X - The Blood Vessels - ARTERIOSCLEROSIS

Question 1

In these arteries, elastic fibers alternate in layers with smooth muscle cells. Examples are the common carotid artery, iliac arteries and pulmonary arteries.

Answer 1

Large or elastic arteries(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

Question 2

In these arteries, tunica media is composed primarily of smooth muscle cells, with elastin limited to the internal and external elastic lamina. Examples are the coronaries and renal arteries.

Answer 2

Medium-sized or muscular arteries(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

Question 3

These are the principal control points for regulation of physiologic resistance to blood flow.

Answer 3

Arterioles(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

Question 4

Literally means hardening of the arteries, term reflecting arterial wall thickening and loss of elasticity, affecting small arteries and arterioles.

Answer 4

Arteriolosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

Question 5

Characterized by calcific deposits in muscular arteries, typical in persons older than 50 yrs old. The radiographically visible, palpable calcifications do not encroach on the vessel lumen, and are not clinically significant.

Answer 5

Mockenberg medial calcific sclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

Question 6

Characterized by intimal lesions called atheromas that protrude into vascular lumina.

Answer 6

Atherosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

Question 7

Three principal components of an atheromatous plaque.

Answer 7

1. Cells (SM cells, macrophages, T cells)
2. Extracellular matrix (collagen, elastic fibers, proteoglycans)
3. Intracellular and extracellular lipidFibrous cap, central lipid core, neovascularization(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 344

Question 8

Non-modifiable risk factors for atherosclerosis. (4)

Answer 8

Increasing age
Male gender
Family history
Genetic abnormalities
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 344

Question 9

Composed of lipid-filled foam cells but are not significantly raised and thus do not cause any disturbance in blood flow. Can appear as early as 1 year, and present in virtually all children older than 10 years old.

Answer 9

Fatty streaks(TOPNOTCH)

Question 10

Composed of lipid-filled foam cells but are not significantly raised and thus do not cause any disturbance in blood flow. Can appear as early as 1 year, and present in virtually all children older than 10 years old.

Answer 10

Fatty streaks(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 349

Question 11

Arrange in descending order, based on which blood vessel is most extensively involved in development of atherosclerosis.Popliteal arteries, internal carotid arteries, circle of Willis, coronaries, abdominal aorta

Answer 11

Abdominal aorta > coronaries > popliteal arteries > internal carotid arteries > circle of Willis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 350

Question 12

Fate of an atheromatous plaque wherein the luminal surface exposes the bloodstream to highly thrombogenic substances and induces thrombus formation.

Answer 12

Rupture, ulceration or erosion(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

Question 13

Fate of an atheromatous plaque due to rupture of the overlying fibrous cap or the thin-walled vessels in the areas of neovascularization.

Answer 13

Hemorrhage(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

Question 14

Fate of an atheromatous plaque causing discharge of debris into the bloodstream, producing microemboli composed of plaque contents.

Answer 14

Atheroembolism(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

Question 15

Fate of an atherosclerotic plaque due to increased pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, leading to weakness of the vessel wall.

Answer 15

Aneurysm formation(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

Question 16

Most common cause of hypertension.

Answer 16

Idiopathic (essential hypertension)(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 355

Question 17

This vascular lesion consists of a homogenous pink hyaline thickening of the walls of arterioles with loss of underlying structural detail and with narrowing of the lumen. A major morphologic characteristic in benign nephrosclerosis.

Answer 17

Hyaline arteriolosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 356

Question 18

Characteristic of malignant hypertension, associated with “onion-skin” concentric, laminated, thickening of the walls of arterioles with luminal narrowing. These laminations consist of smooth muscle cells and thickened duplicated basement membrane.

Answer 18

Hyperplastic arteriolosclerosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 356

Question 19

It is a localized abnormal dilation of a blood vessel or heart.

Answer 19

Aneurysm(TOPNOTCH)

Question 20

It is a localized abnormal dilation of a blood vessel or heart.

Answer 20

Aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

Question 21

Aneurysm which involves all three layers of the arterial wall, or the attenuated wall of the heart.

Answer 21

True aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

Question 22

A breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space.

Answer 22

False aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

Question 23

Two most important causes of aortic aneurysms.

Answer 23

AtherosclerosisCystic medial degeneration of the arterial media(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

Question 24

Atherosclerotic lesions infected by lodging of circulating microorganisms in the wall, particularly in the setting of bacteremia from a Salmonella gastroenteritis. Suppuration further destroys the media, potentiating rapid dilation and rupture.

Answer 24

Mycotic abdominal aortic aneurysm(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

Question 25

Form of hypertension characterized by systolic pressure more than 200 mmHg or diastolic pressure more than 120 mmHg, renal failure, and retinal hemorrhages and exudates.

Answer 25

Malignant Hypertension (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 488

Question 26

The most important independent risk factor for atherosclerosis.

Answer 26

Family history(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 492.

Question 27

The initial event in the pathogenesis of atherosclerosis

Answer 27

Endothelial injury and dysfunction. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

Question 28

The major lipoprotein involved in the pathogenesis of atherosclerosis.

Answer 28

LDL(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

Question 29

2 most important causes of endothelial dysfunction

Answer 29

Hemodynamic disturbances and hypercholesterolemia. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

Question 30

The key processes in atherosclerosis

Answer 30

Intimal thickening and lipid accumulation (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 496

Question 31

The major structural component of fibrous cap in an atheromatous plaque

Answer 31

Collagen(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 500

Question 32

Medial ischemia leading to degenerative changes of aorta, leading to scarring, loss of elastic fibers, inadequate extracellular matrix synthesis, and production of amorphous ground substance. This can be seen in Marfan syndrome and scurvy.

Answer 32

Cystic medial degeneration(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 502

Question 33

A 13 year old male dies of a stray bullet to the head on New Year’s Eve. At autopsy, there is a flat yellowish streak seen on the intimal surface of his abdominal aorta, near the bifurcation of the renal arteries. This streak (A) causes minor disturbance in blood flow (B)is expected in his age group (C) is composed of hemosiderin-filled foam cells (D) would have certainly evolved into an atheromatous plaque if he lived to old age

Answer 33

expected in his age group (“fatty streak” (TOPNOTCH)Robbins Basic Pathology, 8th Ed pp 348-349)

Question 34

Early atherosclerotic lesions are usually focal, patchy, and eccentric because (A) there are differences in the vascular hemodynamics at various points (B) the expression of LDL receptors along the blood vessels is varied (C) concentrations of macrophage-activating cytokines are different along blood vessels (D) certain endothelial cells are more sensitive to toxins and hyperglycemia than others

Answer 34

there are differences in vascular hemodynamics at various points (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 349

Question 35

A 65 year old diabetic female with poor glycemic control and a 5 year history of intermittent chest pain develops pallor, shortness of breath and diaphoresis. She dies 16 hours later. At autopsy, the left ventricular wall is thickened, with dark mottling of the anterior portion, along with the septum and apex. Which of the following describes the likely histology of her left anterior descending artery? (A) an eccentric atheromatous plaque with a fibrous cap (B) a ruptured fibrous cap with calcifications in the lumen of the vessel (C) a ruptured fibrous cap with thrombus formation (D) complete occlusion of the original lumen by fibrous tissue, with neovascularization in the periphery

Answer 35

a ruptured fibrous cap with thrombus formation (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.351

Question 36

What is the most common cause of aneurysms?

Answer 36

atherosclerosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

Question 37

What is the most common site of atherosclerotic aneurysms?

Answer 37

abdominal aorta(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358