Phys 69 Flashcards

In the minority of cases of familial hypercholesterolemia, mutations to PCSK9 gene lead to conformation changes of ___ receptors that lead to its destruction

Presence of apolipoprotein(a) doubles the risk of _______

A 45-year-old with hyperlipidemia has elevated molecules that transport dietary triglycerides from the intestine. Which list best matches the major lipid classes involved?
A. Cholesterol, bile salts, free glycerol
B. Triglycerides, phospholipids, cholesterol
C. Triglycerides, glycolipids, bile salts
D. Phospholipids, fatty aldehydes, ceramides

A biochemist isolates a 16-carbon saturated fatty acid with the formula CH₃(CH₂)₁₄COOH. Which fatty acid is this?
A. Oleic acid
B. Stearic acid
C. Palmitic acid
D. Linoleic acid

The triglycerides in human adipose tissue are predominantly composed of which three fatty acids?
A. Arachidonic, linoleic, linolenic
B. Palmitic, oleic, stearic
C. Myristic, lauric, palmitoleic
D. Stearic, arachidonic, linoleic

A fatty acid is described as having an 18-carbon chain and being fully saturated with hydrogen. Which fatty acid fits this description?
A. Oleic acid
B. Myristic acid
C. Palmitic acid
D. Stearic acid

A lipid analyst reports an 18-carbon fatty acid with a single double bond in the middle of its chain. Which is most consistent?
A. Oleic acid
B. Palmitic acid
C. Stearic acid
D. Lauric acid

A 16-carbon fatty acid that is fully saturated is most likely:
A. Stearic acid
B. Palmitic acid
C. Oleic acid
D. Arachidonic acid

A researcher notes a structural protein lightly adsorbed to the outer surface of chylomicrons, important for their stability in plasma. Which protein is this?
A. Apoprotein A-I
B. Apoprotein C-II
C. Apoprotein E
D. Apoprotein B

A patient with lipoprotein lipase deficiency shows markedly elevated triglyceride-rich chylomicrons. Normally, what is the key action of lipoprotein lipase on these particles?
A. Esterifies cholesterol within chylomicrons
B. Hydrolyzes triglycerides at capillary endothelium
C. Transfers apoproteins between lipoproteins
D. Oxidizes fatty acids within hepatocytes

After extensive removal of triglycerides from circulating chylomicrons, what happens next to these cholesterol-enriched particles?
A. Spontaneously disintegrate in plasma
B. Rapidly cleared as chylomicron remnants
C. Converted directly into VLDL particles
D. Stored intact in adipocytes

Chylomicron remnants are taken up by the liver. To which cells do they primarily bind within hepatic sinusoids?
A. Endothelial cells
B. Kupffer macrophage cells
C. Ito (stellate) fat-storing cells
D. Hepatocyte canalicular cells

A mutation that disrupts apolipoprotein E would most directly impair which process related to dietary lipid transport?
A. Activation of lipoprotein lipase on endothelium
B. Assembly of nascent chylomicrons in enterocytes
C. Stabilization of LDL particles in circulation
D. Binding of chylomicron remnants to hepatic receptors

During prolonged fasting, adipocytes sense low glucose availability. Which specific glucose-derived metabolite becomes insufficient, favoring triglyceride hydrolysis in fat cells?
A. Fructose-1,6-bisphosphate
B. Alpha-glycerophosphate
C. Oxaloacetate
D. Pyruvate

A hormone-driven rise in circulating free fatty acids is observed during stress. Which enzyme in adipose tissue is acutely activated by endocrine hormones to accelerate triglyceride breakdown?
A. Lipoprotein lipase
B. Acetyl-CoA carboxylase
C. Hormone-sensitive lipase
D. HMG-CoA reductase

In addition to free fatty acids, which other major forms of fatty acids are normally present in plasma?
A. Ceramides and gangliosides mainly
B. Esters of glycerol and cholesterol
C. Sphingomyelin and cardiolipin esters
D. Free aldehydes and peroxides

