PATHOLOGY – CARDIOVASCULAR SYSTEM

PATHOLOGY – CARDIOVASCULAR SYSTEM

1. Major risk factors for atherosclerosis include:

A. Obesity

B. Hypertension

C. Family history of atherosclerotic diseases

D. Type of A personality

E. Oral contraceptive pill

2. Which of the following plasma cholesterol level identifies those at risk for
atherosclerosis?

A. > 3.0 mmol/L

B. >4. 0 mmol/L

C. >5.0 mmol/L

D. > 6.0 mmol/L

E. No single plasma cholesterol level identifies those at risk

3. Which of the following statements regarding hypertension is FALSE?

A. Diastolic hypertension increases the risk of atherosclerosis whereas systolic hypertension

has no correlation to atherosclerosis.

B. Increased mortality rate is noted with diastolic blood pressure > 7. 0mmHg

C. Hypertension is a stronger risk factor for atherosclerosis than hypercholesterolaemia after

age 45

D. Antihypertensive therapy reduces incidence for ischemic heart disease & stroke

E. None of the above.

4. The decreasing order of frequency of distribution of atherosclerosis are as follows:-

A. Coronary arteries > internal carotid arteries> abdominal aorta> popliteal arteries

B. Internal carotid arteries> coronary arteries> abdominal aorta> popliteal arteries

C. Abdominal aorta> coronary arteries popliteal arteries > internal carotid arteries

D. popliteal arteries> Internal Carotid Arteries> Coronary Arteries > Abdominal Aorta

5. Which of the following statements is FALSE?

A. Aneurysmal dilation of atherosclerotic blood vessel occurs as a result of pressure atrophy

of the vessel wall with loss of elastic issue.

B. Fatty streaks lead to development of turbulent blood flow

C. Occlusion of blood vessels may occur with thrombosis of fissured or ulcerated

atherosclerotic plaques

D. Fibrous intimal thickening tend to occur at bifurcation point of the artery

E. All of the above

6. Role of macrophage in atherosclerotic plaque does NOT include:-

A. Production of cytokines and chemostaxins foe leukocyte migration and adhesion

B. Production of toxic oxygen species to oxidized LDL

C. Binding to oxidized LDL via scavenger receptor

D. Recruitment of macrophage is responsible for growth of atherosclerotic plaque

E. Production of growth factors to stimulate smooth muscle cell proliferation & deposition
of extracellular matrix

7. Sequelae of atherosclerosis include:-

A. Calcification

B. Aneurysmal formation

C. Thromboembolism
D. Chronic ischemia

E. All of the above

8. Which of the following statements regarding cardiac failure is INCORRECT?

A. In acute cardiac failure, considerable renal fluid retention occurs within 24hours

B. Renal fluid retention may fully compensate for myocardial pump deficit, even with 40-
50% reduction of pump ability.

C. Sympathetic stimulation occur within seconds of acute pump failure

D. Cardiac failure may occur within seconds of acute pump failure

E. All of the above

9. In compressed Chronic CCF due to AMI:-

A. Cardiac output is low

B. Cardiac output is high

C. Right atrial pressure is low

D. Right artrial pressure is high

E. None of the above

10. Causes of high output cardia failure does NOT include:-

A. Arterio-venous fistula

B. Acute myocardial infarction

C. Thiamin deficiency (Beriberi)

D. Thyrotoxicosis

E. All of the above

11. Contributing factors to cardiogenic shock include:-

A. Hypotension

B. Reduced coronary perfusion

C. Reduced urine output

D. Increased right artrial pressure

E. All of the above

12. In acute cardiac failure:-

A. Cardiac output increases

B. Capillary pressure reduces

C. Right atrial pressure reduces

D. Blood pressure increases

E. None of the above

13. Reduced urine output in cardiac failure is NOT due to:-

A. Reduced glomerular filtration

B. Activation of renin-angiotensin system

C. Stimulation of aldosterone

D. Stimulation of artrial natriuretic factor

E. All of the above

14. Cardiac reserve in a normal young person is approximately :-

A. 0 – 100% above normal cardiac output

B. 100 – 200% above normal cardiac output

C. 200 – 300% above normal cardiac output

D. 300 – 400% above normal cardiac output

E. 400-500% above normal cardiac output

15. Which of the following statements is TRUE?

A. Peripheral oedema is a common occurrence in acute CCF

B. Eccentric ventricular hypertrophy is a sequelae of hypertension is

C. Myocardial hypertrophy leads to increased metabolic requirement of myocardium

D. Fluid retention results in concentric hypertrophy.

E. All of the above

16. Causes of ischemic heart disease include:

A. Coronary atherosclerosis

B. Anaemia

C. Cyanotic congenital heart disease

D. Advanced pulmonary disease

E. All of the above

17. Which of the following statements regarding ischemic heart disease is FALSE?

A. Most patient with ischemic heart disease have more than 1 lesion causing more than 75%
reduction in cross sectional area of one or more epicardial coronary arteries

B. Most atherosclerosis plaques is found in proximal 1st few cm of major coronary artery.

C. Atherosclerotic plaques do not develop in collateral circulation

D. Coronary thrombus can contribute to Atherosclerotic growth by activating growth signals

in smooth muscle cells.

