are characteristic?

@Hypertension

Chronic glomerulonephritis

Amyloidosis of kidneys

Pyelonephritis with scarring of kidneys

Acute necrotic nephrosis

#

Malignant hypertension in a 44-year-old African-American man with a blood pressure of 275/150 mm Hg is most closely associated with which of the following pathologic lesions:

@Hyperplastic arteriolosclerosis with fibrinoid necrosis

Nodular glomerulonecrosisand renalhyaline arteriosclerosis

Monckeberg's medial calcific arterial sclerosis

Severe occlusive coronary artery atherosclerosis with recent thrombosis

Thrombophlebitis with pelvic vein thrombosis

#

A 52-year-old male had a long history of hypertension. He presented to emergency care physician with complains of an acute, persisted for few hours rise of a blood pressure. What is the most likely alteration of the arterioles' walls due to hypertonic crisis?

@Fibrinous necrosis •

Hyalinosis

Sclerosis

Amyloidosis

Calcinosis

#

A patient with hypertensive disease was diagnosed a long hypertensive crisis. Name the pathomorphologic changes in the arterioles walls during the hypertensive crisis.

@Fibrinoid necrosis

Hyalinosis

Sclerosis

Amyloidosis

Calcinosis

#

At autopsy, the kidneys are of normal size. Their surfaces appear finely granular. There are small hemorrhages noted. The cortices appear pale. Microscopically, many small renal arteries and arterioles demonstrate concentric intimal thickening with marked luminal narrowing. These finding are most likely to be present in which of the following patients:

A 54-year-old man with chronic renal failure and amyloidosis

A 29- year-old woman with proteinuria and lupus nephritis

@A 44-year-old woman with marked hypertension and scleroderma

A 49-year-old man with acute cellular allograft rejection

A 19- year-old woman with graft versus host disease

#

An elderly male, with 15 years history of essential hypertension, died from renal failure. What would be the most likely gross picture of his kidneys at autopsy?

@Small, dense, a surface is fine-grained.

Large pied and soft.

Large red

Large white and smooth

Large with the plural thin-walled cysts.

#

A 67-year-old patient had hypertensive disease for 20 years and died of chronic renal insufficiency. How did the kidneys look at the autopsy?

Big, white

Big, mottled

Big, red

@Little, solid with fine-grained surface

Big with numerous thin-walled cysts

#

At autopsy the diminished kidneys with weight of 50.0 have been found out, the surface has been closed-grained, cortex has been uniformly thinned. At microscopic examination a wall of arterioles has been considerably thickened because of deposition of homogeneous unstructured pink colored masses, the lumen has sharply narrowed down; the glomeruli have been reduced, with sclerosis and atrophy of tubules. What disease

@Hypertensive disease

Chronic glomerulonephritis

Amyloidosis of kidney

Pyelonephritis with shrinkage of kidneys

Acute necrotic nephrosis

#

An autopsy of a 61-year -old female revealed the thickening of her heart's left ventricle up to 2.5 cm. Her kidneys were small, contracted and firm. The surface of the kidneys had a granular appearance. On a cut, there was a thinning of a cortical substance. Microscopical investigation showed arteriolosclerosis, glomerulosclerosis and interstitial sclerosis. What is the most likely disease?

@Hypertension

Atherosclerosis

Ischemic heart disease

Rheumatism

Amyloidosis of kidneys

#

A 65-year-old male long time was ill by hypertensive disease and died from chronic kidney insufficiency. The autopsy showed, that both kidneys are considerably decrease in sizes, their surfaces are granulated; histologically - most glomeruluses are containing hyaline, part of them in sclerotic condition, other in hyperplasia; in stroma - the fields of sclerosis, arteriolo- and arteriosclerosis, elastofibrosis of large kidney arteries branches. What is the name of the exposed changes?

@Arteriolosclerotic nephrosclerosis

Atherosclerotic nephrosclerosis

Secondary-restricted kidney

Chronic pyelonephritis

Amyloidal- scarring kidney.

#

A 60-year-old man was ill with hypertensive disease for a long time and died of chronic renal insufficiency. At the autopsy was revealed that both kidneys were greatly decreased in size. Their surface was fine-grained. Histologically: the majority of glomeruli were hyalinized, part of them was sclerosed, and some of them were hyperplased. Stroma had the areas of necrosis, arteriolo- and arteriosclerosis, elastofibrosis of large branches of renal arteries. Name these changes.

Secondary wrinkled kidney

Aterosclerotic nephrosclerosis

Chronic glomerulonephritis

Chronic pyelonephritis

@Arteriolosclerotic nephrosclerosis

#

A 64-years-old patient died from the brain's hemorrhage. An autopsy revealed markedly decreased kidneys (6x3x2cm in sizes and 60, 0 grams weight). They were dense, anemic with an even, fine- grained surface. On a cut, there was a constant thinning of the kidneys' cortex. Changes in kidneys are the implication of:

@Arteriolosclerotic nephrosclerosis

Atherosclerotic nephrosclerosis

Secondary- scarring kidney

Amyloidal- scarring kidney.

