Cardiovascular Practice Questions

Q: A 61-year-old man with hypertension and hyperlipidemia comes to the physician for a 4-month history of recurrent episodes of retrosternal chest pain, shortness of breath, dizziness, and nausea. The episodes usually start after physical activity and subside within minutes of resting. He has smoked one pack of cigarettes daily for 40 years. He is 176 cm (5 ft 9 in) tall and weighs 95 kg (209 lb); BMI is 30 kg/m2. His blood pressure is 160/100 mm Hg. Coronary angiography shows an atherosclerotic lesion with stenosis of the left anterior descending artery. Compared to normal healthy coronary arteries, increased levels of platelet-derived growth factor (PDGF) are found in this lesion. Which of the following is the most likely effect of this factor?

Intimal migration of smooth muscle cells. ***Intimal migration of smooth muscle cells*** - **PDGF** is a potent **mitogen** and **chemotactic factor** for smooth muscle cells, promoting their migration from the tunica media into the intima during atherogenesis. - This migration is a crucial step in the formation of the **fibrous cap**, contributing to plaque growth and stability. *Calcification of the atherosclerotic plaque core* - While calcification does occur in advanced atherosclerotic plaques, it is primarily driven by mechanisms involving **osteoblast-like differentiation** of vascular cells and deposition of **calcium phosphate**, not directly by PDGF. - PDGF's primary role is in **cellular proliferation** and **migration**, particularly of smooth muscle cells. *Invasion of T-cells through the disrupted endothelium* - **T-cell invasion** into the arterial wall is an important inflammatory process in atherosclerosis, but it is primarily mediated by **chemokines** like MCP-1 and adhesion molecules, not directly by PDGF. - PDGF typically acts on mesenchymal cells (like smooth muscle cells and fibroblasts) rather than immune cells in this context. *Increased expression of vascular cell-adhesion molecules* - **Expression of adhesion molecules** (e.g., VCAM-1, ICAM-1) is crucial for the recruitment of inflammatory cells, but this process is mainly driven by **pro-inflammatory cytokines** like TNF-α and IL-1, not PDGF. - While there might be indirect effects, PDGF's direct role is not primarily in promoting adhesion molecule expression. *Ingestion of cholesterol by mature monocytes* - **Ingestion of cholesterol** by **macrophages** (which mature from monocytes) leads to the formation of **foam cells**, a hallmark of early atherosclerosis. - This process is largely driven by oxidized LDL uptake, often facilitated by scavenger receptors, rather than directly by PDGF.

Question 1

A 32-year-old man comes to the physician because of a 3-week history of recurrent thumb pain that worsens with exposure to cold temperatures. Examination shows a 6-mm, blue-red papule under the left thumbnail. The overlying area is extremely tender to palpation. The thumbnail is slightly pitted and cracked. This lesion most likely developed from which of the following types of cells?

Accepted Answer

Modified smooth muscle cells

Answer

Dysplastic melanocytes

Answer

Injured nerve cells

Answer

Basal epidermal cells

Answer

Hyperpigmented fibroblasts

Question 2

A 61-year-old man with hypertension and hyperlipidemia comes to the physician for a 4-month history of recurrent episodes of retrosternal chest pain, shortness of breath, dizziness, and nausea. The episodes usually start after physical activity and subside within minutes of resting. He has smoked one pack of cigarettes daily for 40 years. He is 176 cm (5 ft 9 in) tall and weighs 95 kg (209 lb); BMI is 30 kg/m2. His blood pressure is 160/100 mm Hg. Coronary angiography shows an atherosclerotic lesion with stenosis of the left anterior descending artery. Compared to normal healthy coronary arteries, increased levels of platelet-derived growth factor (PDGF) are found in this lesion. Which of the following is the most likely effect of this factor?

Accepted Answer

Intimal migration of smooth muscle cells

Answer

Calcification of the atherosclerotic plaque core

Answer

Invasion of T-cells through the disrupted endothelium

Answer

Increased expression of vascular cell-adhesion molecules

Answer

Ingestion of cholesterol by mature monocytes

Cardiovascular — MCQs

Cardiovascular — MCQs

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