Atheroma (Pathophysiology)

Question 1

What is an atheroma?

Answer 1

A formation of focal elevated lesions in the intima of large and medium arteries

Question 2

What is arteriosclerosis?

Answer 2

Agee related change to muscular arteries

Muscle hypertrophy and duplication of the IEL (fibrosis)

Question 3

What does arteriosclerosis cause?

Answer 3

Cerebral, colonic and renal ischaemia in the elderly

Question 4

What is the first stage of atheroma?

Answer 4

Fatty Streak

Question 5

What follows the fatty streak?

Answer 5

Early atheromatous plaque

Question 6

What follows the Early atheromatous plaque?

Answer 6

Fully developed atheromatous plaque

Question 7

What follows the Fully developed atheromatous plaque?

Answer 7

Complicated atheroma

Question 8

How does the fatty streak look like?

Answer 8

Yellow lipid-laden streak

Question 9

What is contained within a fatty streak?

Answer 9

Masses of lipid-laden macrophages

Question 10

What is contained within an atheromatous plaque?

Answer 10

Lipid core
Dead macrophage (foamy macrophages)
Extensive calcification

Question 11

What are foamy macrophages?

Answer 11

Lipid laden macrophages containing oxidised lipoproteins

Question 12

What is a complicated atheroma?

Answer 12

A FDAP with ruptured plaque leading to thrombosis

Question 13

What causes the development of atheromatous plaque?

Answer 13

Endothelial damage with chronic inflammation

Question 14

What changes to injured cells to increase the likelihood of atheroma formation?

Answer 14

Increased cell adhesion molecule expression
(ICAM-1, E-selectin)
Increased LDL permeability

Question 15

What causes endothelial injury?

Answer 15

Turbulent flow
Hypercholesterolaemia
Increased free radicals
Growth factor release

Question 16

What is the prevalence of hypercholesterolaemia in caucasians?

Answer 16

1/500

Question 17

What are the signs of hypercholesterolaemia?

Answer 17

Family history of MI, atheroma
High blood LDL, HDL, total cholesterol
Corneal arcus
Xanthalasmata

Question 18

What are biggest risk factors of atheroma?

Answer 18

Smoking
Hypertension
DM
Male
Age

Question 19

Which plaques are most vulnerable?

Answer 19

Thin caps
Large lipid cores
Prominent inflammation

Question 20

Primary prevention of atheroma

Answer 20

Smoking cessation
Control BP
Lose weight
Exercise
Diet control

Question 21

Drug prevention of atheroma

Answer 21

Statins

Aspirin

Question 22

Normal blood flow is what?

Answer 22

Laminar

Question 23

What changes make up Virchow’s Triad?

Answer 23

Blood vessel wall
Blood constituents
Pattern of blood flow

Question 24

What are Virchow’s triad?

Answer 24

Factors causing thrombosis

Question 25

What is thrombosis?

Answer 25

Formation of a solid mass from the constituents of blood within the vascular system during life

Question 26

What is the relationship between atheroma and thrombosis?

Answer 26

Arterial thrombosis most commonly superimposed on atheroma

Question 27

What are the outcomes of thrombosis?

Answer 27

Resolution Organisation Recanalisation Propagation

Question 28

What is an embolism?

Answer 28

Movement of abnormal material in the bloodstream and its impaction in a vessel, blocking its lumen

Question 29

What factors effect the consequences of systemic thromboembolus?

Answer 29

Size of occluded vessel | Collateral circulation

Question 30

Where do venous thromboembolus most commonly travel to?

Answer 30

Pulmonary circulation

Question 31

Multiple PE over time lead to what?

Answer 31

Pulmonary Hypertension | RVF

Question 32

Risk factors for PTE, DVT?

Answer 32

``` Cardiac Failure Severe trauma Post-partum Nephrotic syndrome Malignancy Oral contraceptive Immobilisation Obesity PMH ```

Question 33

Prophylaxis for surgical patients at risk of PTE/DVT

Answer 33

Compression stockings | Herparin

Question 34

When can fat emboli occur?

Answer 34

After major fractures

Question 35

What is effected by fat emboli?

Answer 35

Brain Kidneys Skin

Question 36

When can cause gas emboli?

Answer 36

Air embolus | Decompression sickness

Question 37

What causes air embolus?

Answer 37

Head and neck wounds Surgery CV lines

Question 38

What is a trophoblastic emboli? Where does it effect?

Answer 38

Material from placenta | Lungs

Question 39

What are the different types of embolus?

Answer 39

``` Fat Gas Tumour Bone marrow Foreign Bodies Amniotic Fluid Trophoblastic material Septic material ```

Question 40

What are the presenting features of Rheumatic Fever?

Answer 40

``` Flitting polyarthritis of large joints Rashes Fever Pancarditis Heart Murmurs ```

Question 41

Most common bacteria in Rheumatic fever?

Answer 41

Group A Beta-haemolytic streptococci

Question 42

What are Aschoff bodies?

Answer 42

Foci of chronic inflammation, necrosis and activated macrophages Seen in acute Rheumatic Fever

Question 43

What is the most common cause of mitral regurgitation?

Answer 43

Ischaemic heart disease

Question 44

What is hypoxic hypoxia?

Answer 44

Low inspired O2 | (or) Low PaO2

Question 45

What is anaemic hypoxia?

Answer 45

Abnormal blood with normal inspired O2

Question 46

What is stagnant hypoxia?

Answer 46

Abnormal delivery - local (occlusion) - systemic (shock)

Question 47

What is cytotoxic anaemia?

Answer 47

Tissue level disorder

Question 48

Complicated atheroma in the coronary arteries leads to what?

Answer 48

Unstable angina

Question 49

Ulcerated/fissured plaques of the coronary arteries lead to what?

Answer 49

Thrombosis --> MI

Question 50

What is ischaemia?

Answer 50

Lack of blood supply to a tissue relative to demand, leading to hypoxia

Question 51

What factors affect Oxygen supply to tissues?

Answer 51

``` Inspired O2 Pulmonary function Blood flow/constituents Integrity of vasculature Tissue mechanisms ```

Question 52

What are the clinical presentations of ischaemia?

Answer 52

Cell dysfunction Pain Damage (specialised cells)

Question 53

The scale of damage in infarction is dependent on what?

Answer 53

Duration Tissue being cut off Collateral blood supply Previous disease

Question 54

How long does ATP depletion take post MI?

Answer 54

Seconds

Question 55

How long does loss of contractility take post MI?

Answer 55

<2 minutes

Question 56

How long do reversible changes take post MI?

Answer 56

Minutes

Question 57

How long do irreversible changes take post MI?

Answer 57

20-30 minutes

Question 58

How long does myocyte necrosis onset take post MI?

Answer 58

20-40 minutes

Question 59

How long does microvascular injury take post Infarct?

Answer 59

1hr

Question 60

How long do swollen mitochondria take to appear post infarct (electron microscopy)?

Answer 60

3-12 hours

Question 61

Where do pale infarcts occur?

Answer 61

Myocardium Spleen Kidney

Question 62

Where do red infarcts form?

Answer 62

Loose tissues Liver Lung

Question 63

How long does chronic inflammation/granulation tissue onset take post infarct?

Answer 63

72hrs

Question 64

What are the end results of infarcts?

Answer 64

Scar | Reperfusion injury