front 1 Compared with corresponding veins at the same branching level, arterial walls are generally: A. thinner | back 1 C. thicker |
front 2 The main reason arterial walls are thicker than comparable veins is to accommodate: A. lower flow velocities | back 2 B. pulsatile flow and higher pressure |
front 3 The basic constituents of blood vessel walls are endothelial cells, smooth muscle cells, and: A. neural crest cells | back 3 B. extracellular matrix |
front 4 Which set best represents major extracellular matrix components of vessel walls? A. keratin, fibrin, actin | back 4 C. elastin, collagen, glycosaminoglycans |
front 5 The tunica intima normally consists primarily of a single layer of: A. mesothelial cells | back 5 C. endothelial cells |
front 6 Beneath the endothelial cells of the intima lies a: A. thick muscular coat | back 6 B. basement membrane |
front 7 The intima is separated from the media by the: A. external elastic lamina | back 7 D. internal elastic lamina |
front 8 Compared with arteries, the smooth muscle cells in veins are arranged more: A. concentrically | back 8 C. haphazardly |
front 9 Which vessel type has several well-organized concentric layers of smooth muscle cells? A. veins | back 9 D. arteries |
front 10 The media of elastic arteries such as the aorta contains abundant: A. collagen | back 10 D. elastin |
front 11 The high elastin content of the aortic media allows the vessel to: A. resist all dilation | back 11 B. expand and recoil |
front 12 Expansion during systole and recoil during diastole in elastic arteries primarily helps: A. filter plasma proteins | back 12 B. propel blood forward |
front 13 In older individuals, arteries often become progressively tortuous and dilated, a change termed: A. stenotic | back 13 C. ectatic |
front 14 The principal sites of physiologic resistance to blood flow are the: A. elastic arteries | back 14 D. arterioles |
front 15 The vessel layer external to the media is the: A. intima | back 15 B. adventitia |
front 16 In many arteries, the adventitia is separated from the media by the: A. internal elastic lamina | back 16 C. external elastic lamina |
front 17 The adventitia is composed mainly of loose: A. epithelial tissue | back 17 B. connective tissue |
front 18 Which structures are characteristically found within the adventitia? A. glomeruli and podocytes | back 18 D. nerve fibers and vasa vasorum |
front 19 The vasa vasorum are best described as small vessels that supply the: A. middle media of large arteries | back 19 C. outer media of large arteries |
front 20 A pathology specimen from a large artery shows ischemic injury in the outer portion of the media. Dysfunction of which structure is most directly implicated? A. internal elastic lamina | back 20 B. vasa vasorum |
front 21 Capillaries are approximately the diameter of a: A. platelet | back 21 C. red blood cell |
front 22 The typical capillary diameter is closest to: A. 2 to 3 μm | back 22 B. 7 to 8 μm |
front 23 Capillaries possess an endothelial lining but lack a true: A. intima | back 23 D. media |
front 24 Cells lying just deep to capillary endothelium that resemble smooth muscle are called: A. fibroblasts | back 24 B. pericytes |
front 25 Veins have less rigid walls than arteries, making them especially prone to: A. calcification and compression | back 25 C. dilation and compression |
front 26 Because of their less rigid walls, veins are also more susceptible to: A. tumor and inflammatory infiltration | back 26 A. tumor and inflammatory infiltration |
front 27 Which statement about vascular layers is most accurate? A. intima contains multiple muscle layers | back 27 C. intima is endothelial-based |
front 28 A histology slide shows a vessel with a single endothelial layer, basement membrane, no media, and nearby pericytes. This vessel is a: A. muscular artery | back 28 D. capillary |
front 29 A cerebral vascular lesion creates a direct communication between an artery and a vein, bypassing the capillary bed. This lesion is a: A. Arteriovenous fistula | back 29 A. Arteriovenous fistula |
front 30 Some arteriovenous fistulas arise most commonly as: A. Atherosclerotic plaques | back 30 B. Developmental defects |
