Vascular Diseases I Arteriosclerosis

Question 1

Three layers of arteries:

Answer 1

• Intima
• Media
• Adventitia

Question 2

Principal point of physiologic resistance to blood pressure:

Answer 2

Arterioles

Question 3

Response to injury - intimal thickening (3):

Answer 3

• Smooth muscle cells migrate into intima from media or circulating precursors
• Smooth muscle cells proliferate
• Smooth muscle cells synthesize ECM

Question 4

Arteriolosclerosis is associated with (2):

Answer 4

• HTN

- DM

Question 5

Hyaline arteriolosclerosis (2):

Answer 5

• Seen in mild chronic HTN

- Hyaline thickening of arteriolar walls

Question 6

Hyperplastic arteriolosclerosis (2):

Answer 6

• Seen in malignant or accelerated HTN

- “Onionskin” thickening of arteriolar walls

Question 7

Monckeberg arteriosclerosis:

Answer 7

Ring-like calcifications in the media of muscular arteries

Question 8

Modifiable risk factors of atherosclerosis (4):

Answer 8

• Hyperlipidemia
• Hypertension
• Cigarette smoking
• DM

Question 9

Atherosclerosis - response-to-injury hypothesis:

Answer 9

Atherosclerosis is a chronic inflammatory and healing response or the arterial wall to endothelial injury.

Question 10

Atherosclerosis pathogenesis (7):

Answer 10

1. Endothelial injury
2. Lipoproteins move into vessel wall
3. Monocytes migrate into subendothelium –> foam cells
4. Platelets stick to injured endothelium
5. Smooth muscle cells (SMCs) recruited from media or circulating precursors
6. SMCs proliferate and produce ECM
7. Lipid accumulates

Question 11

Fatty streak (3):

Answer 11

• Earliest lesion in atherosclerosis
• Composed of lipid-filled foamy macrophages
• May be precursor to plaques

Question 12

Atherosclerotic plaques (3):

Answer 12

• Intimal thickening
• Lipid accumulation
• Covered by a fibrous cap

Question 13

Most common sites of atherosclerotic plaques (5):

Answer 13

1. Lower abdominal aorta
2. Coronary arteries
3. Popliteal arteries
4. Internal carotid arteries
5. Vessels of the Circle of Willis

Question 14

Atherosclerotic plaque - fibrous cap (2):

Answer 14

• Subendothelial

- Composed of smooth muscle cells and collagen

Question 15

Atherosclerotic plaque - lipid core (4):

Answer 15

• Cholesterol
• Foam cells
• Necrotic debris
• Fibrin

Question 16

Atherosclerotic stenosis results in angina at ____% occlusion:

Answer 16

70%

Question 17

Vulnerable atherosclerotic plaques (3):

Answer 17

• Fibrous cap is thinner
• Lipid core is larger
• Often do not cause clinically significant stenosis