Atheroma, Thrombosis & Embolism

Question 1

what is the definition of atheroma?

Answer 1

Intimal lesion that protrudes into a vessel wall. It consists of a raised lesion with a soft core of of lipid (mainly cholesterol and cholesterol esters) and is covered by a fibrous cap.

Question 2

what is the two features of an atheroma?

Answer 2

fibrous cap

necrotic centre

Question 3

what are commonly affected vessels for atheroma?

Answer 3

bifurcations 
abdominal aorta 
coronary arteries 
popliteal arteries 
carotid vessels
circle of willis

Question 4

what are non-modifiable major risk factors for development of atherosclerosis?

Answer 4

increasing age
male gender
family history
genetic abnormalities

Question 5

what are modifiable major risk factors for development of atherosclerosis?

Answer 5

hyperlipidemia Ldl:Hdl 
hypertension 
cigarette smoking 
diabetes 
c-reactive proteins

Question 6

How does atherosclerosis develop?

Answer 6

it develops as chronic inflammatory response of the arterial wall to endothelial injury.

Question 7

how does lesion progression occurs?

Answer 7

occurs through interactions of modified lipoproteins, monocyte-derived macrophages, T-lymphocytes and the normal cellular constituent of the arterial wall

Question 8

what is the contemporary view of atherosclerosis?

Answer 8

the response-to-injury hypothesis

Question 9

what is the fatty streak?

Answer 9

its the earliest lesion in atherosclerosis and is composed of lipid filled foamy macrophages

Question 10

how does the fatty streak begin?

Answer 10

begins as multiple minute flat yellow spots that eventually coalesce into streaks

Question 11

what does atherosclerotic plaque consist of?

Answer 11

consists of intimal thickening and lipid accumulation

Question 12

what does atherosclerotic appear as?

Answer 12

appears white yellow and superimposed thrombus on the plaque appears red.

Question 13

what is a thrombus?

Answer 13

a solid mass of blood constituents formed within the vascular system in vivo

Question 14

where is arterial thrombosis most commonly superimposed on?

Answer 14

on a atheroma

Question 15

what is venous thrombosis most commonly due to

Answer 15

stasis

Question 16

what are three areas of virchows triad

Answer 16

endothelial injury
hyper coagulability
abnormal blood flow

Question 17

what is the typical mechanism arterial thrombosis?

Answer 17

Typically from rupture of atheromatous plaque

Question 18

what is the typical mechanism venous thrombosis?

Answer 18

Typically from combination of factors from Virchow triad

Question 19

where is arterial thrombosis normally located

Answer 19

Left heart chambers, arteries

Question 20

where is VTE normally located?

Answer 20

Venous sinusoids of muscle and valves of veins

Question 21

what diseases associated with arterial thrombosis?

Answer 21

Acute coronary syndrome
Ischaemic stroke
claudication

Question 22

what diseases associated with VTE?

Answer 22

Deep vein thrombosis (DVT)

Pulmonary embolism

Question 23

what’s the composition of arterial thrombosis?

Answer 23

Mainly platelets

Question 24

what’s the composition of VTE?

Answer 24

Mainly fibrin

Question 25

how do you treat arterial thrombosis?

Answer 25

Anti-platelet agents (clopidogrel)

Question 26

how do you treat VTE?

Answer 26

Anticoagulants (heparin, warfarin)

Question 27

what are the causes of endothelial damage? 5

Answer 27

``` smoking hypertension surgery catheter PICC lines trauma ```

Question 28

what's the hereditary components of hypercoagulability? 3

Answer 28

Factor V leiden Prothrombin G20210A Protein C and S deficiency

Question 29

what's the acquired factors of hypercoagulability? 5

Answer 29

``` Cancer chemotherapy OCR/HRT Pregnancy Obesity HIT ```

Question 30

what are the two causes of stasis?

Answer 30

immobility | polycythemia

Question 31

what are the differences between clot vs thrombus?

Answer 31

platelets only involved in thrombus clot can occur inside or outside clot whereas thrombus occurs only inside vessel clot is gelatinous whereas thrombus is firm thrombus attached to the vessel wall whereas clot isn't attached

Question 32

what leads to an embolisation?

Answer 32

``` occlusion of vessel dissolution incorporation into vessel wall recanalisation embolisation ```

Question 33

what is an embolus?

Answer 33

A mass of material in the vascular system able to become lodged in the vessel and block its lumen

Question 34

what is the most common embolism and where is it derived from?

Answer 34

Pulmonary embolus derived from deep vein thrombosis

Question 35

what are the types of emboli? 7

Answer 35

``` thrombus derived atheromatous plaque material vegetation on heart valves fragments of tumour amniotic fluid gas fat ```