front 31 Fibromuscular dysplasia is best described as focal irregular: A. Dilation | back 31 C. Thickening |
front 32 Fibromuscular dysplasia classically affects: A. Medium and large arteries | back 32 A. Medium and large arteries |
front 33 Which vessel is a classic site of fibromuscular dysplasia? A. Renal artery | back 33 A. Renal artery |
front 34 Which additional vascular bed is commonly involved in fibromuscular dysplasia? A. Carotid artery | back 34 A. Carotid artery |
front 35 Fibromuscular dysplasia is seen most frequently in: A. Older men | back 35 B. Young women |
front 36 The specialized lining of blood vessels is formed by: A. Smooth muscle cells | back 36 C. Endothelial cells |
front 37 One major physiologic property of intact endothelium is a: A. Prothrombotic surface | back 37 B. Nonthrombogenic surface |
front 38 The endothelial surface normally helps maintain blood in a: A. Coagulated state | back 38 C. Fluid state |
front 39 In acute inflammation, histamine most directly causes rapid egress of fluid by acting as a: A. Vasoactive agent | back 39 A. Vasoactive agent |
front 40 In response to vasoactive agents such as histamine, endothelial junctions allow rapid escape of: A. Erythrocytes, electrolytes, protein | back 40 B. Fluid, electrolytes, protein |
front 41 During inflammation, which cells can slip between adjacent endothelial cells? A. Myocytes | back 41 C. Leukocytes |
front 42 Endothelial cells influence vascular smooth muscle relaxation by producing: A. Endothelin | back 42 B. Nitric oxide |
front 43 Endothelial cells influence vascular smooth muscle contraction by producing: A. Nitric oxide | back 43 C. Endothelin |
front 44 Low blood pressure causes tissue injury chiefly because it produces inadequate organ: A. Compliance | back 44 C. Perfusion |
front 45 Sustained systolic pressure above which value is associated with increased atherosclerotic risk? A. 119 mm Hg | back 45 C. 139 mm Hg |
front 46 Sustained diastolic pressure above which value is associated with increased atherosclerotic risk? A. 79 mm Hg | back 46 B. 89 mm Hg |
front 47 A patient’s hypertension is traced to primary aldosteronism. This is classified as: A. Essential hypertension | back 47 D. Secondary hypertension |
front 48 Which condition is a classic cause of secondary hypertension? A. Pheochromocytoma | back 48 A. Pheochromocytoma |
front 49 Renal artery stenosis most classically causes: A. Essential hypotension | back 49 B. Secondary hypertension |
front 50 Approximately what proportion of hypertension is essential? A. 20% to 30% | back 50 D. 90% to 95% |
front 51 Essential hypertension is best described as: A. Idiopathic hypertension | back 51 A. Idiopathic hypertension |
front 52 Left untreated, about half of hypertensive patients die from: A. Pulmonary embolism | back 52 C. IHD or heart failure |
front 53 Another major cause of death in untreated hypertension, accounting for about one-third, is: A. Stroke | back 53 A. Stroke |
front 54 A patient has rapidly rising blood pressure, renal failure, retinal hemorrhages, and papilledema. The best diagnosis is: A. White coat hypertension | back 54 D. Malignant hypertension |
front 55 Malignant hypertension, if untreated, may lead to death within: A. 1 to 2 months | back 55 B. 1 to 2 years |
front 56 Which pressure profile best matches malignant hypertension? A. >180/>120 mm Hg | back 56 C. >200/>120 mm Hg |
front 57 Retinal findings classically seen in malignant hypertension include: A. Cotton wool absence and exudates | back 57 B. Hemorrhages and exudates |
front 58 Papilledema in malignant hypertension may be: A. Always absent | back 58 C. Present or absent |
front 59 Cardiac output is determined by: A. Preload and afterload | back 59 B. Stroke volume and heart rate |
front 60 A patient’s stroke volume falls, but heart rate is unchanged. Cardiac output will: A. Increase | back 60 B. Decrease |
front 61 Renin is released by the: A. juxtaglomerular cells | back 61 A. juxtaglomerular cells |
front 62 Renin release is increased by: A. high distal sodium delivery | back 62 D. low afferent arteriolar pressure |
front 63 A patient with marked sympathetic activation develops RAAS stimulation. Which trigger can directly promote renin release? A. increased distal sodium | back 63 B. elevated catecholamines |
