atherosclerosis

Question 1

Atherosclerosis
-is characterized by lesions called _______ or ______

• they (Weaken or Strengthen?) the underlying ______

Answer 1

atheromas or atheromatous/fibrofatty plaques

Weaken; media

Question 2

In Atherosclerosis, the atheromas do not protrude into and obstruct vascular lumen

T/F

Answer 2

F

They do

Question 3

Atherosclerosis

• It is one of the 3 morphologic patterns of ___________.

• Others are
___________
__________

Answer 3

arteriosclerosis

Monckeberg Medial Calcific Sclerosis - Arteriolosclerosis

Question 4

the cause of atheroma is ( simple or complex?) and __________.

Answer 4

Complex

multifactorial

Question 5

Atherosclerosis

There are many risk factors. The various risk factors are considered in three main groups by some authors.

________
_________
_________

Answer 5

ENDOGENOUS FACTORS

ENVIRONMENTAL FACTORS

DISEASES

Question 6

Aetiology of atherosclerosis
ENDOGENOUS FACTORS
•_____
•_____
•______ factors
•______ differences

Answer 6

Age

Sex

Genetic

Racial

Question 7

ENDOGENOUS FACTORS
• Age
• atherosclerosis is a slow complex disease that typically starts in ______ and often progresses when people grow older.

Answer 7

childhood

Question 8

In some people atherosclerosis progresses rapidly in the third decades

T/F

Answer 8

T

Question 9

ENDOGENOUS FACTORS
• Sex
• in men risk increases after the age of _____ and in woman risk increases after the age ——-.

Answer 9

45

55

Question 10

IHD- ____________

Answer 10

Ischemic heart disease

Question 11

The lower incidence of IHD in women, especially in premenopausal age, is probably due to high levels of _________, both of which have anti- atherogenic influence.

Answer 11

oestrogen and high- density lipoproteins

Question 12

ENDOGENOUSFACTORS

Genetic factors

• A well-established _____ predisposition to atherosclerosis and ischaemic heart disease is most likely _______.

• Genetic defects in _____ metabolism causing ______ are associated with accelerated atherosclerosis,

Answer 12

familial; polygenic

lipoprotein; hyperlipoproteinemia

Question 13

____zygous familial hypercholesterolemia which often results in myocardial infarction before age ____ years

Answer 13

homo

20

Question 14

Monozygotic twin of an affected individual of atherosclerosis has ____-fold increase compared to the general population.

Answer 14

eight

Question 15

ENDOGENOUS FACTORS

• Racial differences

• (higher or lower ?) fasting blood glucose and (lesser or greater?) prevalence of diabetes in blacks and (lower or greater?) high-density lipoprotein values than in white men.

Answer 15

Higher
Greater
Lower

Question 16

there is a striking difference in obesity between white and black women

T/F

Answer 16

T

Question 17

ENVIRONMENTALFACTORS

• Higher incidence of atherosclerosis in (developed or underdeveloped ?) countries and low prevalence in (developed or underdeveloped?) countries, suggests the role of environmental influences.

Answer 17

Developed

Underdeveloped

Question 18

Indeed, of all the known risk factor, _________ seems to be the most important determinant of the geographic differences in the incidence of atherosclerotic coronary artery disease.

Answer 18

serum cholesterol

Question 19

ENVIRONMENTAL FACTORS

Cigarette smoking
• There is substantial (lesser or greater?) mortality from cigarette smoking.

The death rate depends on ____________

Answer 19

Greater; number of cigarettes smoked.

Question 20

Cigarette smoking alter lipid profile

T/F

Answer 20

T

Question 21

Cigarette smoking alter lipid profile.

(Low or High?) levels of HDL and (lower or higher?( values of LDL and triglycerides have been documented in heavy smokers.

Endothelial injury consequent to ______ exposure and chronic _____ that results in rapid ————— in smokers seems to be some of the mechanisms involved.

Answer 21

Low

Higher

carbon monoxide; hypoxia; aggregation of platelets

Question 22

ENVIRONMENTAL FACTORS
• Cigarette smoking

It is a major risk factor for developing coronary artery disease, producing a marked decline in _____ dependent vasomotor response. It causes endothelial _______, possibly through increased _______, and this is also true for __________ or _________.

Significant increases in _______ and _____ are demonstrable in smokers and ___________ metabolites are reduced significantly.

Answer 22

endothelium; dysfunction

oxidative stress; passive smoking or environmental tobacco smoke

sICAM-1 and sVCAM-1

nitric oxide

Question 23

ENVIRONMENTALFACTORS
• Hyperlipoproteinemia and diet

Meat, egg, and milk contain mostly (saturated or unsaturated?) fats and considerable quantities of ______, which leads to the concentration of ____LP in the plasma tend to be high.

