Lesson 1.2.1

1.2.1 Atherosclerosis and its course of events Quiz: Pearson Edexcel Biology A (Salters-Nuffield), Unit 1

20 questions

Written by Revision Ninja · Last reviewed 11 October 2026

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Lesson 1.2.1, Atherosclerosis and its course of events: 20 multiple choice questions for the Pearson Edexcel Biology A (Salters-Nuffield) (9BI0), Unit 1: Lifestyle, Health and Risk, written with Revision Ninja.

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The 20 questions

  1. What is the first step in the development of atherosclerosis?

    • Build-up of calcium salts in the middle layer of the artery wall as a deposit of plaque
    • Damage to or dysfunction of the endothelium lining the artery
    • Blockage of the lumen by a clot formed from fibrinogen and platelets in the artery
    • Thickening of the lumen by smooth muscle that is stimulated by adrenaline in the blood

  2. Which cells are involved in the inflammatory response that contributes to plaque formation?

    • White blood cells such as monocytes, which move into the artery wall and take up lipid
    • Red blood cells, which pass through the damaged endothelium and deposit lipid into the wall
    • Platelets, which enter the wall and engulf cholesterol but do not change into any other cell
    • Neurones in the artery wall, which release cholesterol in response to raised blood pressure

  3. Which substance is most closely linked with the build-up of cholesterol in the artery wall?

    • High-density lipoprotein (HDL), which carries cholesterol into the artery wall and deposits it there
    • Low-density lipoprotein (LDL), which carries cholesterol into the artery wall
    • Fibrinogen, which binds cholesterol and converts to fibrin in the artery wall
    • Haemoglobin, which carries cholesterol bound to the iron atoms in each red blood cell

  4. Which of these is a feature of a mature atherosclerotic plaque?

    • A fully open lumen with a thick, elastic wall that has been reinforced by plasma proteins
    • A ring of platelets that has been completely converted to red blood cells in the artery
    • A smooth layer of endothelial cells only, with no lipid or inflammatory cells present
    • A fibrous cap over a core containing lipid, dead cells and sometimes calcium deposits

  5. How does raised blood pressure contribute to atherosclerosis?

    • It increases the rate of diffusion of oxygen through the artery wall, which kills smooth muscle
    • It damages the endothelium, making it easier for lipids and white blood cells to enter the artery wall
    • It forces red blood cells out of the lumen into the wall, where they form a lipid deposit
    • It stops blood flowing through the artery so that plaque can form in the still blood

  6. A patient's artery has a plaque that reduces the lumen cross-sectional area by 75%. Approximately what fraction of the original flow would be expected if flow is proportional to the fourth power of the radius?

    • The flow falls to about one quarter of the original value, because flow is proportional to the cross-section
    • The radius is halved, so flow falls to about one sixteenth of the original value
    • The flow falls to about one half of the original value, because flow is proportional to the radius
    • The flow is unchanged, because the plaque does not alter the blood pressure in the artery

  7. Why is a fibrous cap important in an atherosclerotic plaque?

    • It increases the lumen diameter, so blood pressure falls and the plaque regresses
    • It stabilises the plaque, but if it ruptures the lipid core is exposed and a clot can form
    • It makes the plaque completely impermeable, which stops any further lipid entering the artery
    • It converts cholesterol into bile salts, which are then removed by the liver

  8. Which process is directly responsible for the growth of a plaque in the artery wall?

    • Smooth muscle cells migrate into the intima and proliferate, adding matrix and lipid to the plaque
    • Plasma proteins are filtered out of the artery and precipitate as calcium phosphate deposits
    • Endothelial cells lose their adhesion and float into the lumen, forming a loose lipid layer
    • Erythrocytes are trapped in the artery wall and divide to form a dense fibrous plaque

  9. Why is atherosclerosis described as a chronic disease that develops slowly?

    • The endothelium regenerates within a few hours, so damage is repeated only occasionally
    • Blood clotting takes several years to complete in an artery, which is why symptoms appear late
    • Plaques form within a single day but are removed only over several years by white blood cells
    • Plaques build up over many years and only narrow the artery significantly after a long period

  10. Which pair of events is most likely to lead to a heart attack?

    • Formation of foam cells in the pulmonary vein followed by an excess of oxygen in the heart muscle
    • Hardening of the aorta followed by an increase in the number of red blood cells in the coronary arteries
    • Narrowing of a capillary followed by a fall in the rate of breathing in the lungs
    • Plaque rupture in a coronary artery followed by thrombosis that blocks blood flow to heart muscle

