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[{"id":75580,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:09:50","updated_at":"2016-05-31 21:09:50","questionName":"A 30-year-old man goes to his physician for a routine health checkup. On physical examination there are no abnormal findings. Laboratory test findings include serum glucose 80 mg\/dL, hemoglobin A1C 4%, total cholesterol 240 mg\/dL, LDL cholesterol 180 mg\/dL, and HDL cholesterol 20 mg\/dL. Through which of the following mechanisms is endothelial vascular injury in this patient most likely to occur?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"He has hypercholesterolemia with more of the 'bad' LDL cholesterol that can become oxidized and taken up by modified arterial wall LDL receptors. The lipid collects in macrophages that transform to foam cells. These foam cells accumulate and becomes a lip","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75653,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:38:06","updated_at":"2016-05-31 21:38:06","questionName":"Following a meal, lipids are digested and absorbed. Lipids collect within enterocytes. Which of the following chemical components of the blood is mainly responsible for transporting exogenous (dietary) triglyceride from the intestine to the liver?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"Chylomicrons formed in intestinal epithelial cells contain apoproteins, triglyceride and cholesterol.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75657,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:41:51","updated_at":"2016-05-31 21:41:51","questionName":"Some cells demonstrate glucose uptake from the blood regardless of the plasma insulin level. In persons who have had persistent hyperglycemia for years, cellular injury can occur. Which of the following cell types is most likely to show injury from hyperglycemia?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":" Neurons do not require insulin for glucose uptake. The excess glucose diffusing into the cells is shunted into the sorbitol pathway and can lead to osmotic injury, resulting in neuropathy.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75583,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:22:06","updated_at":"2016-05-31 21:22:06","questionName":"A atudy of persons with essential hypertension is performed. They have blood pressures in the range of 140\/90 to 160\/100 mm Hg. Laboratory studies show normal serum electrolyte values. Which of the following physiologic abnormalities is most likely to account for their hypertension?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"The causes for essential hypertension are obscure. The 'set point' for sodium diuresis is probably increased at a higher blood pressure in affected persons. Diuretics that promotes natriuresis are effective in treating essential hypertension.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75575,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 20:17:40","updated_at":"2016-05-31 20:17:40","questionName":"A 70-year-old man has noted coldness and numbness of his lower left leg, increasing over the past 4 months. He also experiences pain in this extremity when he tries walking more than the distance of half a city block. On physical examination, his dorsalis pedis, posterior tibial, and popliteal artery pulses are not palpable. Which of the following laboratory test findings is he most likely to have?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"This is peripheral arterial vascular disease from severe atherosclerosis, which is promoted by diabetes mellitus. The absence of pulses defines this as an arterial process, as does the claudication (pain with exercise). Thrombophlebitis is a venous proces","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75661,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:45:09","updated_at":"2016-05-31 21:45:09","questionName":"During hospitalization, a 40-year-old woman develops thrombophlebitis. She recovers and is discharged. She returns to her job as an electrician. A couple of months later, which of the following terms would best describe the process seen in a femoral vein after recovery from her thrombophlebitis:","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":null,"explanation":"Thrombi may either lyse or will organize over time, with much of the clot eventually removed and the vascular lumen restored.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75648,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:33:38","updated_at":"2016-05-31 21:33:38","questionName":"A 27-year-old woman had a hemoglobin A1C of 7.9% noted during a prenatal visit. She gives birth to a 4350 gm baby at 37 weeks gestation. Just after the delivery, the baby becomes irritable and displays seizure activity. Which of the following laboratory findings is most likely to be found in the baby:","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":" Infants of diabetic mothers are at risk for hypoglycemia following delivery, because they have islet hypertrophy and hyperplasia, and the increased islet production of insulin carries into the immediate postpartum period.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75579,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:05:57","updated_at":"2016-05-31 21:05:57","questionName":"A study is performed involving persons who have a history of diabetes mellitus type 1 or type 2. These patients are found to have cellular injury that results from glycosylation end products and from sorbitol accumulation within cells. The same patients are also shown to have ischemic tissue damage from accelerated and advanced atherosclerosis. Which of the following complications is most likely to result from atherosclerosis in these patients?