front 64 Low sodium at the distal convoluted tubule most directly promotes: A. endothelin release | back 64 C. renin secretion |
front 65 Renin converts plasma angiotensinogen into: A. angiotensin II | back 65 B. angiotensin I |
front 66 Angiotensin I is converted to angiotensin II by: A. angiotensin-converting enzyme | back 66 A. angiotensin-converting enzyme |
front 67 ACE is produced mainly by vascular: A. smooth muscle | back 67 D. endothelium |
front 68 Angiotensin II raises blood pressure directly by inducing vascular: A. dilation | back 68 C. contraction |
front 69 Angiotensin II also raises blood pressure by stimulating adrenal secretion of: A. aldosterone | back 69 A. aldosterone |
front 70 Another blood pressure-raising effect of angiotensin II is increased tubular: A. potassium secretion | back 70 D. sodium resorption |
front 71 Which hormones are released from atrial and ventricular myocardium during volume expansion? A. catecholamines | back 71 B. myocardial natriuretic peptides |
front 72 Myocardial natriuretic peptide release is most strongly triggered by: A. hypoglycemia | back 72 C. volume expansion |
front 73 In renovascular hypertension, renal artery stenosis first causes decreased: A. renal venous return | back 73 D. glomerular flow |
front 74 The pressure sensed as low in renovascular hypertension is in the glomerular: A. afferent arteriole | back 74 A. afferent arteriole |
front 75 Liddle syndrome is caused by a gain-of-function mutation in an epithelial: A. potassium channel | back 75 C. sodium channel |
front 76 The sodium channel abnormality in Liddle syndrome increases distal tubular sodium reabsorption in response to: A. renin | back 76 B. aldosterone |
front 77 Hypertension is associated with which two small-vessel lesions? A. hyaline and hyperplastic arteriolosclerosis | back 77 A. hyaline and hyperplastic arteriolosclerosis |
front 78 Hyperplastic arteriolosclerosis occurs classically in: A. chronic hypotension | back 78 D. severe hypertension |
front 79 The wall change in hyperplastic arteriolosclerosis is concentric laminated: A. calcification | back 79 C. thickening |
front 80 The classic appearance of hyperplastic arteriolosclerosis is: A. fatty streaking | back 80 B. onion-skinning |
front 81 The concentric laminations consist mainly of: A. foam cells | back 81 D. smooth muscle cells |
front 82 These laminations are accompanied by thickened reduplicated: A. basement membrane | back 82 A. basement membrane |
front 83 In malignant hypertension, hyperplastic arteriolosclerosis is accompanied by: A. cholesterol clefts | back 83 B. fibrinoid deposits and necrosis |
front 84 Necrotizing arteriolitis in malignant hypertension is especially prominent in the: A. liver | back 84 C. kidney |
front 85 Arteriosclerosis literally means: A. hardening of arteries | back 85 A. hardening of arteries |
front 86 Mönckeberg medial sclerosis is characterized by: A. intimal cholesterol deposition | back 86 D. calcification of muscular arteries |
front 87 Mönckeberg medial sclerosis typically involves the: A. external elastic lamina | back 87 C. internal elastic membrane |
front 88 Atheromas are also called: A. fibrous nodules | back 88 B. atherosclerotic plaques |
front 89 Atheromas characteristically: A. protrude into vessel lumens | back 89 A. protrude into vessel lumens |
front 90 Between ages 40 and 60, myocardial infarction incidence increases: A. twofold | back 90 C. fivefold |
front 91 Statins lower circulating cholesterol by inhibiting: A. acyl-CoA oxidase | back 91 D. HMG-CoA reductase |
front 92 HMG-CoA reductase is the rate-limiting enzyme in hepatic: A. triglyceride breakdown | back 92 B. cholesterol biosynthesis |
front 93 Which process is present throughout all stages of atherogenesis? A. inflammation | back 93 A. inflammation |
front 94 This process is closely linked to plaque formation and rupture in atherosclerosis: A. fibrosis | back 94 D. inflammation |
front 95 C-reactive protein is synthesized primarily by the: A. spleen | back 95 B. liver |
front 96 CRP expression is increased by inflammatory mediators, especially: A. IL-2 | back 96 C. IL-6 |
