Cardiovascular — MCQs

A 67-year-old man with a long-standing history of gastroesophageal reflux disease undergoes upper endoscopy. A biopsy from 2 cm above the gastroesophageal junction is obtained from an area of salmon-colored mucosa. Histological examination shows replacement of the normal squamous epithelium by columnar epithelium containing goblet cells interspersed among columnar absorptive cells, with intact basement membrane and no nuclear stratification, pleomorphism, or loss of polarity. Which of the following statements most accurately characterizes the biological behavior and reversibility of this histological change?

A 34-year-old woman presents with fatigue, night sweats, and painless cervical lymphadenopathy. Excisional biopsy of a cervical lymph node is performed. Large binucleate cells with prominent eosinophilic 'owl-eye' nucleoli are surrounded by a mixed inflammatory background of lymphocytes, eosinophils, plasma cells, and neutrophils. Which of the following cell types is the neoplastic cell of origin responsible for generating the observed inflammatory microenvironment?

A 58-year-old man with a long history of gastroesophageal reflux disease undergoes upper endoscopy. A biopsy is taken from the distal esophagus. The photomicrograph shows replacement of the normal stratified squamous epithelium by columnar epithelium with goblet cells. The patient is counseled that this change carries an increased risk of malignant transformation. Which of the following best describes the reversibility of the currently observed change and the next step in the malignant progression sequence?

A 14-year-old Caucasian female with a family history of familial hypercholesterolemia commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots?

A 51-year-old man comes to the physician for the evaluation of a 3-week history of fatigue and shortness of breath. One year ago, a screening colonoscopy showed colonic polyps. His brother has a bicuspid aortic valve. On examination, a late systolic crescendo-decrescendo murmur is heard at the right upper sternal border. Laboratory studies show: Hemoglobin 9.1 g/dL LDH 220 U/L Haptoglobin 25 mg/dL (N = 41–165 mg/dL) Urea nitrogen 22 mg/dL Creatinine 1.1 mg/dL Total bilirubin 1.8 mg/dL A peripheral blood smear shows schistocytes. Which of the following is the most likely cause of this patient's anemia?

A 38-year-old man comes to the physician because of a 3-week history of a painful rash affecting his left foot. For the past 2 years, he has had recurrent episodes of color changes in his fingers when exposed to the cold; his fingers first turn white and then progress to blue and red before spontaneously resolving. He has smoked two packs of cigarettes daily for 20 years. His blood pressure is 115/78 mm Hg. Physical examination shows multiple tender, dark purple nodules on the lateral surface of the left foot with surrounding erythema that follow the course of the lateral marginal vein. There are dry ulcers on the tip of his right index finger and on the distal aspect of his right hallux. Serum lipid studies show no abnormalities. Biopsy of the dorsalis pedis artery will most likely show which of the following findings?

A 73-year-old man with coronary artery disease and hypertension is brought to the emergency department by ambulance 90 minutes after the acute onset of substernal chest pain and dyspnea. He has smoked 2 packs of cigarettes daily for 52 years. Shortly after arriving at the hospital, he loses consciousness and is pulseless. Despite attempts at cardiopulmonary resuscitation, he dies. Examination of the heart at autopsy shows complete occlusion of the left anterior descending artery with a red thrombus overlying a necrotic plaque. Which of the following pathophysiologic mechanisms is most likely responsible for this patient's acute coronary condition?

A 60-year-old man is brought to the emergency department by his wife with a sudden onset of right-sided weakness 2 hours ago. He can speak clearly without difficulty and denies any similar symptoms in the past. Past medical history is significant for hypertension and diabetes, both poorly managed due to medication non-compliance. Family history is significant for heart disease and diabetes in multiple paternal and maternal relatives. His vital signs include: blood pressure 150/88 mm Hg, pulse 86/min, and respiratory rate 15/min. On physical examination, strength is 3/5 on the right and 5/5 on the left upper and lower extremities. The sensation is intact, and no impairments in balance or ataxias are present. An initial noncontrast CT scan of the head is unremarkable, but a repeat noncontrast CT scan of the head performed a month later reveals the 2 lesions circled in the image. Which of the following is the most likely diagnosis in this patient?

A 74-year-old man presents with complaints of sudden severe crushing retrosternal pain. The pain radiated to his left arm shortly after it began, and he was subsequently rushed to the emergency department for evaluation. His troponins and creatine kinase-MB (CK-MB) were elevated. Unfortunately, the patient died within the next 2 hours and an autopsy was performed immediately. The gross examination of the heart will show?

A 79-year-old homeless man is brought to the emergency department by ambulance 30 minutes after being found unresponsive by the police. On arrival, he is apneic and there are no palpable pulses. Despite appropriate life-saving measures, he dies. Examination of the heart during autopsy shows normal ventricles with a sigmoid-shaped interventricular septum. A photomicrograph of a section of the heart obtained at autopsy is shown. Which of the following is the most likely underlying cause for the structure indicated by the arrow?