Deck 48: Cardiovascular Disease: The Metabolic Syndrome and Atherosclerosis

Question 1

You are examining the characteristics of monocyte transmigration through a monolayer of endothelial cells in a culture system. Your studies reveal that the addition of an experimental compound induces a significant increase in the rate of monocyte transmigration. This compound most likely induced the expression of which in the monolayer of endothelial cells?

A) E-selectin
B) endothelial-leukocyte adhesion molecule-1, ELAM-1
C) Intercellular adhesion molecule-1, ICAM-1
D) monocyte chemotactic protein-1, MCP-1
E) vascular cell adhesion molecule-1, VCAM-1

Answer 1

monocyte chemotactic protein-1, MCP-1

Question 2

During a routine examination of a 58-year-old male patient, blood work indicates a significant elevation in the level of homocysteine. Elevated levels of homocysteine in the blood have been shown to correlate with cardiovascular dysfunction and thus, it is imperative to determine the cause of this patient's homocysteine levels. Analysis for activity of which of the following enzymes is likely to show a defect resulting in the elevation in serum homocysteine in this patient?

A) cystathionine β-synthase
B) dihydrofolate reductase
C) dihydropteridine reductase
D) methionine adenosyltransferase
E) methionine synthase

Answer 2

cystathionine β-synthase

Question 3

You are examining a 63-year-old woman who has come to you complaining of headache, lightheadedness, and facial swelling. Upon physical examination of the patient you suspect she may have restricted blood flow in a major artery or vein so you order a routine angiography. The results of the angiography indicate a reduction in blood flow entering the right side of the heart. Where is the most likely location of the restriction to blood flow?

A) common iliac artery
B) external carotid artery
C) pulmonary artery
D) superior vena cava
E) thoracic aorta

Answer 3

superior vena cava

Question 4

You are carrying out a routine follow-up examination a 59-year-old asymptomatic man. He jogs a
Little bit everyday and plays golf. His LDL in the
Past was 177 mg/dL. He has a history of hypertension, and there is a history of premature heart disease in his family. A stress test is normal to stage
6) He is on a statin, an antihypertensive, and lowdose aspirin. Physical examination demonstrates he is 6 ft 2 in tall and weighs 220 lb with a waist circumference of 41 in and his BMI is 28 kg/m2. His blood pressure, on this treatment, is 150/88 mm Hg; his cholesterol is 220 mg/dL, LDL is 140 mg/dL, HDL is 36 mg/dL, triglycerides are 220 mg/dL, and his fasting blood glucose is 120 mg/ dL. Because he is doing so well, he stops his statin and low-dose aspirin. Decreased activity in which of the following would be apparent in this patient given his change in medication?

A) adiponectin
B) monocyte chemotactic protein-1, MCP-1
C) nitric oxide synthase, NOS
D) plasminogen activator inhibitor-1, PAI-1
E) prostaglandin E₂, PGE₂

Question 5

Which of the following represents a fibrous clot present in the circulation due to being sheared from a fixed clot somewhere else in the body?

A) embolus
B) hemangioma
C) plaque
D) thrombus
E) thrombophlebitis

Question 6

A 46-year-old man is being evaluated by his physician in the course of a routine physical examination for his new job. He denies any complaints at present, nor any recent history of illness or injury. His last physical examination was over 10 years ago for a job-related injury to his knee. He has no allergies, takes no prescription medications, but takes acetaminophen occasionally for his "aches and pains." Family history is significant for his mother and brother having heart disease, hypertension, and obesity. His mother has had 2 myocardial infarctions, and his older brother takes oral medication for type 2 diabetes. He carries a significant amount of central fat, his waist is 44 in, and his calculated BMI is 36 kg/m2. The working diagnoses of obesity and hypertension are attributed to the patient's history and is suggestive of the metabolic syndrome. Testing for which of the following would be most beneficial to ensure proper diagnosis and treatment in this patient?

A) creatine phosphokinase levels in the serum
B) creatinine clearance rate
C) fasting serum cholesterol level
D) liver enzyme levels in the serum
E) serum insulin levels

Question 7

You are examining a 62-year-old female patient during a routine physical. The examination shows the patient is 5 ft 4 in tall, weighs 150 lb, has a waist circumference of 38 in, and a calculated BMI of 26 kg/m2. Her blood pressure is 128/80 mm Hg and blood analysis indicates elevated fasting plasma glucose and hypertriglyceridemia. The physical examination and blood work indicate your patient is likely manifesting symptoms of the metabolic syndrome. Which of the following would be a useful test to confirm this initial diagnosis?

A) bile excretion rate
B) C-reactive protein (CRP) levels
C) creatine phosphokinase level in the serum
D) creatinine clearance rate
E) serum aspartate aminotransferase level

Question 8

You are carrying out a routine examination of a 54-year-old white male patient with a past medical history of hypertension. He has no complaints other than some dyspnea on exertion, which has been long-standing. Current medications include a thiazide diuretic and aspirin. He does not get much physical activity during the day. Physical examination indicates he is 5 ft 11 in tall, weighs 210 lb, has a waist circumference of 40.5 in, and a calculated BMI of 29 kg/m2. His blood pressure is 135/80 mm Hg sitting and 130/80 mm Hg standing. The rest of his physical examination is unremarkable. Blood work indicates total cholesterol of 230 mg/dL, HDL 38 mg/dL, LDL 152 mg/dL, triglycerides 200 mg/dL, and fasting plasma glucose 120 mg/dL. Based on these observations and test results this patient is the greatest risk for which of the following?

A) esophageal reflux disease
B) gallstones
C) insulin resistance
D) liver failure
E) renal failure

Question 9

You are treating a 48-year-old white woman who is clearly manifesting signs and symptoms of the metabolic syndrome, MetS. Given the correlation between MetS and coronary artery disease (CAD), treatment to increase expression of which of the following would be most beneficial to treating intravascular inflammation associated with MetS in this patient?

A) endothelial-leukocyte adhesion molecule-1, E-selectin
B) monocyte chemotactic protein-1, MCP-1
C) nitric oxide, NO
D) tumor necrosis factor-α, TNF-α
E) vascular endothelial growth factor, VEGF

Question 10

A 62-year-old woman has had atrial fibrillation since experiencing a myocardial infarction 7 months prior. Two weeks ago she was hospitalized following a car accident in which she suffered a compound fracture of her left femur and several severe contusions. She now returns to the emergency room with right flank pain, hematuria, and left-sided paralysis. These newly developing problems are most likely the result of which of the following?

A) air embolism from the compound fracture
B) bone marrow embolus from the fractured femur
C) fat embolism from the fractured femur
D) systemic thromboemboli from the left atrium
E) venous thromboemboli from the deep leg veins