Answer 23

Saturated; cholesterol

low density

Question 24

Diet rich in (saturated or unstaturated?) fats and cholesterol is androgenic.

Answer 24

saturated

Question 25

Unsaturated fat is androgenic. T/F

Answer 25

F not

Question 26

Excessive refined carbohydrates _______, ____eases blood lipid cholesterol lipoprotein

Answer 26

sucrose incr

Question 27

ENVIRONMENTAL FACTORS • Lack of exercise It has been shown that people with sedentary life style generally suffer (more or less?) from coronary artery disease than those with strenuous jobs.

Answer 27

More

Question 28

physical activity may reduce the incidence of complicated atheroma T/F

Answer 28

T

Question 29

Individual with coronary prone behaviours such as ______,________,____,_______ (Type ___ personality) have a _______-fold increase risk of coronary artery disease compared with type ___ behaviour of _______ and ______ type.

Answer 29

time urgency, aggressiveness, ambition, competitiveness A two- to three B; relaxed and happy- go-lucky

Question 30

Atherosclerosis is (more or less?) common in low socioeconomic person.

Answer 30

More

Question 31

ENVIRONMENTAL FACTORS • Alcohol A moderate intake of alcohol (_______ a day) appears to offer some protection from coronary disease T/F

Answer 31

2 to 4 units T

Question 32

heavy drinking is associated with hypertension and excess cardiac events. T/F

Answer 32

T

Question 33

ENVIRONMENTAL FACTORS • Other dietary factors Diet deficient in _____,_______, and __________ fatty acids are associated with increased risk of vascular disease. Low level of Vitamin ____, and other anti-oxidants may enhance the production of oxidized LDL.

Answer 33

fresh fruits, vegetables and polyunsaturated E

Question 34

Major risk factors of atherosclerosis • High ____ and ____ levels • Hypertension • Cigarette smoking • Type ___ diabetes • Physical ______ • High ______ fat • Obesity

Answer 34

Cholesterol and Triglyceride 2 inactivity Saturated

Question 35

lesser/uncertain potentially controllable risk factors of atherosclerosis •_____ •_____ level • hardened _____ fat intake •_______ pneumoniae

Answer 35

alcohol Lipoprotein (trans)unsaturated Chlamydia

Question 36

INSUDATION HYPOTHESIS/VIRCHOW’S IMBIBITION THEORY • Virchow holds that atheromatous deposits are lined by __________ • Hence B Lp from plasma is imbibed through _____ (by _____) where it splits into ______ and ____ • These are retained and deposited while _____ are removed in the circulation. • There is ________ connective tissue proliferation by _____ reaction towards cholesterol

Answer 36

vascular endothelium endothelium; stress cholesterol and its esters PLs(phospholipids) sub-intimal ; fibroblastic

Question 37

ENCRUSTATION THEORY • First suggested in the 19th century by _______ • He asserted that materials from blood is deposited on the ____ surface of arteries and leads to _____ of the ____ lining • A mordern version of this theory holds that _____ represents the initial event in atherosclerosis. Organization of these, leads to the formation of _____ & expansion of these lesions reflects repeated episodes of ______ and ____

Answer 37

Rokitansky inner; thickening; inner thrombi; plaques thrombosis & organization

Question 38

THROMBOGENIC HYPOTHESIS • This proposes that thrombus is _____________ • Lipid is derived from _______ and cells stimulated to proliferation by _____

Answer 38

incorporated into the intima of blood vessels cell membrane PDGFs

Question 39

Arteriosclerosis Literally, " ________________ ;" due to ______ of the blood vessel wall

Answer 39

hard arteries thickening

Question 40

Three pathologic patterns of Arteriosclerosis _______,_________, and __________

Answer 40

atherosclerosis, arteriolosclerosis, and Monckeberg medial calcific sclerosis

Question 41

__________ is the most common type of arteriosclerosis

Answer 41

Atherosclerosis

Question 42

Atherosclerosis Affects ____ arteries and _________ sized muscular arteries

Answer 42

elastic large/medium-

Question 43

Characteristics OF ATHEROSCLEROSIS ______ on the endothelium leads to Endothelial ______, which leads to Invasion of ______ cells (mainly _____ and ______) through the disrupted endothelial barrier

Answer 43

Chronic stress; dysfunction; inflammatory; monocytes and lymphocytes

Question 44

Characteristics OF ATHEROSCLEROSIS Adhesion of platelets to the damaged vessel wall → platelets release inflammatory mediators (e.g., cytokines) and _________ which stimulates ______ and _____ of _______ cells (___) in the tunica ______ and mediates differentiation of ________ into _____

Answer 44

platelet-derived growth factor (PDGF) migration and proliferation ; smooth muscle ; SMC intima; fibroblasts into myofibroblasts

