Atherosclerosis

Question 1

Calcification of the walls of muscular arteries, typically involving the internal elastic membrane. Does not encroach of vessel lumen and not clinically significant.

Answer 1

Monckeberg medial sclerosis

Question 2

Two most important causes of endothelial dysfunction

Answer 2

Hemodynamic disturbances
Hypercholesterolemia and dyslipoproteinemias

Question 3

Foam cells and their effect

Answer 3

Modified LDL accumulated in macrophages in hyperlipidemia

Directly impair endothelial cell function

Question 4

Produced by inflammasome activation from foam cells

Answer 4

IL1

Question 5

Result of inflammation in hyperlipidemia

Answer 5

Smooth muscle cell proliferation and synthesis of ECM proteins

Question 6

Infections that can cause endothelial injury in vessels

Answer 6

Herpesvirus
CMV
Chlamydophila pneumonia

Question 7

Factors that drive intimal smooth muscle proliferation and matrix synthesis to stabilize atherosclerotic plaques

Answer 7

PDGF
Fibroblast growth factor
TGF-alpha

Question 8

Frequency of vessel involvement in atherosclerosis

Answer 8

Lower abdominal aorta
Coronary arteries
Popliteal A
Internal carotid A
Vessels in circle of Willis

Question 9

Composition of fatty streak in atherosclerosis

Answer 9

Lipid filled foamy macrophages that coalesce

Question 10

Intimal thickening plus lipid accumulation that encroach on vessel lumen

Answer 10

Atherosclerotic plaque

Question 11

Composition of superficial fibrous cap on atherosclerotic plaque

Answer 11

Smooth muscle cells and relatively dense collagen

Question 12

Shoulder of atherosclerotic plaque

Answer 12

Beneath and to the side of the cap. More cellular area containing macrophages, T cells, and smooth muscle cells

Question 13

Deep to fibrous cap of atherosclerotic plaque

Answer 13

Necrotic core

Question 14

Composition of necrotic core of an atherosclerotic plaque

Answer 14

Lipids
Debris from dead cells
Foam cells
Fibrin
Thrombus
Other plasma proteins

Question 15

Type of lipids primarily found in necrotic core of atherosclerotic plaque

Answer 15

Cholesterol and cholesteryl esters

Question 16

Possible pathologic changes in an atheromatous plaque

Answer 16

Rupture, ulceration, or erosion of the plaque surface
Thrombosis
Hemorrhage into plaque
Atheroembolism
Aneurysm formation

Question 17

Soft, velvety, yellow, flat papules or plaques on the eyelids

Answer 17

Xanthelasma

Question 18

Subcutaneous nodules on the Achilles tendon, associated with atherosclerosis

Answer 18

Tendinous xanthomas

Question 19

Possible physical exam findings in atherosclerosis

Answer 19

Xanthelasma
Tendinous xanthomas
Eruptive xanthoma
Arcus senilis

Question 20

Lipid deposit in cornea, common in elderly or younger with hyperlipidemia

Answer 20

Arcus senilis

Question 21

Complications of atherosclerosis in the coronary arteries

Answer 21

IHD
Exercise induce CP
MI

Question 22

Complication of atherosclerosis in the mesenteric artery

Answer 22

Ischemic colitis

Question 23

Complications of atherosclerosis in iliac A

Answer 23

Claudication pain
Limb gangrene
Impotence

Question 24

Complications of atherosclerosis in femoral and/or popliteal A

Answer 24

Claudication pain
Limb gangrene

Question 25

Complications of atherosclerosis in renal A

Answer 25

Elevated renin and aldosterone Secondary HTN

Question 26

Complication of atherosclerosis in the subclavian A

Answer 26

Subclavian steal syndrome

Question 27

Indicator of significant atherosclerotic disease

Answer 27

Subclavian steal syndrome

Question 28

Exercise leads to ischemia due to increased metabolic demand in affected arm. Affected arm is perfused through retrograde flow in the ipsilateral vertebral A, leading to diminished posterior cerebral circulation. Pt has vertigo and lightheadedness 2/2 vertebrobasilar insufficiency.

Answer 28

Subclavian steal syndrome

Question 29

Early stage characteristics of atherosclerotic stenosis

Answer 29

Outward vessel remodeling Preserved lumen patency

Question 30

Cut-off point for critical stenosis

Answer 30

Occlusion of 70% of vessel lumen

Question 31

Three general acute atherosclerotic plaque changes

Answer 31

Rupture/fissuring Erosion/ulceration Hemorrhage into the atheroma

Question 32

Characteristics of vulnerable atherosclerotic plaques

Answer 32

Thin fibrous caps Large lipid cores Greater inflammation

Question 33

Characteristics of stable atherosclerotic plaques

Answer 33

Thickening and densely collagenous fibrous caps Minimal inflammation Underlying atheromatous core