A pharmacologist studies turnover of plasma free fatty acids. Which statement best describes their kinetics under resting conditions?
A. Turnover rate occurs only postprandially
B. Turnover rate is negligible at rest
C. Turnover rate is very slow
D. Turnover rate is extremely rapid

Conditions that increase the rate of fat utilization for cellular energy will typically:
A. Lower plasma free fatty acid concentration
B. Have no effect on plasma lipids
C. Increase plasma free fatty acid concentration
D. Shift fatty acids entirely into chylomicrons

Marked elevations of plasma free fatty acids are most characteristic of which conditions?
A. Hypothyroidism and chronic liver failure
B. Nephrotic syndrome with heavy proteinuria
C. Acute pancreatitis after large fatty meals
D. Poorly controlled diabetes and prolonged starvation

Under normal resting conditions, approximately how many free fatty acid molecules bind to each albumin molecule in plasma?
A. About three fatty acids per albumin
B. About one fatty acid per albumin
C. About ten fatty acids per albumin
D. About thirty fatty acids per albumin

When demand for fatty acid transport becomes extreme, as many as how many fatty acid molecules can bind a single albumin molecule?
A. Ten fatty acids per albumin
B. Thirty fatty acids per albumin
C. Three fatty acids per albumin
D. Sixty fatty acids per albumin

Which description best defines plasma lipoproteins?
A. Micelles of bile salts and cholesterol
B. Complexes of glycogen, protein, and lipid
C. Particles with triglycerides, cholesterol, phospholipids, protein
D. Vesicles containing only phospholipids and protein

Which list correctly names the four major plasma lipoprotein classes?
A. VLDL, IDL, LDL, HDL
B. Chylomicrons, VLDL, LDL, albumin
C. HDL, myelin, chylomicrons, VLDL
D. IDL, bile salts, LDL, HDL

VLDL particles are characterized by which composition?
A. High protein, low cholesterol and phospholipids
B. High cholesterol, minimal triglyceride or protein
C. Equal triglycerides, cholesterol, and protein
D. High triglycerides, moderate cholesterol and phospholipids

Intermediate-density lipoproteins (IDLs) are best described as:
A. HDLs that have gained additional protein
B. VLDLs partially depleted of triglycerides
C. LDLs lacking apolipoprotein B entirely
D. Chylomicron remnants enriched in triglycerides

Low-density lipoproteins (LDLs) are formed:
A. Directly from HDL remodeling
B. By intestinal assembly and secretion of chylomicrons
C. From IDLs after removal of most triglycerides
D. Only during severe hypercholesterolemia episodes

Which statement best characterizes high-density lipoproteins (HDLs)?
A. High protein, smaller cholesterol and phospholipids
B. High triglycerides with minimal protein content
C. High cholesterol with negligible phospholipids
D. High triglycerides and cholesterol but no protein

In adults, almost all plasma lipoproteins are synthesized primarily in the:
A. Bone marrow hematopoietic cells
B. Endothelial cells of systemic capillaries
C. Adipocytes within subcutaneous tissue
D. Hepatocytes of the liver

During intestinal absorption of dietary fatty acids, small amounts of HDL are additionally synthesized in which location?
A. Pancreatic acinar cell cytoplasm
B. Intestinal epithelial cells of the mucosa
C. Renal proximal tubular epithelium
D. Skeletal muscle fiber sarcoplasm

What is the primary function of plasma lipoproteins?
A. Buffering sudden changes in blood pH
B. Providing oncotic pressure within plasma
C. Transporting lipid components through the bloodstream
D. Catalyzing triglyceride synthesis in tissues

VLDL particles leaving the liver primarily deliver newly synthesized triglycerides to which tissue?
A. Adipose tissue for storage
B. Renal cortex for oxidation
C. Cerebral white matter myelin
D. Skeletal muscle exclusively

Beyond serving as an energy reservoir, stored adipose fat additionally:
A. Synthesizes catecholamines for stress responses
B. Produces renin to regulate blood pressure
C. Detoxifies xenobiotics like hepatic cytochrome
D. Insulates body and secretes leptin and adiponectin