front 97 Which circulating mediator can directly stimulate vasoconstriction at an atheroma site? A. Bradykinin | back 97 C. Adrenergic agonists |
front 98 A ruptured plaque is followed by local vasospasm. Which source can directly provoke vasoconstriction near the atheroma? A. Platelet contents | back 98 A. Platelet contents |
front 99 Endothelial dysfunction over an atherosclerotic plaque promotes vasoconstriction mainly by reducing secretion of: A. Endothelin | back 99 D. Nitric oxide |
front 100 Perivascular inflammatory cells can worsen vasoconstriction at an atheroma by releasing: A. Surfactant proteins | back 100 B. Vasoactive mediators |
front 101 An aneurysm is best defined as a localized abnormal: A. Thrombosis | back 101 B. Dilation |
front 102 An aneurysm involving an attenuated but intact arterial wall is called a: A. False aneurysm | back 102 D. True aneurysm |
front 103 A vascular wall defect allows blood to collect outside the vessel while still communicating with the lumen. This is a: A. True aneurysm | back 103 B. Pseudo-aneurysm |
front 104 Blood enters a defect in the arterial wall and tunnels between wall layers. This process is an arterial: A. Ectasia | back 104 D. Dissection |
front 105 A spherical outpouching involving only part of a vessel wall is termed: A. Fusiform aneurysm | back 105 B. Saccular aneurysm |
front 106 Which aneurysm type often contains thrombus and involves only a portion of the vessel wall? A. Saccular aneurysm | back 106 A. Saccular aneurysm |
front 107 A diffuse circumferential dilation of a long vascular segment is called a: A. Saccular aneurysm | back 107 D. Fusiform aneurysm |
front 108 Which aneurysm pattern can involve extensive portions of the aortic arch, abdominal aorta, or iliac arteries? A. Pseudo-aneurysm | back 108 C. Fusiform aneurysm |
front 109 A tall young patient with lens problems and aortic root dilation has a connective tissue disorder caused by defective synthesis of: A. Fibrillin | back 109 A. Fibrillin |
front 110 In Marfan syndrome, abnormal aortic dilation is linked to aberrant activity of: A. VEGF | back 110 B. TGF-β |
front 111 Which syndrome causes aneurysms through mutations in TGF-β receptors? A. Marfan syndrome | back 111 D. Loeys-Dietz syndrome |
front 112 In Loeys-Dietz syndrome, defective vessel support includes impaired synthesis of: A. Fibrin and laminin | back 112 C. Elastin and collagens I/III |
front 113 Weak vessel walls from defective type III collagen are characteristic of vascular: A. Osteogenesis imperfecta | back 113 B. Ehlers-Danlos syndrome |
front 114 In the vascular form of Ehlers-Danlos syndrome, the defective collagen type is: A. Type III | back 114 A. Type III |
front 115 Atherosclerotic thickening of the intima can cause ischemia of the inner media because it: A. Blocks venous drainage | back 115 D. Increases diffusion distance |
front 116 In a large artery with severe intimal plaque, the inner media becomes ischemic primarily because oxygen and nutrients must diffuse a: A. Lower concentration gradient | back 116 C. Greater radial distance |
front 117 A rare infectious cause of aortic aneurysm in late disease is: A. Tertiary syphilis | back 117 A. Tertiary syphilis |
front 118 The vascular lesion underlying syphilitic aortic aneurysm is an obliterative: A. Vasculitis | back 118 B. Endarteritis |
front 119 Late-stage syphilitic vascular injury shows a predilection for: A. Large veins | back 119 D. Small vessels |
front 120 The two most important causes of aortic aneurysms are: A. Diabetes and smoking | back 120 C. Atherosclerosis and hypertension |
front 121 A patient with infective endocarditis develops a bacterial aneurysm after septic material lodges in an arterial wall. This aneurysm is best termed: A. fusiform aneurysm | back 121 C. mycotic aneurysm |
front 122 Mycotic aneurysms can arise from all of the following except: A. adjacent suppurative spread | back 122 B. chronic medial calcification |
front 123 A vascular infection spreads from a nearby abscess into the arterial wall, producing aneurysmal dilation. This is a classic mechanism for: A. fusiform aneurysm | back 123 D. mycotic aneurysm |