E. There is pronounced circadian periodicity for acute coronary events, with peak incidence
at 9-11 a.m.
18. Which of the following pairing of ischemic heart disease and pathology is FALSE?

A. Stable angina ->75% stenosis in coronary artery

B. Unstable angina ->90% - stenosis in coronary artery

C. Transmural AMI – Atherosclerotic rupture with complete occlusion by thrombus

D. Sudden death – severe multivessel disease with plaque rupture & thromboembolism

E. All of the above

19. Printzmeral angina is characterized by:-

A. ST elevation

B. ST depression

C. Is associated with exercise

D. Is not relieved with vasodilators

E. All of the above

20. Subendocardial MAI does NOT:-

A. Involve inner 1/3 – ½ of ventricular wall

B. Involve diffuse stenosing atherosclerotic disease

C. Occurs when there is acute plaque or thrombosis.

D. All of the above

E. None of the above.

21. Which of the following timing of events in coronary artery occlusion is WRONG?

A. Onset of anaerobic glycolysis occurs within seconds

B. Loss of myocardial contractility occurs within 60 seconds

C. ATP is completely depleted by 10mins

D. Irreversible cell injury occurs by 20 – 40 minutes

E. None of the above

22. The most common complications of AMI is?

A. Acute pulmonary oedema

B. Cardiogenic shock

C. Thromboembolism

D. Arrhythmia

E. Rupture of free wall or septum or papillary muscle

23. Which of the following statements is TRUE?

A. Cardiogenic shock occurs when >40% of LV is infarcted.

B. Risk of myocardial rupture is greatest at D4-7 post AMI

C. Overall mortality rate of AMI in 1st year is 35%

D. Pericarditis tends to occur at D2-3 post AMI

E. All of the above.

24. Ventricular fibrillation post AMI is due to?

A. Local hyperkalaemia in the ischemic area

B. Sympathetic reflexes

C. Establishing new prolonged conduction pathway and so increase risk of re-entry

arrhythmia
D. Membrane potential of ischemia area is more negative than normal area.

E. All of the above

25. Highest risk for regional dilation & rupture occurs in:-

A. Anterior AMI

B. Posterior AMI

C. Subendocardial AMI

D. Right ventricular MAI

E. All of the above

26. Highest risk for serious conduction block occurs in:-

A. Anterior AMI

B. Posterior AMI

C. Subendocardial AMI

D. Right ventricular AMI

E. All of the above

RESPIRATORY

1.All of the following are neoplastic syndromes associated with lung cancer except

a. Cushing’s

b. SIADH

c. Hypocalcaemia

d. Carcinoid

e. Hypertrophic osteoarthropathy
2. The features of bronchogenic carcinoma include

a. The classification of oat cell tumour within the large cell type

b. High initial response to chemotherapy for all small cell type

c. The strongest correlation with cigarette smoking in adenocarcinoma type

d. That 50% of small cell type occur in nonsmokers

e. Histological features identical in small cell carcinoma and squamous cell types

3. The histological findings in asthma include

a. A thinning of the basement membrane of bronchial epithelium

b. Oedema and an inflammatory infiltrate in bronchial walls with a predominance of

neutrophils

c. An increase in size of submucosal glands

d. Atrophy of bronchial wall muscle

e. None of the above

4. Respiratory cilial function is affected by all except

a. Smoking

b. Loss of cough reflex

c. Haemaglutins

d. Cystic fibrosis

e. Aspiration
5. Primary pulmonary TB

a. Commonly progresses to a tuberculosis pneumonia

b. Is usually asymptomatic

c. Begins as several granulomatous lesions

d. Occurs in the apical region of the lung

e. Spreads by draining to the supraclavicular nodes

6. Regarding emphysema

a. the types include centriacinar, paraseptal, periseptal and irregular

b. the disease is caused by an excess of α1 antitrypsin

c. the pattern is centriacinar in smokers

d. the protease- antiprotease hypothesis has been proven incorrect

e. the bullae or blebs are <1cm diameter

7. Pneumonia

a. Bacterial bronchopneumonia is most commonly caused by Klebsiella pneumoniae

b. Only occurs when normal lung systemic defense mechanisms are impaired

c. Classical sequence of stages in lobar pneumonia (complicated) would be red hepatisation,

congestion, grey hepatisation, resolution

d. Abscess formation is a common complication of bronchopneumonia

e. Resolution of exudates usually does not restore normal architecture

8. emphysema

a. is abnormal temporary enlargement of air spaces

b. is distal to terminal bronchioles

c. has obvious fibrosis of alveolar walls

d. is not a destructive process

e. is similar in nature to overinflation

9. all are types of emphysema except

a. centriacinar

b. panacinar

c. paraseptal

d. irregular

e. intraseptal

10. which of the types of emphysema are associated with α1 antitrypsin deficiency

