Cardiovascular Practice Questions

Q: A 34-year-old woman presents with fatigue, night sweats, and painless cervical lymphadenopathy. Excisional biopsy of a cervical lymph node is performed. Large binucleate cells with prominent eosinophilic 'owl-eye' nucleoli are surrounded by a mixed inflammatory background of lymphocytes, eosinophils, plasma cells, and neutrophils. Which of the following cell types is the neoplastic cell of origin responsible for generating the observed inflammatory microenvironment?

Mature B lymphocyte arrested at germinal center stage. ***Mature B lymphocyte arrested at germinal center stage*** - **Reed-Sternberg (RS) cells** are the neoplastic cells in classic Hodgkin lymphoma, originating from **germinal center B-cells** that have undergone failed somatic hypermutation. - These cells produce cytokines like **IL-5** and **CCL5**, which actively recruit the characteristic mixed background of **lymphocytes, eosinophils, and plasma cells**. *Follicular dendritic cell of lymph node sinuses* - **Follicular dendritic cells** are involved in antigen presentation to B-cells and are typically associated with **Follicular Lymphoma** or FDC sarcomas. - They do not manifest as **binucleate cells** with eosinophilic nucleoli and do not drive the specific inflammatory milieu of Hodgkin lymphoma. *Plasmacytoid dendritic cell of interfollicular zones* - These cells specialize in secreting **Type I Interferon** and are part of the innate immune response to viral infections. - They are not the precursors to RS cells and are not responsible for the **'owl-eye'** morphology described. *Peripheral T lymphocyte of paracortical origin* - **T-cell lymphomas**, such as Anaplastic Large Cell Lymphoma, can show large cells, but they lack the specific **B-cell lineage gene rearangements** found in RS cells. - In Hodgkin lymphoma, T-lymphocytes are part of the **reactive background**, not the primary neoplastic cell initiating the tumor. *Mantle zone B lymphocyte with cyclin D1 overexpression* - This describes **Mantle Cell Lymphoma**, which is characterized by the **t(11;14)** translocation involving the CCND1 gene. - Mantle zone B-cells are typically smaller and present in a **monomorphic** population rather than a mixed inflammatory background.

Q: A 14-year-old Caucasian female with a family history of familial hypercholesterolemia commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots?

Macrophages. ***Correct: Macrophages*** - The "flat yellow spots" on the aorta in a familial hypercholesterolemia patient are characteristic of **fatty streaks**, the earliest lesions of atherosclerosis. - These fatty streaks are primarily composed of **lipid-laden macrophages**, also known as **foam cells**, which have ingested oxidized low-density lipoprotein (LDL). - In familial hypercholesterolemia, elevated LDL levels accelerate the formation of these macrophage-rich lesions even in young patients. *Incorrect: Fibroblasts* - While fibroblasts are involved in the later stages of **atherosclerotic plaque formation** by synthesizing collagen and forming a fibrous cap, they are not the predominant cell type in early fatty streaks. - Their presence signifies a more advanced, **fibrotic lesion**, not the initial yellow spots. *Incorrect: T-cells* - T-cells are involved in the inflammatory response in **atherosclerosis** and are found within plaques, but they are not the dominant cell type forming the bulk of the initial lipid accumulation in fatty streaks. - They contribute to the **immune-mediated aspects** of plaque progression. *Incorrect: Neutrophils* - Neutrophils are primarily involved in **acute inflammation** and bacterial infections. - They are generally not a prominent cell type in either early or advanced **atherosclerotic lesions** under normal circumstances. *Incorrect: Endothelium* - Endothelial cells line the lumen of blood vessels and are crucial in the **initiation of atherosclerosis** by becoming dysfunctional and allowing LDL entry. - However, they do not constitute the "yellow spots" themselves, which are subendothelial accumulations of lipids and immune cells.

