A 68-year-old woman is admitted to the hospital with a chief complaint of substernal chest pain. Examination reveals an obese woman (BMI -32 kg/m2) with a long history of angina pectoris and intermittent claudication (leg cramps). Which of the following is the most likely underlying disease process in this patient?
Atherosclerosis
Deep venous thrombosis
Diabetes mellitus
Necrotizing vasculitis
Systemic hypertension
The Correct Answer is A
A. Atherosclerosis: Atherosclerosis is a chronic disease characterized by plaque buildup in large and medium-sized arteries, leading to reduced blood flow. It commonly manifests as angina pectoris when coronary arteries are involved and intermittent claudication when peripheral arteries are affected. Risk factors such as obesity further increase susceptibility, making atherosclerosis the most likely underlying cause.
B. Deep venous thrombosis: Deep venous thrombosis involves clot formation in the deep veins, usually of the lower extremities, leading to unilateral leg swelling, pain, and redness. It does not cause angina or chronic intermittent claudication, as it affects the venous rather than the arterial system.
C. Diabetes mellitus: Diabetes is a risk factor for atherosclerosis but is not in itself the primary disease process causing angina or intermittent claudication. While it contributes to endothelial dysfunction and accelerated vascular disease, the direct pathology is still atherosclerotic plaque formation.
D. Necrotizing vasculitis: Necrotizing vasculitis involves inflammation and destruction of vessel walls, often causing systemic symptoms like fever, malaise, and organ-specific ischemia. It is uncommon and typically does not present with classic angina or peripheral artery disease patterns seen in this patient.
E. Systemic hypertension: Hypertension is a major risk factor for atherosclerosis and cardiovascular disease, but it is a contributing factor rather than the direct cause of angina or intermittent claudication. The arterial obstruction in this patient is primarily due to plaque buildup rather than elevated blood pressure alone.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Initial tests: normal FEV1, normal FVC, normal FEV/FVC; after inhalation treatment: increased FEV1, increased FVC, normal FEV1/FVC:In asthma, baseline spirometry often shows some degree of airflow obstruction (reduced FEV1 and FEV1/FVC), particularly during symptomatic periods. A completely normal baseline with large increases in FEV1 and FVC after bronchodilator therapy is atypical.
B. Initial tests: normal FEV1, normal FVC, normal FEV1/FVC; after inhalation treatment: no change:Lack of bronchodilator response and normal baseline spirometry suggest either no obstructive airway disease or a condition that is non-reversible, which is inconsistent with asthma.
C. Initial tests: low FEV1, low FVC, low FEV1/FVC; after inhalation treatment: improved FEV1, slightly improved FVC, near normal FEV1/FVC:This pattern is consistent with obstructive airway disease. Asthma is characterized by reversible obstruction: FEV1 and FEV1/FVC improve significantly after administration of a β-adrenergic agonist, reflecting bronchodilation and airway reversibility, which aligns with this patient’s episodic symptoms.
D. Initial tests: normal FEV1, normal FVC, normal FEV1/FVC; after inhalation treatment: no change:Normal spirometry without reversibility indicates no current obstruction and no bronchodilator response, making asthma an unlikely diagnosis, especially in symptomatic patients.
Correct Answer is B
Explanation
A. Acute inflammation:While inflammation can contribute to plaque instability, acute inflammation alone is not the primary cause of coronary artery thrombosis. It may play a role in plaque rupture but does not directly cause occlusion in the absence of atherosclerosis.
B. Coronary artery atherosclerosis:Coronary atherosclerosis is the most common underlying cause of thrombosis leading to acute myocardial infarction. Plaque formation narrows the arterial lumen, and rupture or erosion of an atherosclerotic plaque triggers platelet aggregation and thrombus formation, resulting in sudden vessel occlusion and infarction.
C. Cystic medial necrosis:Cystic medial necrosis affects the aortic wall and predisposes to aneurysms or dissections, not coronary thrombosis. It does not directly narrow or occlude coronary arteries.
D. Mycotic aneurysm:Mycotic aneurysms result from infectious weakening of an arterial wall, usually in larger arteries. They are rare and do not commonly cause coronary artery thrombosis or acute myocardial infarction.
E. Systemic hypertension:Chronic hypertension contributes to vascular injury and accelerates atherosclerosis but is not the immediate cause of thrombotic occlusion. It is a risk factor rather than the direct etiologic agent of coronary thrombosis.
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