Which statement best describes typical white adipocytes in adipose tissue?
A. Derived from myocytes
B. Modified fibroblasts
C. Epithelial cells
D. Macrophages

In adipose tissue, the triglycerides stored within fat cells are predominantly in which physical state at body temperature?
A. Solid crystalline form
B. Highly volatile gaseous form
C. Liquid form within the cell
D. Amorphous glass-like solid state

During prolonged exposure to cold, adipocyte triglyceride fatty acid chains are remodeled over weeks so that they:
A. Become shorter or more unsaturated
B. Become longer and fully saturated
C. Convert to cholesterol esters within membranes
D. Solidify into waxes, preventing circulation

Which enzymes permit dynamic exchange of triglyceride-derived fatty acids between adipose tissue and circulating blood?
A. Transaminases in hepatic mitochondria
B. Cyclooxygenases in endothelial cells
C. Dehydrogenases in skeletal muscle
D. Tissue lipases within adipose depots

In a healthy adult, triglycerides stored in adipose fat cells are typically renewed approximately every:
A. Two to three days
B. Two to three weeks
C. Two to three months
D. Two to three years

Which set best describes the principal functions of the liver in lipid metabolism?
A. Bile salt synthesis and storage only
B. Glucose oxidation and ketone body synthesis
C. Fatty acid degradation, triglyceride and other lipid synthesis
D. Urea, uric acid, and creatinine formation

Large accumulations of fat in hepatocytes are most likely during:
A. High-carbohydrate feeding with minimal fat
B. Short-term fasting with high insulin levels
C. Hyperthyroidism with increased carbohydrate oxidation
D. Early starvation, diabetes, preferential fat use

A young patient has near-total absence of adipose tissue, very low measured adipocyte mass, and a massively fatty liver. This picture is most consistent with:
A. Lipodystrophy
B. Nonalcoholic fatty liver disease
C. Familial hypercholesterolemia type IIa
D. Hereditary fructose intolerance

Which statement about handling of fatty acids is correct?
A. Liver hepatocytes desaturate fatty acids
B. Adipocytes uniquely desaturate circulating cholesterol
C. Skeletal muscle desaturates long-chain fatty acids
D. Red blood cells desaturate membrane lipids

The first stage in using stored triglycerides for energy in tissues is:
A. Oxidation of glycerol in mitochondria
B. Hydrolysis to fatty acids and glycerol
C. Conversion to phospholipids in membranes
D. Direct phosphorylation to glycerol three phosphate

Once glycerol enters cells after triglyceride breakdown, it is rapidly converted to:
A. Glycerol-3-phosphate via intracellular enzymes
B. Dihydroxyacetone phosphate without ATP use
C. Glucose by hepatic gluconeogenesis alone
D. Triglyceride resynthesized in mitochondria

Degradation and oxidation of fatty acids for energy occur primarily in which site?
A. Cytosol of hepatocytes primarily
B. Smooth endoplasmic reticulum lumen
C. Mitochondrial matrix of the cell
D. Peroxisomal matrix during fasting

Long-chain fatty acids must be transferred into mitochondria for β-oxidation. Which carrier mediates this transport?
A. Coenzyme A alone without transporters
B. Albumin within mitochondrial intermembrane space
C. Carnitine shuttling fatty acyl groups
D. Biotin transporting activated carboxyl groups

The mitochondrial β-oxidation spiral primarily degrades fatty acids by:
A. Adding carbons onto growing acyl chains
B. Sequentially removing two-carbon acetyl-CoA units
C. Converting them directly to glucose
D. Reducing them to glycerol backbones

What is the first step in mitochondrial β-oxidation of a fatty acid?
A. Oxidation of the beta-carbon directly
B. Cleavage releasing acetyl-CoA immediately
C. Condensation with oxaloacetate to citrate
D. Formation of fatty acyl-CoA from fatty acid

During steps two through four of β-oxidation, the β-carbon of the fatty acyl-CoA undergoes:
A. Progressive oxidation after binding molecular oxygen
B. Phosphorylation by ATP at beta-carbon
C. Carboxylation to form malonyl-CoA intermediate
D. Reduction to fully saturated hydrocarbon chain