Gouty kidneys

#

A 57-year-old man has had blood pressure measurements in the range of 160/95 to 180/110 mm Hg for many years. He has taken no medications. A renal scan reveals kidneys of normal size for age. These finding with benign nephrosclerosis are most likely to occur with which of the following vascular change:

@Hyaline arteriolosclerosis

Monckeberg's medial calcific sclerosis

Complex calcified atherosclerosis

Arterial mural thrombosis

Hyperplastic arteriolosclerosis

#

An autopsy of 48-year-old patient, who died from the complications of hypertensive disease, revealed small, dense kidneys with fine-grained surface. Parenchyma and cortex matter were atrophied. Give the name for such kidneys.

@Primary-scarring kidneys

Amyloidal-scarring kidneys

Secondary-scarring kidneys

Pyelonephritic-scarring of kidneys

-

#

A 63-year-old man, with a long history of hypertensive disease, died from a hemorrhage in the brain. An autopsy revealed reduced in sizes, firm kidneys with fine-grained surface and thinned cortex matter. These changes in kidneys are characteristic for:

@Primary-scarring kidneys

Secondary-scarring kidneys

Amyloidal-scarring kidneys

Pyelonephritic-scarring of kidneys

Infarct of the kidney

#

An autopsy of an elderly woman, with a long history of hypertensive disease, revealed small size and weight (80 grams), firm kidneys. They had grey color and granular surface. On a cut, there was uniform thinning of a cortex. How it is possible to name the changes in kidneys?

@Primary- scarring kidneys

Pyelonephritic scarring of kidneys

Secondary - scarring kidneys

Amyloidal- scarring kidneys

Diabetic glomerulosclerosis

#

At the autopsy of a man who died of hypertensive disease’ complications, small solid kidneys with fine-grained surface were revealed. They had atrophic parenchyma and cortex. Name these kidneys.

Amyloid-wrinkled

@Primary wrinkled

Secondary wrinkled

Pyelonephritic-wrinkled

Atrophic

#

An elderly male, with 20 years history of hypertension, died from uremia. An autopsy revealed a heart hypertrophy and diffuses cardiosclerosis. There were also small, dense kidneys with granularity of their surface. Histological investigation of kidneys tissue showed the collapse of glomerular's arterioles and sclerosis. Some glomeruli were replaced with pinkish homogenous masses, negative to the Kongo-red staining. Tubules were atrophic. Name the kidney pathology?

@Primary-scarring kidneys

Secondary - scarring kidneys

Amyloidosis

Chronic glomerulonephritis

Chronic pyelonephritis

#

A 53-year-old man presents with severe headaches, nausea, and vomiting. He also relates seeing sport before his eyes and is found to have a diastolic blood pressure of 160 mmHg. Microscopic examination of a renal biopsy demonstrates hyperplastic arteriolitis. Gross examination of his kidneys is most likely to reveal which one of the following changes?

A finely granular appearance to the surface

@Multiple small petechial hemorrhages on the surface

Diffuse, irregular cortical scars overlying dilated calyces

Cortical scars overlying dilated calyces in renal poles

Depressed cortical areas overlying necrotic papillae of varying stages

#

Choose correct features of atherosclerosis (3 points):

Acute disease

@Chronic disease

Lesions develop in the small-sized arteries

Lesions develop in the both small-sized and large-sized arteries

@Aorta have been damaged

Aorta and large veins have been damaged

Branches of pulmonary artery have been damaged

Develops due to lipid disorders

@Develops due to both lipid and protein disorders

#

Choose correct gross-view atherosclerotic changes ofarteria(4 points):

@Fatty streaks

Liposclerosis

Ulceration of intima of small-sized arteries with mural thrombosis

@Ulceration of intima of aorta with intramural hemorrhages

Increased permeability ofendothelial cells and basement membrane

@Fibrous plague

Intracellular accumulation of the lipids

@Fibrofatty atheroma

#

Choose correct morphological features characterized fatty streaks changes of atherosclerosis (4 points):

@Have been revealed in all ages

@More often develop in the zones of branches of aorta

For the first time appear in the abdominal part of aorta

Are elevated upon the intima

@Are not be elevated upon the surface of the intima

Lead to stenosis of the lumen of the aorta

@Histologically are intimal aggregation of foam cells derived from the macrophages

Histologically are intimal aggregation of lipid cells derived from adipose tissue

#

Choose correct features of the malignant form of hypertension disease (3 points):

Hyaline arteriolosclerosis

@Hyperplastic arteriolosclerosis

@Concentric, laminated thickening of the walls of arterioles

Excentric, laminated thickening of the walls of arterioles

Necrotizing phlebitis

Necrotizing arteritis

@Necrotizing arteriolitis

#

All features of hypertension disease are true EXEPT (3 points):

Infarctionofmyocardium

@Infarction of spleen

@Infarction of brain

Hemorrhages of brain

Hyaline arteriolosclerosis

Hyperplastic arteriolosclerosis

@Necrotizing arteritis

#

Date: 2016-03-03; view: 2181