  11. Why is the endothelium important in maintaining healthy arteries?

    • It contracts to propel blood through the artery and maintain blood pressure at the heart
    • It produces collagen to strengthen the artery and prevent the lumen from narrowing with age
    • It produces substances that regulate blood flow and prevent blood cells and lipids adhering to the wall
    • It forms the thick elastic layer that recoils to keep the artery open between heartbeats

  12. A researcher finds that people with higher LDL cholesterol have more plaque in their arteries. Which is the most appropriate conclusion?

    • The data show correlation, and additional experimental evidence is needed to establish cause
    • The data prove that LDL cholesterol directly causes plaque formation in every individual
    • The data show that LDL is the only cause of atherosclerosis and all other factors are irrelevant
    • The data show that plaque formation causes LDL cholesterol to rise in the bloodstream

  13. Which statement about foam cells is correct?

    • They are red blood cells that have lost their haemoglobin and carry excess cholesterol to the liver
    • They are macrophages that have taken up large amounts of lipid, and they accumulate in the early plaque
    • They are fibroblasts that secrete calcium salts into the artery wall to harden the plaque
    • They are endothelial cells that have been destroyed by platelets and removed by the spleen

  14. Which factor is most likely to increase a person's risk of developing atherosclerosis?

    • Chronic high blood pressure, which damages the endothelium and encourages lipid deposition
    • Low body temperature, which reduces the flow of blood through the arteries and prevents plaque
    • Regular moderate exercise, which increases the number of white blood cells in the blood
    • A high intake of fibre, which increases the rate at which HDL is removed from the blood

  15. Which substance is involved in the inflammatory response in the artery wall and is produced as a result of the presence of damaged endothelium?

    • Cytokines released by endothelial cells and immune cells that attract white blood cells to the site
    • Haemoglobin released from damaged red blood cells that inflames the endothelium
    • Thromboplastin released from red blood cells that binds lipids to the artery wall
    • Insulin released by the pancreas that increases the adhesion of platelets to the artery

  16. A plaque is said to have a 'lipid-rich necrotic core'. What is the best explanation of this term?

    • A layer of living endothelial cells packed with cholesterol that grows into the lumen
    • A clot of fibrin and platelets that forms in the artery after a plaque has ruptured
    • A deposit of calcium phosphate crystals that makes the artery wall impermeable to lipid
    • Dead cells and accumulated lipid form a core within the plaque, surrounded by a fibrous cap

  17. Smoking is linked to atherosclerosis. Which mechanism is the best explanation of how smoking might contribute?

    • Smoke increases the number of red blood cells so that more oxygen reaches the artery wall and forms plaque
    • Chemicals in smoke can damage the endothelium and raise blood pressure, both of which promote plaque formation
    • Smoke causes the endothelium to thicken, which prevents white blood cells entering the artery
    • Smoke forces HDL out of the blood so that LDL is no longer removed from the artery wall

  18. Which statement describes the role of the immune system in atherosclerosis?

    • Immune cells are recruited to the damaged artery wall, and their activity sustains inflammation and plaque growth
    • Immune cells are unable to enter the artery wall, so plaque can only develop without any inflammation
    • Immune cells remove all lipids from the artery wall and so reverse plaque formation completely
    • Immune cells prevent platelets adhering to the endothelium, which stops clot formation

  19. Why does narrowing of an artery by plaque reduce the flow of blood according to Poiseuille's principle?

    • Flow is strongly dependent on radius, so a small reduction in radius causes a large fall in flow
    • Flow increases when radius falls because blood moves faster through a narrower tube
    • Flow depends only on the length of the artery, so plaque causes flow to fall only in long vessels
    • Flow is independent of radius, so narrowing changes only the pressure in the artery, not the flow

  20. Which event typically happens between the formation of a fatty streak and a mature fibrous plaque?

    • Red blood cells pass through the wall, which leaves a clear lumen with no lipid present
    • Platelets convert the lipid into fibrin, which dissolves the endothelium over the streak
    • The endothelium regrows fully, removing the lipid from the intima of the artery wall
    • Smooth muscle cells proliferate and produce a fibrous cap over the lipid-rich core

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