In step five of β-oxidation, the “right-hand” two-carbon fragment is:
A. Attached to glycerol forming triglyceride
B. Released as acetyl-CoA; new fatty acyl-CoA forms
C. Converted directly to oxaloacetate intermediate
D. Recycled into cytosol for resynthesis

What happens to the shortened fatty acyl-CoA produced after one turn of β-oxidation?
A. It leaves mitochondria for peroxisomal oxidation
B. It is immediately converted into ketone bodies
C. It is esterified into membrane phospholipids
D. It re-enters steps two through five repeatedly

The acetyl-CoA units produced by β-oxidation primarily enter which pathway next for full oxidation?
A. Citric acid cycle in mitochondrial matrix
B. Pentose phosphate pathway in cytosol
C. Urea cycle in liver mitochondria
D. Gluconeogenesis from acetyl-CoA carbons

Within the citric acid cycle, acetyl-CoA condenses with oxaloacetate to form a molecule that is later degraded to CO₂ and hydrogen atoms. This initial product is:
A. Malate
B. Succinyl-CoA
C. Citric acid
D. Acetoacetate

Complete β-oxidation of one stearic acid (18:0) molecule yields how many acetyl-CoA units?
A. Nine acetyl-CoA molecules
B. Six acetyl-CoA molecules
C. Twelve acetyl-CoA molecules
D. Eighteen acetyl-CoA molecules

Regarding the flavoprotein-linked hydrogens produced during stearic acid oxidation, which pairing of number and ATP yield is correct?
A. Thirty-four hydrogens, 1.5 ATP each
B. Thirty-four hydrogens, one ATP per hydrogen
C. Seventy hydrogens, one ATP each
D. Seventy hydrogens, 1.5 ATP each

For the NADH-linked hydrogens generated from stearic acid degradation, which pairing of number and ATP yield is correct?
A. Seventy hydrogens, 1.5 ATP each
B. Seventy hydrogens, one ATP each
C. Thirty-four hydrogens, one ATP each
D. Thirty-four hydrogens, 1.5 ATP each

Complete oxidation of one stearic acid molecule yields approximately how many ATP before subtracting activation costs?
A. 139 ATP
B. 146 ATP
C. 148 ATP
D. 104 ATP

Two high-energy phosphate bonds are used to activate stearic acid with CoA. What is the approximate net ATP yield per molecule of stearic acid?
A. 146 ATP
B. 139 ATP
C. 148 ATP
D. 104 ATP

How many acetyl-CoA molecules condense to form one molecule of acetoacetic acid?
A. One acetyl-CoA
B. Three acetyl-CoA
C. Four acetyl-CoA
D. Two acetyl-CoA

In the liver, a portion of acetoacetic acid is further converted into which ketone body?
A. Acetone
B. Beta-hydroxybutyric acid
C. Acetoacetyl-CoA
D. Propionic acid

Because ketone bodies are rapidly taken up by tissues, the combined plasma concentration of acetoacetic and beta-hydroxybutyric acids rarely rises above approximately:
A. 1 mg/dL
B. 5 mg/dL
C. 3 mg/dL
D. 20 mg/dL

A patient with uncontrolled diabetes develops fruity breath and elevated “ketones” on lab testing. Biochemically, ketosis is defined by increased blood levels of:
A. Glucose and lactate mainly
B. Triglycerides and free fatty acids
C. Cholesterol esters and phospholipids
D. Acetoacetic acid, beta-hydroxybutyrate, acetone

Which hormonal pattern best promotes removal of fatty acids from adipose tissue and favors ketone body formation?
A. High insulin, low glucagon, low cortisol
B. High glucocorticoids, high glucagon, low insulin
C. Low glucocorticoids, low glucagon, high insulin
D. High insulin, high glucagon, high cortisol

