| Adv Pathophysiology (2026) Q&A
1. What is the initiating event in the development of atherosclerosis?
A) Smooth muscle hypertrophy
B) Endothelial injury or dysfunction
C) Thrombus formation
D) Calcification of the arterial media
Correct Answer: Endothelial injury or dysfunction
Rationale: Atherosclerosis begins with endothelial injury or dysfunction, often
caused by hypertension, smoking, hyperlipidemia, or diabetes. This injury triggers
an inflammatory response, increased permeability, and the expression of adhesion
molecules, which are necessary for the subsequent accumulation of lipids and
immune cells in the vessel wall.
2. What is the effect of oxidized low-density lipoproteins (LDLs) in
atherosclerosis?
A) They cause regression of atherosclerotic plaques
B) They increase levels of inflammatory cytokines and promote foam cell
formation
C) They cause smooth muscle proliferation directly
D) They direct macrophages away from the endothelium
Correct Answer: They increase levels of inflammatory cytokines and promote
foam cell formation
,Rationale: Oxidized LDLs are highly immunogenic and cytotoxic. They stimulate
endothelial cells to produce inflammatory cytokines, upregulate adhesion
molecules, and attract monocytes. Macrophages engulf oxidized LDLs to become
foam cells, which are the hallmark of the early atherosclerotic lesion.
3. Which inflammatory cytokines are released when endothelial cells are injured?
A) Granulocyte-macrophage colony-stimulating factor
B) Interferon-beta and interleukin-12
C) Tumor necrosis factor-alpha, interferon-gamma, and interleukin-1
D) Interferon-alpha and macrophage colony-stimulating factor
Correct Answer: Tumor necrosis factor-alpha, interferon-gamma, and
interleukin-1
Rationale: Injured endothelial cells release proinflammatory cytokines,
including TNF-α, IFN-γ, and IL-1. These cytokines amplify the inflammatory
response, increase vascular permeability, and promote the recruitment and
activation of immune cells, contributing to the progression of atherosclerosis.
4. Which factor is primarily responsible for the myocardial hypertrophy associated
with hypertension?
A) Increased norepinephrine
B) Angiotensin II
C) Insulin resistance
D) Adducin
Correct Answer: Angiotensin II
, Rationale: Angiotensin II is a potent growth factor that stimulates protein
synthesis and cellular hypertrophy in cardiac myocytes, leading to left ventricular
hypertrophy in hypertension. While norepinephrine also contributes, angiotensin
II is a primary driver of maladaptive hypertrophy.
5. What effect does atherosclerosis have on the development of an aneurysm?
A) It causes ischemia of the intima
B) It increases nitric oxide production
C) It erodes and weakens the vessel wall
D) It obstructs the vessel lumen
Correct Answer: It erodes and weakens the vessel wall
Rationale: Atherosclerosis degrades the extracellular matrix and smooth muscle
cells within the vessel wall, leading to thinning and weakening of the wall. This
loss of structural integrity allows the vessel to dilate and form an aneurysm under
pressure.
6. Which statement best describes the Frank-Starling law of the heart?
A) Cardiac output is determined by heart rate alone
B) Increased preload leads to increased stroke volume within physiologic limits
C) Afterload is the primary determinant of myocardial oxygen consumption
D) Contractility is independent of end-diastolic volume
Correct Answer: Increased preload leads to increased stroke volume within
physiologic limits