What is the trigger for angina pectoris?

A. A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration: Chronic obstructive pulmonary disease (COPD) is most commonly seen in individuals with a significant smoking history. Progressive shortness of breath is a hallmark symptom of COPD, resulting from chronic airway inflammation and airflow limitation. While pain on deep inspiration is not a classic COPD symptom, it could indicate pleuritic involvement or hyperinflation-related chest discomfort.

B. An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke: Acute shortness of breath and airway constriction in response to tobacco smoke suggests an asthma-like reaction rather than COPD. COPD symptoms tend to be persistent and progressive rather than episodic.

C. An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells: Fever and increased white blood cells indicate an acute infection rather than chronic lung disease. While COPD exacerbations can cause worsening symptoms, an isolated fever and elevated white blood cells suggest pneumonia or another infectious process rather than COPD alone.

D. An 81-year-old male who has a productive cough and recurrent respiratory infections: A productive cough and recurrent respiratory infections are common in chronic bronchitis, a component of COPD. However, this presentation alone is not specific to COPD, as other conditions, such as bronchiectasis, can also cause these symptoms.

A. Atherosclerosis causes ischemia of the intima: While atherosclerosis can affect the intima (the inner layer of the blood vessel), it primarily leads to plaque formation and vessel wall changes rather than causing ischemia directly in the intima. Ischemia typically refers to reduced blood supply to tissues.

B. Atherosclerosis erodes the vessel wall: Atherosclerosis leads to the formation of plaques that can erode and weaken the vessel wall over time. This weakening can create areas of localized dilation, leading to the development of aneurysms. The disruption of the structural integrity of the vessel wall due to atherosclerosis is a key factor in the formation of aneurysms.

C. It increases nitric oxide: Atherosclerosis is associated with impaired endothelial function, which typically results in reduced production of nitric oxide rather than an increase. Nitric oxide is a vasodilator that helps maintain vascular health, and its decrease contributes to vascular dysfunction.

D. It obstructs the vessel: While atherosclerosis can lead to vascular obstruction through plaque buildup, the direct relationship between atherosclerosis and aneurysm formation is more about the weakening and erosion of the vessel wall rather than simply obstructing it. Obstruction can lead to ischemia, but it is not the primary mechanism leading to aneurysm development.