In severe carbohydrate deficiency, why are cells limited in how many ketone bodies they can oxidize?
A. Oxaloacetate deficiency limits acetyl-CoA entry
B. Lack of carnitine stops ketone transport
C. Ketone bodies cannot enter mitochondria
D. Ketone oxidation requires hepatic-specific enzymes

Which population typically consumes a predominantly fat-based diet yet usually does not develop ketosis because of long-term metabolic adaptation?
A. Strict vegans in urban settings
B. Patients starting ketogenic diet suddenly
C. Marathon runners during single race
D. Eskimos (Inuit) on traditional diet

After a few weeks on an all-fat diet, an adapted adult can derive approximately what fraction of their energy from fats?
A. About fifty to seventy-five percent
B. About ten to twenty-five percent
C. About twenty-five to forty percent
D. About eighty to ninety-five percent

Once newly synthesized fatty acid chains reach a certain length, they typically bind glycerol to form triglycerides. This occurs when the chains are:
A. Six to eight carbons long
B. Fourteen to eighteen carbons long
C. Two to four carbons long
D. Twenty-two to twenty-four carbons long

During triglyceride synthesis in adipose tissue, the glycerol portion of the molecule is mainly supplied by:
A. Free glycerol from the plasma
B. Dihydroxyacetone phosphate directly
C. Alpha-glycerophosphate generated from glucose
D. Lactate produced during glycolysis

Approximately what fraction of the energy in glucose is lost as heat during triglyceride synthesis?
A. Approximately fifteen percent lost as heat
B. Approximately five percent lost as heat
C. Approximately thirty percent lost as heat
D. Approximately fifty percent lost as heat

The total amount of glycogen that can be stored in the body of an average adult is closest to:
A. Several kilograms stored in liver
B. About one kilogram bodywide
C. Several tens of grams only
D. Only a few hundred grams total

Compared with total carbohydrate stores, the average person has approximately how much more energy stored as fat?
A. About tenfold more energy
B. About one hundred fiftyfold more
C. About twofold more energy
D. About twentyfold more energy

Each gram of fat contains approximately how many times the calories of one gram of glycogen?
A. About the same calories
B. About five times more
C. About two and a half times
D. About ten times more

In the absence of insulin, which statement about lipid synthesis is most accurate?
A. Carbohydrates cannot be converted into fat
B. Amino acids cannot form triglycerides
C. Fatty acids cannot be oxidized at all
D. Ketone bodies cannot be generated hepatically

Which statement best describes how amino acids can contribute to triglyceride synthesis?
A. They directly polymerize into fatty acids
B. They replace glycerol in triglycerides
C. They only supply nitrogen for lipids
D. They are converted to acetyl-CoA first

A sedentary patient adopts a very high-carbohydrate, low-fat diet. When excess carbohydrate is available, which substrate is preferentially oxidized for energy?
A. Fatty acids
B. Ketone bodies
C. Amino acids
D. Carbohydrates

In an adipocyte loaded with glucose, intracellular α-glycerophosphate levels rise. What happens to free fatty acids under these conditions?
A. Oxidized completely to CO₂
B. Esterified as stored triglycerides
C. Converted mainly to ketone bodies
D. Released unbound into plasma

Excess α-glycerophosphate in adipose tissue shifts the equilibrium between fatty acids and triglycerides toward:
A. Free fatty acid release
B. Phospholipid degradation predominates
C. Cholesterol ester hydrolysis
D. Triglyceride storage within adipocytes

The first step in converting carbohydrate to fat is best described as a:
A. Nonregulated condensation of acetyl-CoA
B. Irreversible ketone body formation step
C. Strictly rate-limiting regulatory step
D. Purely mitochondrial transport process

The initial committed reaction for converting carbohydrate-derived acetyl-CoA to fatty acids is:
A. Reduction of malonyl-CoA to acetyl-CoA
B. Carboxylation of acetyl-CoA to malonyl-CoA
C. Condensation of acetyl-CoA with oxaloacetate
D. Transamination of acetyl-CoA to alanine

The carboxylation of acetyl-CoA to form malonyl-CoA in fatty acid synthesis is catalyzed by:
A. Pyruvate carboxylase
B. Malic enzyme
C. Fatty acid synthase
D. Acetyl-CoA carboxylase

