Atherosclerotic Disease — MCQs
Ankle-brachial index is useful in prediction of:
Falsely elevated ankle brachial index is used for evaluation of?
Claudication due to femoropopliteal incompetence is primarily seen in
Atherosclerosis is associated with:
Which of the following is the best management for radiation induced occlusive disease of carotid artery?
All of the following are risk factors for atherosclerosis EXCEPT which of the following?
Problems which may result from hypotensive anesthesia include:
Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?
All are absolute indications for amputation except,
Which of the following conditions is primarily treated by sympathectomy?
Atherosclerotic Disease Indian Medical PG Practice Questions and MCQs
Question 1: Ankle-brachial index is useful in prediction of:
- A. All of the options
- B. Myocardial infarction (Correct Answer)
- C. Buerger's disease
- D. Meconium ileus
Explanation: ***Myocardial infarction*** - A low **ankle-brachial index (ABI)** indicates broader **atherosclerotic disease**, which is a significant **risk factor** for **myocardial infarction** and other **cardiovascular events** [1]. - ABI measures arterial insufficiency in the lower extremities; a value less than 0.9 suggests **peripheral artery disease (PAD)**, independently predicting future cardiac events [1]. *Buerger's disease* - Not directly predicted by ABI in the context of general cardiovascular risk; **Buerger's disease** is an **inflammatory vasculitis** primarily affecting small and medium-sized arteries and veins. - While it causes digital ischemia, its etiology and pathophysiology are distinct from the general atherosclerotic burden measured by ABI. *Meconium ileus* - **Meconium ileus** is a **gastrointestinal obstruction** in newborns, typically associated with **cystic fibrosis**, and has no relationship with the **ankle-brachial index** measurement. - ABI is a vascular diagnostic tool, not relevant to pediatric gastrointestinal conditions. *All of the options* - This is incorrect because **meconium ileus** and **Buerger's disease** are not primarily or directly predicted by the ankle-brachial index. - ABI is a strong predictor of systemic atherosclerosis and associated events like myocardial infarction, but not unrelated conditions [1].
Question 2: Falsely elevated ankle brachial index is used for evaluation of?
- A. Deep vein thrombosis
- B. Acute limb ischemia
- C. Calcified vessels (Correct Answer)
- D. Chronic venous insufficiency
Explanation: A falsely elevated **ankle-brachial index (ABI)**, often >1.3, indicates that the **ankle arteries are non-compressible** due to calcification [1]. This calcification is common in conditions like **diabetes** and **end-stage renal disease**, where the vessels become stiff and resist compression, leading to inaccurate pressure readings [1].
Question 3: Claudication due to femoropopliteal incompetence is primarily seen in
- A. Calf (Correct Answer)
- B. Thigh
- C. Buttocks
- D. Feet
Explanation: ***Calf*** - **Claudication** pain due to popliteal or femoral artery disease typically manifests in the **calf muscles** because these muscles are distal to the affected arteries and demand increased blood flow during exertion. - The popliteal and femoral arteries are major blood suppliers to the lower leg, and their incompetence leads to **ischemia** in the calf during activity. *Thigh* - **Thigh claudication** usually indicates a more proximal obstruction, such as in the **external iliac artery** or **common femoral artery**. - While the femoral artery supplies the thigh, its incompetence often first affects the more distal calf due to greater metabolic demand during walking. *Buttocks* - **Buttock claudication** is generally associated with very proximal arterial disease, specifically involving the **aortoiliac segment**. - Blockages in the **aorta** or **common iliac arteries** can restrict blood flow to the gluteal muscles, causing pain in the buttocks. *Feet* - **Foot claudication** is less common as a primary symptom and usually signifies **severe, widespread peripheral artery disease** affecting smaller, more distal arteries. - Pain isolated to the feet is more often associated with **rest pain** or **critical limb ischemia**, indicating advanced disease rather than exertional claudication.
