Exam 2; Arteriosclerosis and Hypertension

Question 1

This is responsible for more morbidity and mortality than any other category of disease

Answer 1

vascular disease

Question 2

What are the two principal mechanism of vascular disease

Answer 2

narrowing of obstruction of vascular lumina

weakening of vascular walls, leading to dilation and/or rupture

Question 3

This is medial calcification without luminal narrowing or intimal disruption; clinically insignificant

Answer 3

Monkeberg’s; medial calcific sclerosis

Question 4

This type of arteriolosclerosis is the thickening of the basement membrane involving the arterioles

Answer 4

hyaline arteriolosclerosis

Question 5

This type of arteriolosclerosis is the fibrocellular intimal thickening malignant hypertension and scleroderma

Answer 5

hyperplastic (proliferative) arteriolosclerosis

Question 6

atherosclerosis is associated with the formation of what and where

Answer 6

atherosclerotic plaques or atheroma in the large and medium arteries

Question 7

True or False

atherosclerosis does not protrude int the lumen of the vessel

Answer 7

False; it does

Question 8

Atheromas can obstruct this

Answer 8

blood flow

Question 9

Atheroma can weaken what

Answer 9

the underlying media of the artery

Question 10

Plaques can rupture and result in this

Answer 10

catastrophic vessel thrombosis

Question 11

Where is the highest and lowest prevalence of atherosclerosis

Answer 11

Highest; US and Western Europe

Lowest; Africa and the Far East

Question 12

When and what was the peak death rate from MI

Answer 12

54% in the late 1960’s

Question 13

What is the current death rate from MI

Answer 13

about 50% for all atherosclerosis-related complications

25% due to MI

Question 14

What are three non-modifiable risk factors for atherosclerosis

Answer 14

age
gender
genetics

Question 15

What is it about age that makes someone more susceptible to atherosclerosis

Answer 15

risk of MI increases 5x in men between 40 and 60 years

Question 16

Which gender has the highest risk of atherosclerosis

Answer 16

men > premenopausal women

Question 17

This is the most important non-modifiable risk factor of atherosclerosis

Answer 17

genetics; family history of MI

Question 18

What are four modifiable risk factors for atherosclerosis

Answer 18

cigarette smoking
diabetes
hypertension
hypercholesterolemia

Question 19

1 pack smoker/day increased death rate by what

Answer 19

200%

Question 20

True or False

There is no specific level of hypertension which identifies an increased risk

Answer 20

True

Question 21

what components of hypercholesterolemia are associated with atherosclerosis

Answer 21

low HDL (high HDL is inversely associated)
high LDL (especially above 160mg/dl)

Question 22

What are seven additional risk factors associated with atherosclerosis

Answer 22

lack of exercise
obesity
type A personality (stress)
inflammation
c-reactive protein
lipoprotein A
hyperhomocysteinemia

Question 23

What are the seven steps of the atherosclerosis response-to-injury hypothesis

Answer 23

endothelial injury
accumulation of lipoproteins
monocyte adhesion
lipid accumulation
smooth muscle cell recruitment due to factors released
smooth muscle cell proliferation and ECM production
fully developed plaque

Question 24

This step of the atherosclerosis response-to-injury hypothesis results in endothelial dysfunction

Answer 24

endothelial injury

Question 25

Accumulation of lipoproteins in the atherosclerosis response-to-injury hypothesis results in what

Answer 25

LDL and cholesterol in the vessel wall

Question 26

What is meant by monocyte adhesion in the atherosclerosis response-to-injury hypothesis

Answer 26

migration into intima with differentiation into macrophages and "foam cells" aka macrophages that have ingested lipids

Question 27

There is lipid accumulation in the macrophages which leads to what involving the atherosclerosis response-to-injury hypothesis

Answer 27

the release of inflammatory cytokines

Question 28

What type of molecules recruit the smooth muscle cells in the atherosclerosis response-to-injury hypothesis

Answer 28

activated platelets macrophages vascular wall cells

Question 29

The fully developed plaque with the atherosclerosis response-to-injury hypothesis is composed of what

Answer 29

collagen and smooth muscle cells (myofibroblasts) form a fibrous cap and a central lipid/cellular debris core with cholesterol

Question 30

What are six common sites of atheroma problems

Answer 30

``` major arterial branch points abdominal aorta coronary arteries popliteal arteries carotid arteries cerebral arteries ```

Question 31

Plaques contain these five things

Answer 31

``` collagen lipid myofibroblasts macrophages neovascularization ```

Question 32

What are six progressive changes to atherosclerotic plaques

Answer 32

``` calcification ulceration fissure formation thromobosis embolization hemorrhage into the plaque medial weakenig ```

Question 33

This appears in most children, independent of geography, gender, race and environment occurring at sites both prone and not prone to develop atherosclerosis although some may progress into atheromas

Answer 33

fatty streaks

Question 34

What are five complications of atherosclerosis

Answer 34

``` ischemic heart disease cerebral infarct gangrene renal artery stenosis aortic aneurysm ```

Question 35

What is the prevalence of hypertension in the US

Answer 35

25% of adults

Question 36

What is considered mild hypertension

Answer 36

140/90 to 159/104

Question 37

What is considered moderate to severe hypertension

Answer 37

160/106+

Question 38

What are five symptoms of hypertension

Answer 38

``` none at the early/moderate stages headache fatigue dizziness palpitations ```

Question 39

Essential hypertension accounts for what percentage of patients with hypertension

Answer 39

90-95%

Question 40

What are six contributing factors to essential hypertension

Answer 40

``` genetics obesity inactivity stress high salt intake smoking ```

Question 41

What are the four pathogenesis of essential hypertension

Answer 41

heredity factors reduced renal sodium excretion leading to an increased plasma volume leading to increased CO increased peripheral vascular resistance environmental factors

Question 42

What is compensated hypertensive heart disease

Answer 42

left ventricular concentric hypertrophy provides normal cardiac output

Question 43

What is decompensated hypertensive heart disease

Answer 43

hypertrophy is no longer adequate to provide normal cardiac output due to decreased myocardial contractility, resulting in LV dilation and gradual one of CHF

Question 44

Atherosclerosis caused by hypertension can lead to what

Answer 44

ischemic heart disease, stroke, and ischemic injury to other organs

Question 45

Arteriolosclerosis caused by hypertension can lead to what

Answer 45

retinal injury and kidney damage or nephrosclerosis (kidney failure)

Question 46

Hypertension can cause this of the aorta

Answer 46

dissecting hematoma (longitudinal tear)

Question 47

What is secondary hypertension

Answer 47

A disease that produced hypertension; hypertension is controlled when the underlying disease is treated

Question 48

What is concentric hypertrophy

Answer 48

thickening of the left ventricular wall at the expense of the left ventricular chamber with little or no increase in the outside cardiac dimensions

Question 49

What are two characteristics of malignant hypertension

Answer 49

relatively rapid onset | often superimposed on previous hypertension

Question 50

What are five complications of malignant hypertension

Answer 50

``` cerebral edema papilledema encephalopathy renal failure cerebral hemorrhage 5+/- years to live ```