A patient with new-onset type 1 diabetes has very low insulin levels. Which metabolic change is most expected?
A. Reduced glucose use and increased fat storage
B. Increased glucose utilization and lipogenesis
C. Increased lipoprotein lipase in adipose
D. Increased adipocyte glucose uptake

During intense exercise, which enzyme do epinephrine and norepinephrine directly activate to mobilize fatty acids from adipose tissue?
A. Lipoprotein lipase in capillaries
B. Hormone-sensitive triglyceride lipase
C. HMG-CoA reductase in hepatocytes
D. Carnitine acyltransferase in muscle

Corticotropin and glucocorticoids enhance lipolysis in adipose tissue mainly by activating:
A. Adipocyte lipoprotein lipase
B. Hormone-sensitive triglyceride lipase
C. Pancreatic phospholipase A₂
D. Hepatic cholesterol ester hydrolase

A patient with central obesity, striae, hypertension, chronic hypercortisolism, and elevated ACTH develops ketosis despite no change in diet. Which diagnosis best explains the fat mobilization–induced ketosis?
A. Addison’s disease
B. Diabetic ketoacidosis only
C. Primary hyperparathyroidism
D. Cushing’s syndrome

Growth hormone is:
A. Mildly ketogenic, promoting fat mobilization
B. Strongly anti-ketogenic, inhibiting lipolysis
C. Exclusive increase in hepatic glycogen stores
D. Inhibition of hormone-sensitive triglyceride lipase

Thyroid hormone causes rapid fat mobilization primarily because it:
A. Directly inhibits adipocyte insulin receptors
B. Directly activates lipoprotein lipase only
C. Directly converts triglycerides into ketones
D. Increases overall cellular energy metabolism

Which set lists the three major classes of body phospholipids?
A. Lecithin, cardiolipin, plasmalogens
B. Cephalins, gangliosides, cerebrosides
C. Lecithins, cephalins, sphingomyelin
D. Sphingomyelin, cholesterol, triglycerides

A typical membrane phospholipid molecule is composed of:
A. Two sugars, nitrogen base, sulfate
B. Fatty acids, nitrogen base, single phosphate
C. Cholesterol, phosphates, multiple nitrogen bases
D. Triglycerides, sulfur groups, two phosphates

A deficiency of which compound would directly impair lecithin synthesis because it serves as its nitrogenous base?
A. Ethanolamine
B. Serine
C. Inositol
D. Choline

Some cephalins require which molecule for their formation?
A. Carnitine
B. S-adenosylmethionine
C. Inositol
D. Choline

Phospholipids participate in structural elements and can donate phosphate groups. They also act as:
A. Sole long-term energy stores in adipocytes
B. Components of lipoproteins, thromboplastin, neural insulation
C. Primary oxygen carriers within erythrocytes
D. Exclusive precursors of all steroid hormones

Which statement best describes cholesterol’s solubility properties?
A. Highly water and lipid soluble
B. Water insoluble, protein soluble
C. Equally soluble in water and fat
D. Highly fat soluble, slightly water soluble

Modifying the sterol nucleus with different side chains can yield:
A. Cholesterol, cholic acid, steroid hormones
B. Triglycerides, phospholipids, ketone bodies
C. Glucose, lactate, amino acids
D. Bile pigments, urea, creatinine

Increased intake of exogenous cholesterol affects hepatic cholesterol metabolism by:
A. Increasing endogenous cholesterol synthesis markedly
B. Eliminating intestinal cholesterol absorption completely
C. Inhibiting endogenous cholesterol production by feedback
D. Having no effect on hepatic synthesis

A patient adopts a diet very high in saturated fat. What is the typical effect on plasma cholesterol concentration?
A. Decreases slightly versus baseline
B. Increases about fifteen to twenty-five percent
C. Increases by two- to threefold
D. Remains essentially unchanged