Question 45

Characteristics OF ATHEROSCLEROSIS •Inflammation of the vessel wall •Macrophages and SMCs ingest _____ from ______ and transform into _____ that accumulate to form _______

Answer 45

cholesterol; oxidized LDL; foam cells. fatty streaks

Question 46

Fatty streak Aka ____________ lesions

Answer 46

early atherosclerotic lesions

Question 47

Characteristics OF ATHEROSCLEROSIS •Lipid-laden macrophages and SMCs produce ______ (e.g.,_____) → development of a ___________(____)

Answer 47

extracellular matrix collagen; fibrous plaque (atheroma)

Question 48

fibrous plaque in atherosclerosis Aka _________

Answer 48

atheroma

Question 49

Characteristics OF ATHEROSCLEROSIS •________ cells in the atheroma (e.g., macrophages) secrete matrix _________ that lead to _______ of the fibrous cap of the plaque due to the __________ By this time, a minor stress is enough to rupture the fibrous cap Leading to ________ of the intima

Answer 49

Inflammatory; metalloproteinases weakening; breakdown of extracellular matrix Calcification

Question 50

the ______ and _____ of calcification of the intima affect the risk of complication

Answer 50

amount and pattern

Question 51

Characteristics OF ATHEROSCLEROSIS Basically, Plaque rupture → exposure of _________ (e.g., collagen) → _______ formation with vascular occlusion or ________

Answer 51

thrombogenic material thrombus spreading of thrombogenic material

Question 52

Foam cells are typical and specific for atherosclerotic changes. T/F

Answer 52

F Not specific for it

Question 53

COMPLICATIONS of atherosclerosis 1. Stenosis of _____-sized vessels results in impaired blood flow and ischemia leading to i.__________ (lower extremity arteries, e.g., popliteal) ii.______ (coronary arteries) iii. ________ disease (mesenteric arteries) 2. Plaque rupture with thrombosis results in _______ (coronary arteries) and ____ (e.g., middle cerebral artery). 3. Plaque rupture with embolization results in ___________, characterized by _________ within the embolus 4. Weakening of vessel wall results in ________ (e.g., abdominal aorta)

Answer 53

medium Peripheral vascular disease ; Angina; Ischemic bowel myocardial infarction ; stroke atherosclerotic emboli; cholesterol crystals aneurysm

Question 54

DOWNSTREAM CELLULAR Injury/DEATH In atherosclerosis Coronary arteries = _________ and __________ Internal carotid and & middle cerebral >- ________ and _______ Superior mesenteric > __________ popliteal artery >-______ ISCHEMIA ( ______ + _______ )

Answer 54

ANGINA +MYOCARDAIL INFARCTION STROKE +CEREBRAL ATROPHY SMALL INTESTINE PERIPHERAL gangrene +claudication

Question 55

claudication is ????

Answer 55

Leg cramping

Question 56

Arteriolosclerosis: _______ of the _____ arteries and _______ Two main types are ______ and ________

Answer 56

hardening; small; arterioles Hyaline arteriolosclerosis Hyperplastic arteriolosclerosis

Question 57

Hyaline arteriolosclerosis Deposition of ______ (above or below?) the endothelium due to _____ H&E:__________ deposits (____) within the arteriolar walls

Answer 57

proteins Below; leakage pink amorphous; hyaline

Question 58

Causes of hyaline arteriolosclerosis: __________ hypertension, chronic ______ , and _________

Answer 58

chronic essential diabetes normal aging

Question 59

Hyperplastic arteriolosclerosis Proliferation of ___________ cells in response to __________ H&E: "_______ " appearance of the arteriole

Answer 59

subendothelial smooth muscle very high blood pressure onion-skin

Question 60

Cause of hyperplastic arteriolosclerosis _________ hypertension

Answer 60

malignant

Question 61

Mönckeberg arteriosclerosis (less common) ______ calcification of the _____ and internal elastic lamina causes stiffening of the arteries Mainly affects ______-sized arteries X-ray:______ appearance

Answer 61

Dystrophic; media medium pipestem

Question 62

intima is involved in Mönckeberg arteriosclerosis T/F

Answer 62

F intima is not involved)

Question 63

in Mönckeberg arteriosclerosis There is blood flow obstruction. T/F

Answer 63

F There is no blood flow obstruction.

Question 64

Treatment of atherosclerosis ______ changes Surgery like _______,______,_____ etc And medications

Answer 64

Lifestyle Angioplasty +stent, bypass surgery, endarterectomy

Question 65

Medications of atherosclerosis include ______ medication eg_____ ______ medication eg_____ ______ medication eg___,__,___

Answer 65

Cholesterol; statins Anti-platelets; aspirin Blood pressure; beta blockers, ACE inhibitors, diuretics