B4.021 - Atherosclerosis

Question 1

what is atherosclerosis

Answer 1

lipid laden deposits in the intima of large and medium sized arteries

Question 2

what is atherosclerosis characterized by

Answer 2

linear growth and quantum progression, spatial predilection

Question 3

what is critical stenosis

Answer 3

when chronic occlusion significantly limits flow and demand begins to exceed supply

Question 4

when does critical stenosis occur

Answer 4

usually around 70% occlusion

Question 5

what preserves luminal diameter as the total circumference expands

Answer 5

outward remodeling

Question 6

what are cholesterol crystals

Answer 6

crystal like absences from where cholesterol used to be

Question 7

what is looked at in an angiogram

Answer 7

lumen

Question 8

what is seen within the plaque here

Answer 8

cholsterol crystals

Question 9

describe the response to injury hypothesis

Answer 9

Chronic endothelial cell injury leads to accumulation of lipoproteins (LDL) in injured area. Modification of lesional lipoproteins by oxidation leads to adhesion and migration o fblood monocytes into lesion and transformation to foam cells. Platelets adhese and cytokines and growth factors cause migration of smooth muscle cells from media to intima then that produces extracellular matrix

Question 10

risk factors for atherosclerosis

Answer 10

age

gender

genetic influences

hyperlipidemia

hypertension

smoking

DM

other

Question 11

what is c reactive protein a marker for

Answer 11

inlammation

Question 12

why are women less likeyl to get atherosclerosis earlier in life

Answer 12

estrogen is protective

Question 13

describe the structure of lipoproteins

Answer 13

within the surface: cholesterol, phospholipids

center: cholesteryl esters, triglycerides

Question 14

what is the highest density lipoprotein

Answer 14

HDL

Question 15

what are the largest/least dense lipoproteins

Answer 15

chylomicrons

Question 16

what are the 2 major goals of lipoprotein metabolism

Answer 16

1. transport TGs from intestine and liver to sites of utilization
2. transport of cholesterol to peripheral tissues for membrane synthesis and steroid hormone production

Question 17

what is the main lipoprotein that transports TGs from intestine to liver

Answer 17

chylomicrons

Question 18

what is the main lipoprotein that transports cholesterol from liver to other tisseus

Answer 18

VLDL, LPL

Question 19

what is the “good cholesterol”

Answer 19

HDL

Question 20

what does HDL do

Answer 20

reverse cholesterol transort

takes up cholesterol from extrahepatic sources, esterification by LCAT and transport by large HDL particles

Question 21

how do cells regulate cholesterol content

Answer 21

1. synthesis in the SER
2. receptor mediated endocytosis of LDL
3. efflux of cholesterol from plasma membranes to apo-A1/HDL
4. intracellular cholesterol esterification via acetyl-CoA acetyltransferase

Question 22

clinical assessment of lipids

Answer 22

total cholesterol

TGs

LDL

HDL

Question 23

what is cholestyramine

Answer 23

bile-acid binding resin

Question 24

what does ezetimibe do

Answer 24

cholesterol absorption inhibitor

Question 25

what do statins do

Answer 25

decrease LDL, HMG-CoA inhibitor

Question 26

who are statins indicated for

Answer 26

those with 10 yr cardiac risk \>7.5%

Question 27

what is fenobritate

Answer 27

fibrate inhibits PPAR-alpha

Question 28

what does niacin do

Answer 28

decreases hepatic VLDL secretion

Question 29

what can niacin cause as a side effect

Answer 29

intense flushing

Question 30

not being able to take statins is a risk factor for what

Answer 30

Future events

Question 31

how does aspirin work

Answer 31

inhibits thromboxane A2 by irreversible acetylating COX-1, this attenuates platelet activation

Question 32

how long does it take for aspirin to get out of your system

Answer 32

1 week bc it irreversibly binds

Question 33

if you have a life threatening issue youre taking aspirin for when do you stop taking it before surgery

Answer 33

you dont

Question 34

how is aspirin used for primary prevention of atherosclerosis

Answer 34

prevents events doses \>75 mg/day show clear reduction in mortality and cardiovascular events

Question 35

what are contraindicatinos for aspirin in pts with atherosclerosis

Answer 35

allergy bleeding

Question 36

most common cause of aspirin intolerance

Answer 36

GI upset

Question 37

what are risk factors for atherosclerosis you can prevent/treat

Answer 37

HTN Hyperlipidemia: use of statins smoking cessation DM and glucose intolerance lifestyle

Question 38

how is CRP generated

Answer 38

in response to IL-1/6 pathway

Question 39

what is a biomarker

Answer 39

something that varies with disease, can be detected specifically and sensitiviely and is relatively cheap to test for

Question 40

how early can atherosclerosis be seen

Answer 40

2nd decade of life

Question 41

what is a xanthoma

Answer 41

when foam cells accumulate at site of vascular injury under the epithelium

Question 42

natural history of atherosclerosis

Answer 42

normal--\> fatty streak --\> fibrofatty plaque --\> advanced/vulnerable plaque --\> 1. aneurysm/rupture 2. occlusion by thrombus 3. critical stenosis

Question 43

sites that have a predispostion to atherosclerosis

Answer 43

thoracic and abdominal aorta coronary arteries peripheral arteries carotid arteries

Question 44

sites with natural protection form atherosclerosis

Answer 44

internal mammary (thoracic) artery

Question 45

which artery is used as a bypass conduite

Answer 45

internal mammary (throacic) artery

Question 46

where do plaques form usually in vessels

Answer 46

areas with low sheer stress

Question 47

where are aueurysms common

Answer 47

aorta

Question 48

where are aneurysms rare

Answer 48

coronary peripheral carotids

Question 49

where are plaque ruptures frequent

Answer 49

coronary

Question 50

where are occlusions common

Answer 50

coronary peripheral

Question 51

where are occlusions rare

Answer 51

aorta

Question 52

where are occlusions uncommon

Answer 52

carotids

Question 53

where are embolisms uncommon

Answer 53

coronary

Question 54

where are embolisms common

Answer 54

aorta, peripheral, carotids

Question 55

where are dissections rare

Answer 55

coronary peripheral carotid

Question 56

who are coronary dissections seen in

Answer 56

nonathero females

Question 57

where are dissections common

Answer 57

aorta

Question 58

what is determinant of if a rupture is going to happen in atherosclerosis

Answer 58

thickness of fibrous cap

Question 59

what is ultrasound and virtual histology used for

Answer 59

visualizing TCFA and how likely a plaque is to burst

Question 60

what is optical coherence tomography

Answer 60

flush and clear a blood field to visualize fibrous caps in a vessel

Question 61

which imaging modality is used here

Answer 61

ultrasound and virtual histology

Question 62

what imaging modality is used here

Answer 62

optical coherence tomography

Question 63

what is depicted here

Answer 63

TCFA cholesterol crystals

Question 64

what type of event does this represent

Answer 64

rupture

Question 65

what type of event does this depict

Answer 65

erosion

Question 66

what is virchows triad

Answer 66

3 primary factors contributing to pathogenesis of thrombosis 1. injury to epithelium 2. alterations in blood flow 3. increased coagulability of blood

Question 67

what does this represent

Answer 67

lines of Zahn alternating bands of fibrin with WBC and RBCs entrapped healed thrombi over the years

Question 68

what can cause this

Answer 68

cholesterol emboli from aorta causing skin necroses

Question 69

what is this pathopneumonic for

Answer 69

cholestrol emboli from atherosclerosis note the cholestrol crystals

Question 70

how does abdominal aortic aneurism present

Answer 70

abdominal mass, pay pulsate risk of rupture directly related to size of aneurysm

Question 71

cutoff diameter for intervention in abdominal aortic aneurysm

Answer 71

5 cm

Question 72

what is this

Answer 72

aortic dissection Cross section showing lumen compression due to hemoatoma in tunica media

Question 73

what is this

Answer 73

recanalized coronary artery post bypass

Question 74

treatment for MI

Answer 74

stent

Question 75

treatment for pts with persistent angina

Answer 75

Beta blockers ACEI calcium channel blockers

Question 76

optimal medical therapy for chronic treatment of coronary atherosclerosis

Answer 76

aspirin statins risk factor modification