a. panacinar

b. irregular

c. paraseptal

d. centriacinar

e. none, it is associated with chronic bronchitis

11. smoking irritates the airways and leads to bronchitis by

a. lessening secretion of mucous

b. involuting mucous glands

c. inducing Goblet cell metaplasia

d. causing bronchiolitis

e. suppressing cough reflex

12. with emphysema

a. clinical manifestations appear at 25% loss of parenchyma

b. cough is usually the first symptom

c. patients are often described as blue bloaters

d. weight loss is common

e. massive collapse of lungs is often due to heart failure

13. Which of the following is not a type of extrinsic asthma

a. Aspirin induced

b. Allergic bronchopulmonary dysplasia

c. Dust mite induced

d. Occupational

e. Pollen induced

14. bronchiectasis

a. is manifested by copious amounts of sterile sputum

b. is due to reversible bronchial dilation

c. is not associated with tubercle bacillus

d. is always associated with abnormal structure of cilia

e. is mostly due to obstruction and infection

15. restrictive lung disease

a. is almost always associated with wheezing

b. leads to increased oxygen diffusing capacity

c. is associated with reduced compliance

d. at end stage is referred to as jellybean lung

e. is rarely associated with environmental diseases

16. Regarding bronchogenic carcinoma

a. most often arises around the hilum of the lung

b. distant spread occurs slowly by lymphatic spread

c. metastasis is most commonly to the liver

d. small cell carcinoma is the most common type

e. surgical resection is often effective for small cell carcinoma

17. centriacinar emphysema is

a. predominately of the basal zones of the lung

b. strongly associated with α1 antitrypsin deficiency

c. often the underlying lesion in spontaneous pneumothorax

d. usually involving the distal alveoli

e. is associated with chronic bronchitis primarily in male smokers

18. In regards to bacterial pneumonia

a. A predominately interstitial pattern of inflammation is seen in some paediatric infections

b. Most lobar pneumonias are caused by pneumococci which enter the lung
haematogenously

c. Congestion predominates in the first 72 hours

d. Complications are more common with bronchopneumonias

e. Organization of exudate into a fibrotic scar is not a complication

19. Chronic bronchitis

a. Is 20 times more common in heavy smokers

b. Is present in any patient with a persistent cough with sputum production for at least 2
months in 3 consecutive years

c. Is characterized by early functional respiratory impairment

d. Can progress to cor pulmonale and cardiac failure

e. Is a disease of the large airways

20. Regarding emphysema

a. The commonest type is panacinar

b. In centrilobular form the distal alveoli are spared

c. In panacinar form the upper lobes of the lungs are mainly affected

d. In centrilobular form the lower lobes of the lung are mainly affected

e. There is no association between cigarette smoking and emphysema

21. features of atopic asthma include all of the following except

a. IgE production by β cells

b. Induction of TH1 cells

c. Release of IL-4 and IL-5

d. Growth of mast cells

e. Activation of eosinophils

22. restrictive lung disease is characterized by

a. acute inflammation of alveoli interstitium

b. increased compliance

c. ground glass appearance on CXR

d. long term complication of mesothelioma

e. increased lung volume

23. In the lungs

a. Bacterial invasion evokes exudative liquefaction

b. Bronchopneumonia is commonly caused by Chlamydia organisms

c. 90-95% of lobar pneumonias are caused by Strep. pneumoniae

d. gray hepatisation is the first stage of the inflammatory response

e. bronchopneumonia show characteristic radiologic appearance of radio-opaque well

circumscribed lobe

24. Defense mechanisms against pulmonary infection include

a. Mucous clearance by ciliated epithelium at the front of the nasal cavity

b. Alveolar macrophage clearance of bacteria deposited in the alveoli

c. Mucociliary action of alveolar epithelium

d. Vomiting reflex

e. All of the above

A murmur is heard at the second left intercostal space along the left sternal border.

Which valve area is this?

a. Aortic

b. Mitral

c. Pulmonic

d. Tricuspid

Non-atopic asthma

f. Has a strong family history

g. Is mediated by IgE

h. Is triggered by chemical irritants

i. Can be divided into acute and late phase reactions

j. Cannot be triggered by drugs

25. TB is characterized by (2 CORRECT)

a. lymphatogenous spread to abdominal viscera

b. bridging vessels across fibrocaseous cavities

c. reactivation not re-infection

d. Ghon complexes forming in areas of high oxygen tension

e. Invariable fatal in long or short term depending on host immunity and virulence

26. Emphysema

a. Is characterized by destruction and fibrosis of air spaces distal to the terminal bronchioles

b. Has no clear cut association with cigarette smoking

c. Is clinically manifested when 60% of the pulmonary parenchyma is incapacitated

d. Gives rise to a slowing of forced expiration

e. Is most commonly panacinar