1: Atherosclerosis & Aneurysm

Question 1

What types of arteries are affected by Atherosclerosis?

Answer 1

Large and medium sized arteries

Question 2

What is responsible for ~50% of all coronary, cerebral, and peripheral vascular diseases?

Answer 2

Atherosclerosis

Question 3

What are the consitutional risk factors of atherosclerosis?

Answer 3

Genetics (family history), age (middle age or later), and gender (males and post-menopausal women)

Question 4

Which of the following is a modifiable major risk factor for athersclerosis?

a. hyperlipidemia
b. hypertension
c. cigarette smoking
d. diabetes mellitus
e. all of the above
f. a and c only

Answer 4

e. all of the above

Question 5

On autopsy, you see that the insides of the pt’s arteries show flat, yellow elongated intimal streaks. You also see aggregates of lipid- filled foam cells in layers. The chart tells you that the pt had a family history of atherosclerosis. What type of atherosclerotic lesion did this patient have?

Answer 5

Type II –> describes the hallmark “fatty streak”

**Type II can be seen in people of all ages and is frequently seen in infants due to the high fat content of breast milk

Question 6

What can you expect to see in type 1 atherosclerotic lesions?

Answer 6

Isolated foamy macrophages–> “initial lesions”

Question 7

What is the major difference between a type IV and a type V atherosclerotic plaque?

Answer 7

Both have lipid pools with a necrotic core –> AKA plaque

Type V has an obvious fibrous capover the plaque

Question 8

What is safer– a thick fibrous cap or a thin one (in a Type V atherosclerotic lesion)?

Answer 8

A thick fibrous cap is safer–> a thin one can rupture and cause a clot in the vessel

Question 9

If the pathologist writes on a report that the patient’s vessel shows a “modified atheroma”, what does that mean?

Answer 9

Type V atherosclerotic lesion–> multiple layers of thin fibrous caps that are stacked up on top of one another.

May also see:

• inflammation, medial (tunica media) smooth muscle loss, and thrombosis
• calcification of intima

Question 10

What are the three prinicpal components of type IV and V atherosclerosis?

Answer 10

1) Cells: smooth muscle cells, macrophages, T cells
2) Extracellular matrix (ECM)
3) Intracellular and extracellular lipid

Question 11

The distribution of an atherosclerotic plaque is:

a. patchy, rarely circumferential
b. evenly distributed all the way around the vessel lumen
c. complicated– not really sure what it’s looking for in life

Answer 11

a. patchy, rarely circumferential

Question 12

Arrange the common locations of atherosclerosis from most common to least:

• internal carotid arteries
• circle of willis
• abdominal aorta
• popliteal
• coronary

Answer 12

Abdominal aorta >>> coronary, popliteal, internal carotid >>> circle of willis

Question 13

In a type VI atherosclerotic “complicated advanced” lesion, what are some things you could expect to see?

Answer 13

• Focal rupture/ulceration/erosion of the fibrous cap
• exposure of thrombogenic substances–> thrombus formation
• microemboli of lesion contents

Also may see (not emphasized):

• hemorrhage into plaque
• atheroembolism

Question 14

What are the features of a vulnerable plaque?

Answer 14

• large lipid core (foam cells & extracellular lipids)
• thin fibrous cap w/ few smooth muscle cells
• clusters of inflammatory cells

Question 15

Which of the following is not a clinical consequence of atherosclerosis?

a. myocardial infarction
b. cerebral infarction
c. stenosis of medium-sized vessels
d. aortic aneurysm
e. hyperlipidemia

Answer 15

e. hyperlipidemia

Hyperlipidemia is a risk factor that can lead to atherosclerosis, not develop because of it.

Question 16

What are the two most important causes in atherosclerosis pathogenesis?

Answer 16

• Hemodynamic disturbances
• Hypercholesterolemia

Question 17

What is the “response to injury” hypothesis of atherosclerosis pathogenesis?

Answer 17

A chronic inflammatory and healing process

Question 18

Which of the following describes a true aneurysm?

a. outward bulging of intact artery wall
b. rupture or breach of artery wall with sac formation
c. separation of vessel wall layers by blood
d. when your classmates stress you out with their cockiness and you blow a vessel in your brain

Answer 18

a. true aneurysm
b. false/pseudo aneurysm
c. dissection

Question 19

What are the three main sources in aneurysm pathogenesis?

Answer 19

• poor intrinsic quality of connective tissue
• imbalance of collagen degredation and synthesis
• loss of smooth muscle cells, and synthesis of proteoglycans

Question 20

What genetic conditions can predispose you to aneurysm formation?

Answer 20

Connective tissue disorders:

Marfan’s syndrom, Loeys-Dietz syndrome, Ehlers-Danlos syndrome

Also, scurvy (not genetic, but can contribute)

Question 21

What acquired conditions can contribute to aneurysm pathogenesis?

Answer 21

• Atherosclerosis
• Hypertension
• Tertiary syphilis
• Cystic medial necrosis (tunica media)

Question 22

In what condition would you see fragmentation of elastic fibers, loss of smooth muscle cells, and an accumulation of acid glycosaminoglycan in the tunica media?

Answer 22

Cystic medial necrosis

Question 23

What is the most common clinical cause of an abdominal aortic aneurysm?

Answer 23

Atherosclerosis

Question 24

What is the most common clinical cause of an ascending aortic aneurysm?

Answer 24

Hypertension

Question 25

A 58yr old male pt comes in to the emergency room complaining of pain in his middle back. He has a history of smoking and hypertension.

You perform a physical examination and when sqeezing his back, you feel a pulsatile mass below the origin of renal arteries.

What do you suspect?

Answer 25

Abdominal aortic aneurysm

Buzz words:

• older male (>50yrs)
• smoker
• hypertension
• pulsatile mass below origin of renal arteries

Question 26

At what size would you expect an abdominal aortic aneurysm to rupture?

Answer 26

>6cm