Question 1

A 67-year-old man with a long-standing history of gastroesophageal reflux disease undergoes upper endoscopy. A biopsy from 2 cm above the gastroesophageal junction is obtained from an area of salmon-colored mucosa. Histological examination shows replacement of the normal squamous epithelium by columnar epithelium containing goblet cells interspersed among columnar absorptive cells, with intact basement membrane and no nuclear stratification, pleomorphism, or loss of polarity. Which of the following statements most accurately characterizes the biological behavior and reversibility of this histological change?

Accepted Answer

The change is a metaplastic transformation that is not itself malignant but confers increased risk of adenocarcinoma, and may regress with acid suppression or ablation but is not reliably reversed by medical therapy alone

Answer

The change is a form of metaplasia that reduces the risk of adenocarcinoma compared with normal squamous epithelium and is irreversible without ablative therapy

Answer

The change represents dysplasia, is potentially reversible with proton pump inhibitor therapy, and carries a low but nonzero annual risk of progression to invasive carcinoma

Answer

The change constitutes carcinoma in situ because the altered cells have lost their tissue-of-origin identity, and surgical resection is the only appropriate management

Answer

The change is a form of hyperplasia driven by chronic acid exposure that is fully reversible with proton pump inhibitor therapy and carries no independent malignant potential

Question 2

A 34-year-old woman presents with fatigue, night sweats, and painless cervical lymphadenopathy. Excisional biopsy of a cervical lymph node is performed. Large binucleate cells with prominent eosinophilic 'owl-eye' nucleoli are surrounded by a mixed inflammatory background of lymphocytes, eosinophils, plasma cells, and neutrophils. Which of the following cell types is the neoplastic cell of origin responsible for generating the observed inflammatory microenvironment?

Accepted Answer

Mature B lymphocyte arrested at germinal center stage

Answer

Follicular dendritic cell of lymph node sinuses

Answer

Plasmacytoid dendritic cell of interfollicular zones

Answer

Peripheral T lymphocyte of paracortical origin

Answer

Mantle zone B lymphocyte with cyclin D1 overexpression

Question 3

A 58-year-old man with a long history of gastroesophageal reflux disease undergoes upper endoscopy. A biopsy is taken from the distal esophagus. The photomicrograph shows replacement of the normal stratified squamous epithelium by columnar epithelium with goblet cells. The patient is counseled that this change carries an increased risk of malignant transformation. Which of the following best describes the reversibility of the currently observed change and the next step in the malignant progression sequence?

Accepted Answer

The current change is reversible; the next step is dysplasia

Answer

The current change is irreversible; the next step is dysplasia

Answer

The current change is irreversible; the next step is invasive adenocarcinoma

Answer

The current change is reversible; the next step is invasive adenocarcinoma

Answer

The current change is reversible; the next step is invasive squamous cell carcinoma

Question 4

A 14-year-old Caucasian female with a family history of familial hypercholesterolemia commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots?

Accepted Answer

Macrophages

Answer

Fibroblasts

Answer

T-cells

Answer

Neutrophils

Answer

Endothelium

Question 5

A 51-year-old man comes to the physician for the evaluation of a 3-week history of fatigue and shortness of breath. One year ago, a screening colonoscopy showed colonic polyps. His brother has a bicuspid aortic valve. On examination, a late systolic crescendo-decrescendo murmur is heard at the right upper sternal border. Laboratory studies show:
Hemoglobin 9.1 g/dL
LDH 220 U/L
Haptoglobin 25 mg/dL (N = 41–165 mg/dL)
Urea nitrogen 22 mg/dL
Creatinine 1.1 mg/dL
Total bilirubin 1.8 mg/dL
A peripheral blood smear shows schistocytes. Which of the following is the most likely cause of this patient's anemia?

Accepted Answer

Fragmentation of erythrocytes

Answer

Erythrocyte membrane fragility

Answer

Erythrocyte enzyme defect

Answer

Gastrointestinal bleeding

Answer

Autoimmune destruction of erythrocytes

Cardiovascular — MCQs

Cardiovascular — MCQs

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