MoD Session 6- Atheroma

Question 0

Define atherosclerosis

Answer 0

A hardening and thickening of arterial walls as a result of atheroma.

Question 1

Define atheroma

Answer 1

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

Question 2

Define arteriosclerosis

Answer 2

A hardening and thickening of artery and arteriole walls as a result of hypertension and DM.

Question 3

What are the 3 macroscopic features of atheroma?

Answer 3

1. Fatty streak
2. Simple plaque
3. Complex plaque

Question 4

What is a fatty streak?

Answer 4

A yellow, raised lipid deposit in the intima.

Question 5

What is a simple plaque?

Answer 5

A yellow/white raised, widely distributed deposit.

Question 6

How does a complex plaque form?

Answer 6

By the enlargement and coalescing of simple plaques.

Question 7

What are the complex plaque complications? (4)

Answer 7

Calcification, thrombosis, haemorrhage and aneurysm formation.

Question 8

What are the 5 common sites of atheroma formation?

Answer 8

• aorta (abdominal)
• carotid arteries
• cerebral arteries
• leg arteries
• coronary arteries

Question 9

What are the 3 early microscopic features of atheroma?

Answer 9

• smooth muscle cell proliferation
• foam cell accumulation (phagocytosis of lipids)
• extracellular lipid deposition

Question 10

What are the 5 later microscopic features of atheroma?

Answer 10

• fibrosis and necrosis
• cholesterol clefts
• disrupted internal lamina which extends into media
• in growth of blood vessels
• plaque fissuring

Question 11

What is the difference between angina and an MI?

Answer 11

If you stop what is causing the pain, in angina the pain will go away, whereas it will not in an MI.

Question 12

Define infarction

Answer 12

Obstruction of the blood supply to an organ or tissue causing local death of the tissue.
Typically by a thrombus/embolus

Question 13

Define Ischaemia

Answer 13

An inadequate blood supply to an organ.

Question 14

Define aneurysm

Answer 14

A excessive, localised swelling of the wall of an artery.

Question 15

Name 5 clinical effects of atheroma

Answer 15

• cerebral Ischaemia
• ischaemic heart disease
• mesenteric Ischaemia
• peripheral vascular disease
• abdominal aortic aneurysm

Question 16

5 things ischaemic heart disease can cause

Answer 16

• angina pectoris
• MI
• arythmias
• cardiac failure
• sudden death

Question 17

How does a cerebral infarction/stroke come about in cerebral Ischaemia?

Answer 17

Atherosclerosis in carotid arteries
Thrombus and then embolus formation
Embolus occludes cerebral arteries
Stroke

Question 18

What 3 things can mesenteric Ischaemia cause?

Answer 18

• ischaemic colitis
• malabsorption
• intestinal infarction

Question 19

What is intermittent claudication in peripheral vascular disease?

Answer 19

It is interval pain in calves due to exercise

Question 20

What is leriche syndrome?

Answer 20

It is claudication of the buttocks, and impotence

Question 21

What is ischaemic rest pain?

Answer 21

When there is claudication (due to artery obstruction) even when no exercise is being performed.

Question 22

Name 11 risk factors of atheroma

Answer 22

• age
• gender
• hyperlipidaemia
• smoking
• hypertension
• DM
• alcohol
• infection
• geography
• familial hypercholesterolaemia
• apolipoprotein E genotype

Question 23

Which gender is more susceptible to atheroma formation?

Answer 23

Males

Question 24

What are associated physical signs of familial hypercholesterolaemia? (3)

Answer 24

• xanthelasma
• tendon xanthomas
• arcus

Question 25

What are xanthelasmas?

Answer 25

Foam cell accumulations in the dermis

Question 26

What is corneal arcus?

Answer 26

A thin pale arc around the cornea of the eye that is cholesterol deposits

Question 27

What is the predicted link between hypertension and IHD?

Answer 27

That the higher pressure damages endothelial cells

Question 28

By what proportion does DM increase IHD risk by?

Answer 28

Doubles the risk

Question 29

What infections are associated with atheroma?

Answer 29

• chlamydia pneumoniae
• helicobacter pylori
• cytamegalovirus

Question 30

What are the processes involved in atheroma formation? (4)

Answer 30

• thrombosis
• lipid accumulation
• production of intercellular matrix
• cell type interactions

Question 31

What are the 6 cell types involved?

Answer 31

• endothelial cells
• lymphocytes
• neutrophils
• platelets
• macrophages
• smooth muscle cells

Question 32

What is the function of endothelial cells?

Answer 32

• haemostasis
• collagen secretion
• proliferation and migration stimulus for smooth muscle cells

Question 33

What is the function of platelets?

Answer 33

• haemostasis

- proliferation and migration stimulus for smooth muscle cells

Question 34

What is the function of smooth muscle cells?

Answer 34

• take up LDLs to become foam cells

- synthesise collagen and proteoglycans

Question 35

What is the function of macrophages?

Answer 35

• phagocytosis of LDLs to become foam cells
• oxidise LDLs
• stimulate proliferation and migration of smooth muscle cells

Question 36

What is the function of neutrophils?

Answer 36

-secrete proteases that lead to continued local damage and inflammation

Question 37

What is endothelial injury due to? (3)

Answer 37

• raised LDLs
• hypertension
• toxins

Question 38

What does endothelial injury cause? (3)

Answer 38

• platelet adhesion and SMC proliferation
• lipid accumulation and taken up by SMCs and macrophages
• monocytes migration into the intima