Question 4: Atherosclerosis is associated with:
- A. Histidine
- B. Lysine
- C. Homocysteine (Correct Answer)
- D. Leucine
Explanation: ***Homocysteine*** - Elevated plasma levels of **homocysteine**, known as hyperhomocysteinemia, are an independent **risk factor for atherosclerosis** and cardiovascular disease. - While the precise mechanism is complex, homocysteine is thought to promote endothelial damage, oxidative stress, and lipid peroxidation, contributing to **plaque formation**. *Histidine* - **Histidine** is an essential amino acid involved in various metabolic processes, including the synthesis of **histamine** and carnosine. - It is not directly associated with the pathogenesis or risk factors for atherosclerosis. *Lysine* - **Lysine** is an essential amino acid important for **protein synthesis** and many bodily functions. - There is no established direct link between lysine levels and the development or progression of atherosclerosis. *Leucine* - **Leucine** is a branched-chain amino acid (BCAA) crucial for **muscle protein synthesis** and energy metabolism. - While some studies hint at associations between BCAAs and metabolic health, leucine itself is not a known direct risk factor or etiologic agent for atherosclerosis.
Question 5: Which of the following is the best management for radiation induced occlusive disease of carotid artery?
- A. Carotid endarterectomy
- B. Low dose aspirin
- C. Carotid bypass procedure
- D. Carotid angioplasty and stenting (Correct Answer)
Explanation: ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.
Question 6: All of the following are risk factors for atherosclerosis EXCEPT which of the following?
- A. Hypercholesterolemia
- B. Smoking
- C. Hypertension
- D. Normal LDL cholesterol (Correct Answer)
Explanation: ***Normal LDL cholesterol*** - **Normal LDL cholesterol** levels indicate a healthy lipid profile, which is protective against rather than a risk factor for **atherosclerosis**. - **Low-density lipoprotein (LDL)** is often referred to as "bad cholesterol" because high levels contribute to plaque buildup in arteries [1]. *Hypercholesterolemia* - **Hypercholesterolemia**, particularly elevated **LDL cholesterol**, is a primary independent risk factor for the development and progression of **atherosclerosis** [1]. - Excess cholesterol leads to the formation of **fatty streaks** and **atheromatous plaques** within arterial walls [2]. *Smoking* - **Smoking** severely damages the **endothelium**, making blood vessels more susceptible to plaque formation and promoting **atherosclerosis**. - It also reduces **HDL cholesterol**, increases **oxidative stress**, and promotes **inflammation**, all contributing to arterial damage [1]. *Hypertension* - **Hypertension** (high blood pressure) causes chronic mechanical stress on the arterial walls, leading to **endothelial injury** and dysfunction [3]. - This damage facilitates the infiltration of lipids and inflammatory cells, accelerating the development of **atherosclerotic plaques** [2].
Question 7: Problems which may result from hypotensive anesthesia include:
- A. Deep vein thrombosis
- B. Reactionary hemorrhage
- C. Retraction anemia
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - Hypotensive anesthesia is a technique used to reduce **blood pressure** during surgery, aiming to decrease **blood loss** and improve the **surgical field visibility**. - While beneficial, it carries inherent risks including **deep vein thrombosis (DVT), reactionary hemorrhage**, and complications like **retraction anemia** if not managed properly. *Deep vein thrombosis (DVT)* - While hypotension might seem to reduce the risk by lowering **blood flow velocity**, prolonged immobility and potential for **venous stasis** during any surgery, especially under hypotension, can increase DVT risk. - The combination of **endothelial dysfunction** and **hypercoagulability** often seen in surgical patients, coupled with reduced peripheral blood flow due to hypotension, can contribute to DVT formation. *Reactionary hemorrhage* - This is a common post-operative complication where bleeding restarts hours after surgery. With hypotensive anesthesia, **blood vessels** are constricted and may not be actively bleeding during the surgery. - As the patient's **blood pressure** returns to normal post-operatively, these previously undetected bleeds can manifest as significant **hemorrhage** due to the increased pressure. *Retraction anemia* - This term is less commonly used in medical literature. However, it likely refers to the complications arising from prolonged tissue retraction during surgery, which, when combined with reduced **perfusion** from hypotensive anesthesia, can lead to **tissue ischemia** or damage akin to anemia in the affected area. - The reduced **oxygen delivery** to tissues during hypotensive states, especially when further compromised by retraction, may result in localized tissue injury or contribute to systemic complications if severe or prolonged.
