A 51 year old male presents with recurrent chest pain on exertion. Investigation determines he has angina pectoris. What is the pathophysiology of this type of chest pain?

A. Weight loss–muscle wasting: Muscle wasting can occur in Cushing’s disease due to protein catabolism, but it is usually accompanied by weight gain rather than weight loss. Clients typically experience redistribution of fat rather than overall loss of body mass. Weight loss is more characteristic of conditions such as Addison’s disease or hyperthyroidism.

B. Truncal obesity–moon face: Excess cortisol leads to abnormal fat redistribution, resulting in central (truncal) obesity and a rounded “moon face.” These are classic physical assessment findings in clients with Cushing’s disease. The pattern reflects prolonged exposure to high cortisol levels.

C. Pallor–swollen tongue: Pallor and a swollen tongue are more suggestive of anemia or vitamin B12 deficiency. These findings are not associated with the hormonal and metabolic effects of excess cortisol. They do not reflect the typical physical changes seen in Cushing’s disease.

D. Depigmented skin–eyelid lag: Depigmented skin is commonly associated with autoimmune conditions, while eyelid lag is a hallmark of hyperthyroidism. These findings are unrelated to cortisol excess and do not align with the expected assessment findings in Cushing’s disease.

A. Cigarette smoke: Cigarette smoking is the leading risk factor for lung cancer and is strongly associated with multiple histologic types. Tobacco smoke contains numerous carcinogens that cause DNA damage in lung tissue. Risk increases with duration and intensity of exposure.

B. Arsenic: Arsenic exposure, particularly in occupational or environmental settings, has been linked to an increased risk of lung cancer. Chronic inhalation can lead to cellular damage and malignant transformation. It is a well-established environmental carcinogen.

C. Asbestos: Asbestos exposure is strongly associated with lung cancer and mesothelioma, especially when combined with cigarette smoking. Inhaled fibers cause chronic lung irritation and fibrosis, increasing cancer risk. The latency period can be several decades.

D. Viral infection: Viral infections are not recognized as a primary risk factor for lung cancer. While some viruses are associated with other cancers, they do not play a significant role in lung carcinogenesis. Lung cancer risk is mainly related to environmental and occupational exposures.

E. Radioactive dust: Exposure to radioactive dust, such as radon decay products, is a known risk factor for lung cancer. Inhaled radioactive particles emit radiation that damages lung tissue over time. This exposure is a significant risk, especially in poorly ventilated areas.