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Chapter 9. Arterial Disease

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Sectioning of atherosclerotic lesions at postmortem can reveal the architecture of atherosclerotic plaques. Which of the following would typically be present in plaques at low risk of rupture?

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A. Thin fibrous cap

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B. Abundant expression of collagen fibrils

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C. Abundant free cholesterol esters

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D. Abundant inflammatory cells

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E. High concentration of matrix metalloproteinases

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The correct answer is B

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Vulnerable plaques are characterized by thin fibrous caps, which are relatively poor in smooth muscle cells (SMCs) and extracellular matrix proteins (such as collagens), and large lipid-rich necrotic cores, which are abundant in inflammatory cells.

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Immune cells can be divided into those involved in the adaptive response and the innate response to antigens. Which of the following cell types belongs to the innate response?

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A. Macrophages

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B. Platelets

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C. Dendritic cells

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D. T lymphocytes

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E. Mast cells

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The correct answer is D

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The immune response can be divided into the innate immune response, which is an immediate response to foreign antigens and injury and is largely based on phagocytic cells and preformed mediators, and the adaptive response, which is a learned response to specific antigens and involves cell-mediated and humoral immune responses. The innate immune response has traditionally been thought of as the major player in atherosclerosis, with macrophages being the predominant cell type. However, there is mounting evidence for an important role for the adaptive response as well, as evidenced by the presence of T cells within atherosclerotic plaques.

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A 55-year-old man presents with increasing angina despite best medical therapy. A high-grade lesion is identified in the proximal left anterior descending artery (LAD) with a minimal lumen diameter of 0.5 mm. After stent placement, the diameter is increased to 3.5 mm. The patient returns at 6 months with recurrent angina, and an angiogram shows a minimal lumen diameter of 1.5 mm. What is the loss index?

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A. 0.1

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B. 0.25

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C. 0.33

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D. 0.5

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E. 0.66

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The correct answer is E

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Loss index is equal to the late loss divided by acute gain. The acute gain in this example is 3 mm and ...

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