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":" Stroke from cerebral atherosclerosis or from embolization of mural thrombi from a heart involved with ischemic injury as a consequence of atherosclerosis....","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75578,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:01:34","updated_at":"2016-05-31 21:01:34","questionName":"A 60-year-old woman has become increasingly obtunded over the past day. She was found by her daughter in a stuporous condition and brought to the emergency department. On physical examination, she has poor skin turgor. She is afebrile. Her vital signs reveal a blood pressure of 90\/40 mm Hg, respirations 15 and shallow, pulse 95, and temperature 36\u00b0C. Laboratory studies show a hemoglobin A1C of 10%. Her serum electrolytes show sodium 144 mmol\/L, potassium 5 mmol\/L, chloride 95 mmol\/L, CO2 22 mmol\/L, and glucose 940 mg\/dL. Which of the following is the most likely diagnosis?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"This is an extremely elevated serum glucose that would increase the serum osmolality markedly.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75663,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:48:10","updated_at":"2016-05-31 21:48:10","questionName":"A 52-year-old man has an ulcerated area on the sole of his foot that has not healed for 2 months. He is 180 cm tall, weighs 126 kg, and has continued to gain weight gradually. He has not had any major illnesses. His blood pressure is normal. Which of the following laboratory tests performed on serum from a blood sample would be most useful in elucidating the underlying cause for his problem:","questionTimeSeconds":"0","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"The history suggests diabetes mellitus, most likely type II, and persistent hyperglycemia would confirm the diagnosis.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75576,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 20:24:26","updated_at":"2016-05-31 20:24:26","questionName":"A 72-year-old man suffered a myocardial infarction involving half the left ventricular free wall 3 months ago. He now has increasing dyspnea and orthopnea. On echocardiography his ejection fraction is 29%. On examination he has poor capillary filling in hands and feet. A chest x-ray shows pulmonary edema. Which of the following laboratory test analytes is most likely to be increased in this man at this point in time?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"With congestive heart failure, there is volume overload that triggers an increase in natriuretic peptide, typically measured as the b-type (BNP). This hormone normally leads to natriuresis, diuresis, and vasodilation, lessening the strain on the myocardiu","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75581,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 21:17:35","updated_at":"2016-05-31 21:17:35","questionName":"A 65-year-old man has had increasing lower leg swelling along with reduced exercise tolerance for the past 5 years. He has chest pain on exertion. He has not experienced dyspnea. He has had 4 transient ischemic attacks in the past year. He has experienced abdominal pain in the past 2 months. Vital signs show T 37\u00b0C, P 82\/min, RR 16\/min, and BP 130\/85 mm Hg. He has pitting edema to the knees bilaterally. The lower extremities have palpable pulses, no tenderness, and no erythema. An abdominal CT scan shows dilation of the abdominal aorta to 5 cm, filled with mural thrombus. Other family members have had similar problems. Which of the following underlying conditions is the most likely risk factor for his findings?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"He has findings associated with atherosclerosis, including coronary and aortic disease at least, with congestive heart failure and evidence for an aortic aneurysm. Metabolic syndrome predisposes to atherosclerosis. Some patients may eventually develop ove","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75172,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 10:57:42","updated_at":"2016-05-31 10:57:42","questionName":"A 49-year-old woman has experienced marked pain in her lower extremities on ambulation more than 300 meters for the past 5 months. On physical examination, her lower extremities are cool and pale, without swelling or erythema. No dorsalis pedis or posterior tibial pulses are palpable. Her body mass index is 32. She is a smoker. Which of the following abnormalities of the vasculature is most likely to account for these findings?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"She has claudication from severe peripheral arterial atherosclerosis, most likely from the iliac arteries down. Her major risk factor is obesity that promotes insulin resistance and diabetes mellitus that leads to atherosclerosis.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75577,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 20:53:36","updated_at":"2016-05-31 20:53:36","questionName":"A 44-year-old African-American man has had elevated blood pressure for years which has not been treated. He now has severe headaches. On physical examination his blood pressure is 275\/150 mm Hg. Laboratory studies show Hgb 13.8 g\/dL, serum glucose 76 mg\/dL, and creatinine 3.5 mg\/dL. These findings are most likely to be associated with which of the following pathologic lesions involving his kidneys?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":" Hyperplastic arteriolosclerosis is seen in the setting of malignant hypertension, and renal failure is common","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":75574,"quiz_id":"5670","answer_id":null,"answerType_id":"0","created_at":"2016-05-31 20:12:47","updated_at":"2016-05-31 20:12:47","questionName":"A 57-year-old woman has experienced episodes of altered mental status for the past month. On physical examination, she has bilateral carotid artery bruits. She is given folic acid supplementation. Which of the following laboratory test findings is she most likely to have?","questionTimeSeconds":"30","questionTimeMinutes":"1","questionImagePath":null,"position":null,"explanation":"An elevated plasma homocysteine level is a risk for atherosclerosis as well as thrombosis. Her findings point to transient ischemic attacks (TIAs) with risk for stroke. The carotid bruits represent arterial narrowing as the result of atherosclerosis.","question_score_id":null,"lang":null,"questionAudioPath":null}]