Which endocrine deficiency pattern is most likely to raise blood cholesterol levels?
A. Lack of thyroid hormone or insulin
B. Excess insulin plus excess thyroxine
C. Lack of cortisol plus epinephrine
D. Excess glucagon plus aldosterone

Which dietary change would be expected to slightly decrease blood cholesterol concentration?
A. Increase intake of unsaturated fatty acids
B. Increase intake of saturated animal fats
C. Increase exogenous cholesterol-rich foods
D. Eliminate all dietary fat entirely

The most abundant non-membranous use of cholesterol in the body is formation of:
A. Steroid hormones in adrenal cortex
B. Cholic acid synthesized in liver
C. Vitamin D in skin and kidney
D. Cell membrane cholesterol in hepatocytes

High cholesterol content in the corneum of the skin mainly:
A. Resists water-soluble absorption and chemical injury
B. Enhances conduction along peripheral nerves
C. Promotes capillary angiogenesis in dermis
D. Increases transepidermal water evaporation greatly

“Arteriosclerosis” is best defined as:
A. Fatty plaques in coronary arteries
B. Immune-mediated necrotizing vasculitis
C. Calcification limited to muscular arteries
D. General thickening, stiffening of all vessels

Endothelial injury in early atherogenesis increases adhesion molecule expression and reduces release of which anti-adhesive mediator?
A. Prostacyclin mediated platelet inhibitors
B. Endothelin derived vasoconstrictor peptides
C. Nitric oxide mediated anti adhesion signals
D. Angiotensin II mediated vasoconstrictors

Aggregation of macrophage foam cells along the intima produces what visible lesion in arteries?
A. Organized fibrous fibrofatty cap
B. A visible intimal fatty streak
C. Calcified, ulcerated fibrous plaque
D. Mural thrombus overlying rupture

Over time, an early fatty streak most typically progresses to:
A. Non-occlusive mural thrombus
B. Medial calcific degenerative lesion
C. Small-vessel hyaline arteriolosclerosis
D. Larger fibrous atherosclerotic plaque

Activated macrophages within a developing plaque most importantly:
A. Decrease cytokine release and cell turnover
B. Promote inflammation and smooth muscle growth
C. Reduce lipid deposition in the intima
D. Induce regression of existing fibrous caps

As lipid deposits and cellular proliferation expand within an artery, a key hemodynamic consequence is:
A. Increased downstream perfusion pressure
B. Immediate vessel rupture and dissection
C. Luminal blood flow becomes significantly reduced
D. Complete elimination of turbulent flow patterns

In the United States and Europe, vascular disease accounts for approximately:
A. Approximately one half of all deaths
B. Approximately one quarter of all deaths
C. Approximately one tenth of all deaths
D. Approximately three quarters of all deaths

A 20-year-old with tendon xanthomas and very high LDL has familial hypercholesterolemia. The primary inherited defect is:
A. Overexpression of hepatic HMG-CoA reductase
B. Defective genes for LDL receptors
C. Excessive synthesis of apolipoprotein A-I
D. Absent intestinal chylomicron formation

In familial hypercholesterolemia lacking functional LDL receptors, hepatic lipid handling is best described as:
A. Increased uptake of circulating LDL particles
B. Decreased VLDL secretion into the plasma
C. Complete failure to synthesize cholesterol
D. Liver overproduces cholesterol and VLDL

Epidemiologic studies show which group has a higher incidence of atherosclerosis, suggesting a role for sex hormones?
A. Premenopausal women only
B. Children younger than ten years
C. Men have higher atherosclerosis incidence
D. Postmenopausal women regardless of therapy

Bile acid sequestrants for high cholesterol?
A. Inhibit intestinal cholesterol absorption directly
B. Bind bile acids and increase fecal loss
C. Irreversibly inhibit LDL receptor synthesis
D. Completely block hepatic VLDL secretion

Another patient is started on a statin. These drugs lower cholesterol primarily by:
A. Blocking bile salt reabsorption in ileum
B. Inhibiting intestinal chylomicron assembly
C. Stimulating LDL receptor degradation pathways
D. Inhibiting HMG CoA reductase competitively