Question 8: Which of the following changes is NOT seen in atherosclerotic plaque at the time of rupture?
- A. Inflammatory cell infiltration
- B. Thick fibrous cap (Correct Answer)
- C. Cell debris
- D. Smooth muscle cell atrophy
Explanation: ***Smooth muscle cell hypertrophy*** - **Smooth muscle cell hypertrophy** is generally associated with stable plaques and does not typically occur in ruptured atherosclerotic plaques [2]. - At rupture, there is **loss of smooth muscle cells** and thinning of the fibrous cap, leading to plaque instability [2]. *Thin fibrosis cap* - A **thin fibrous cap** is a critical feature of vulnerable plaques, making them prone to rupture [2]. - It indicates a **weakened structure** that can no longer withstand the pressure of the underlying lipid core [2]. *Cell debris* - **Cell debris** is often found at the site of rupture, resulting from the necrosis of foam cells and smooth muscle cells. - This indicates **plaque instability** and contributes to the thrombus formation at the rupture site. *Multiple foam cap* - The presence of **multiple foam cells** reflectsing lipid accumulation in the plaque but does not contribute to the phenomenon of plaque rupture directly. - While foam cells are associated with rupture, a **foam cap** is not a recognized pathological finding at the time of rupture. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 271-272. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 268-270.
Question 9: All are absolute indications for amputation except,
- A. Frost bite (Correct Answer)
- B. Buerger's gangrene
- C. Gas gangrene
- D. Diabetic gangrene
Explanation: ***Frost bite*** - While severe **frostbite** can lead to amputation, it is not an absolute indication as initial management often involves **rapid rewarming**, observation, and conservative measures to preserve tissue. - Amputation is typically considered only after the full extent of tissue damage is clear, and conservative treatments have failed or severe infection develops. *Buerger's gangrene* - **Buerger's disease (thromboangiitis obliterans)** is a progressive inflammatory obliterative disease of small and medium-sized arteries and veins, mainly affecting the limbs. - **Gangrene** in Buerger's disease is often severe and progressive, frequently leading to **autoamputation** or surgical amputation to prevent spread and manage pain. *Gas gangrene* - **Gas gangrene** is a rapidly progressive and life-threatening infection caused by Clostridium species, which produces toxins and gas in tissues. - It necessitates urgent and aggressive treatment, including **radical débridement** or **amputation** to remove infected tissue and prevent sepsis. *Diabetic gangrene* - **Diabetic gangrene** arises from severe peripheral artery disease and neuropathy in diabetic patients, compromising blood supply and sensation. - The compromised blood flow and presence of infection often result in tissue necrosis requiring **amputation** to prevent further spread of infection and systemic complications.
Question 10: Which of the following conditions is primarily treated by sympathectomy?
- A. Buerger's disease
- B. Acrocyanosis
- C. Hyperhidrosis (Correct Answer)
- D. Raynaud's disease
Explanation: ***Hyperhidrosis*** - **Sympathectomy** (especially thoracic sympathectomy) is a definitive treatment for severe, localized **hyperhidrosis** (excessive sweating) that has not responded to conservative therapies. - The procedure aims to interrupt the sympathetic nerves responsible for stimulating sweat glands, commonly in the palms, soles, or axillae. *Buerger's disease* - While **sympathectomy** was historically used, its efficacy in **Buerger's disease** (thromboangiitis obliterans) is questionable and largely replaced by smoking cessation and other treatments for limb salvage. - The primary issue is **inflammation** and **thrombosis** of small and medium-sized arteries and veins, not primarily sympathetic overactivity. *Acrocyanosis* - **Acrocyanosis** is a benign condition characterized by persistent, painless, blue discoloration of the extremities due to vasospasm of small skin arteries and arterioles. - Treatment is generally reassurance and avoidance of cold, and **sympathectomy** is rarely, if ever, indicated or effective due to the non-progressive and cosmetic nature of the condition. *Raynaud's disease* - **Raynaud's disease** is a vasospastic disorder, but **sympathectomy** is usually reserved for severe cases with impending tissue loss or critical ischemia that fail medical management. - Medical management with calcium channel blockers is the primary treatment, as the condition involves episodic vasospasm of digital arteries.
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