front 124 Aneurysms caused by atherosclerosis form most commonly in the: A. thoracic arch, common iliacs | back 124 B. abdominal aorta, common iliacs |
front 125 Atherosclerotic abdominal aortic aneurysms are usually located: A. above renals, above bifurcation | back 125 B. below renals, above bifurcation |
front 126 An abdominal aortic aneurysm may take which gross form? A. saccular or longitudinal | back 126 D. saccular or fusiform |
front 127 A large AAA may reach a maximum diameter of approximately: A. 15 cm | back 127 A. 15 cm |
front 128 The maximal length of an abdominal aortic aneurysm can be approximately: A. 10 cm | back 128 C. 25 cm |
front 129 AAA may occasionally involve which arteries by extension or ostial thrombus? A. renal and mesenteric arteries | back 129 A. renal and mesenteric arteries |
front 130 AAA may compromise branch vessels because mural thrombi can: A. rupture the intima | back 130 D. occlude vessel ostia |
front 131 A patient with AAA is also found to have smaller aneurysms in the: A. coronary arteries | back 131 B. iliac arteries |
front 132 A subset of inflammatory AAA is now linked to: A. ANCA-associated vasculitis | back 132 C. IgG4-related disease |
front 133 A mycotic AAA is best defined as an aneurysm that: A. contains sterile thrombus | back 133 D. becomes infected in its wall |
front 134 In mycotic AAA, suppuration most directly accelerates rupture by destroying the: A. intima | back 134 B. media |
front 135 In general, aneurysms of what size are managed aggressively? A. 5 cm or larger | back 135 A. 5 cm or larger |
front 136 Standard aggressive management for large aneurysms classically involves: A. anticoagulation | back 136 C. bypass with prosthetic graft |
front 137 In selected patients, AAA can also be treated with: A. coil embolization only | back 137 C. endoluminal stent grafts |
front 138 A thoracic aortic aneurysm compressing the esophagus would most likely cause: A. difficulty swallowing | back 138 A. difficulty swallowing |
front 139 Thoracic aortic aneurysm can cause persistent cough by compressing the: A. phrenic nerves | back 139 D. recurrent laryngeal nerves |
front 140 Thoracic aortic aneurysm may produce cardiac disease by causing: A. aortic valve dilation | back 140 A. aortic valve dilation |
front 141 Aortic dissection occurs most commonly in which patient? A. woman aged 20, lupus | back 141 C. man 40 to 60, hypertension |
front 142 Younger adults with aortic dissection often have abnormalities affecting aortic: A. platelets | back 142 B. connective tissue |
front 143 More than 90% of dissections in the older major group occur in patients with antecedent: A. hyperlipidemia | back 143 D. hypertension |
front 144 An aortic dissection most commonly begins with which lesion? A. Medial calcification | back 144 C. Intimal tear |
front 145 In a fortunate case, the dissecting hematoma passes through a second distal tear. What happens next? A. It thromboses immediately | back 145 D. It reenters the lumen |
front 146 Reentry of the dissecting hematoma into the aortic lumen through a distal tear creates a: A. Fusiform aneurysm | back 146 B. Double-barreled aorta |
front 147 The most serious complications occur when dissection involves the aorta between the: A. Aortic valve, distal arch | back 147 A. Aortic valve, distal arch |
front 148 The more common and more dangerous proximal lesions are called: A. DeBakey type III | back 148 D. Type A dissections |
front 149 Type A dissections involve: A. Ascending aorta only | back 149 B. Ascending aorta, ± descending |
front 150 A dissection that begins distal to the subclavian artery and spares the ascending aorta is: A. DeBakey type II | back 150 C. Type B dissection |
front 151 The classic pain of aortic dissection is best described as: A. Sudden, excruciating, radiates back | back 151 A. Sudden, excruciating, radiates back |
front 152 As an aortic dissection progresses, the pain classically: A. Resolves after minutes | back 152 D. Moves downward |
front 153 The pain of aortic dissection may be confused with: A. Pulmonary embolism | back 153 C. Myocardial infarction |
front 154 The most common cause of death in aortic dissection is: A. Renal infarction | back 154 B. Rupture into body cavities |