Atherosclerosis And Atheroma

Question 1

Define atherosclerosis

Answer 1

The thickening and hardening of arterial walls as a consequence of atheroma

Question 2

Define arteriosclerosis

Answer 2

The thickening of the walls of arteries and arterioles usually as a result of hypertension or diabetes mellitus

Question 3

What are the 3 stages of atheroma?

Answer 3

Fatty streak
Simple plaque
Complicated plaque

Question 4

Describe the macroscopic features of a fatty streak

Answer 4

Lipid deposit in in time

Yellow, slightly raised

Question 5

Describe the macroscopic appearance of a simple plaque

Answer 5

Raised, yellow/white
Irregular outline
Widely distributed
Enlarge and coalesce

Question 6

Describe the macroscopic appearance of a complicated plaque

Answer 6

Thrombosis (disrupts flow)
Haemorrhage into plaque
Calcification
Aneurysm formation

Question 7

What are the early microscopic changes of atheroma?

Answer 7

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid

Question 8

What are the intermediate microscopic changes seen in atheroma?

Answer 8

Fibrosis
Necrosis
Cholesterol clefts
Possibly inflammatory cells

Question 9

What are the late microscopic changes of atheroma?

Answer 9

Disruption of internal elastic lamina (stops compliance)
Damage extends into media
Ingrowth of blood vessels
Plaque fissuring

Question 10

What are some of the risk factors for atheroma formation?

Answer 10

Age
Gender 
Hyperlipidaemia 
Cigarette smoking
Hypertension
Diabetes mellitus 
Alcohol 
Infection

Question 11

Genetic variations in which apolipoprotein are associated with changes in LDL levels?

Answer 11

Apolipoprotein E

Question 12

What effect does PDGF have on atheroma formation?

Answer 12

Stimulates proliferation and migration of smooth muscle cells

Question 13

The unifying hypothesis states endothelial injury may be due to …

Answer 13

Raised LDL
Toxins
Hypertension
Haemodynamic stress

Question 14

What does endothelial injury cause?

Answer 14

Platelet adhesion, PDGF release, smooth muscle proliferation and migration
Insulation of lipid, LDL oxidation, uptake of lipid by smooth muscle cells and macrophages
Migration of monocytes into intima
SMCs produce more matrix material
Recruitment of other inflammatory cells

Question 15

What are the symptoms of MI?

Answer 15

Chest pain
Profuse sweating
Nausea
Vomiting
(Angor animi)

Question 16

Where do berry aneurysms occur?

Answer 16

Circle of Willis

Question 17

How can we treat hyperlipidaemia?

Answer 17

Statins
Bile salt sequestrants
Diet and lifestyle changes

Question 18

What is Leriche syndrome?

Answer 18

Aortoiliac occlusive disease

Intermittent claudication of buttocks, thighs or calves

Question 19

What is prostacyclin?

Answer 19

A prostaglandin which prevents adhesion and aggregation of platelets to endothelium

Question 20

Which clotting factor requires vitamin K to be made?

Answer 20

Prothrombin (clotting factor II)

Question 21

Which enzyme converts cholesterol to cholesterol ester?

Answer 21

LCAT

Question 22

How many classes of apolipoproteins are there?

Answer 22

6

A, B, C, D, E and H

Question 23

What is the cofactor for lipoprotein lipase?

Answer 23

ApoC-II

Question 24

Why is LDL not efficiently cleared by the liver?

Answer 24

Doesn’t have apoC or apoE

Question 25

What acts as the ligand for LDL RME?

Answer 25

ApoB-100

Question 26

Type I hyperlipoproteinaemia is due to …

Answer 26

Defective lipoprotein lipase

Question 27

Type IIa hyperlipoproteinaemia is due to …

Answer 27

Defective LDL receptor

Question 28

Define atheroma

Answer 28

The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries