Haem/CVS Microanatomy

Question 1

When conducting a blood test, which substance is elevated if you have infarct / damage to myocytes? [1]

Answer 1

Troponin

Question 2

How does fat building up in intima cause complicated atheromas?

Answer 2

If fat / atheroma builds up in intima –> causes blood to create microtrauma on the endothelium –> causes clots on the endothelium –> complicated atheromas

Question 3

What are the 3 layers of cardiac tissue called? [3]

Answer 3

Endocardium (endothelial layer)
Myocardium (muscle)
Epicarcium (Connective tissue and single layer of cells)

Question 4

Label A-C

Answer 4

A: endocardium
B: myocardium
C: epicardium

Question 5

Identify the blood vessel

arteriole
venule
large vein
medium artery
medium vein

Answer 5

Identify the blood vessel

arteriole
venule
large vein
medium artery
**medium vein**

Question 6

what makes cardiac and skeletal muscle striated? [1]

Answer 6

cardiac and skeletal muscle are arranged in myofibrils

Question 7

what type of muscle cell is this?

cardiac
smooth
skeletal

Answer 7

what type of muscle cell is this?

cardiac
smooth
skeletal

Question 8

what type of cell junctions do u find in intercalated disc? [3]

Answer 8

fascia adherens
desmosomes
gap junctions

Question 9

label A-C

what is PM?

Answer 9

A: epicardium
B: myocardium
C: endocardium

PM:
papillary muscles

Question 10

which part of the heart is this?

epicardium
myocardium
endocardium

Answer 10

which part of the heart is this?

epicardium
myocardium
​**endocardium: has a surface layer of flattened endothelial cells.

(p = purkinje fibres)**

Question 11

where are the purkinje fibres located in the heart? [1]

Answer 11

immediately under the endocardium, before penetrating the myocardium

Question 12

what is A? [1]

Answer 12

purkinje fibres

Question 13

how do purkinje fibres connect other purkinje fibre cells? [1]

Answer 13

no T tubule or intercalated discs! - instead have desmosomes & gap junctions

Question 14

what do you find eitherside of the tunica media in muscular arteries? [2]

Answer 14

internal elastic lamina
tunica media
external elastic lamina

Question 15

label A-C

Answer 15

A: tunica adventitia
B: tunica media
C: endothelial cell

Question 16

blood flow within the capillary bed is controlled by WHAT? [1]

Answer 16

blood flow within the capillary bed is controlled by arterioles [1] and precapillary sphincters

Question 17

Label A-C [3]

Answer 17

Heart valves:

A: Fibrosa
B: Spongiosum
C: Ventricularis

Question 18

Why is splachnic system low pressure? [1]

Answer 18

Splachnic system: liver [0.5]

Where exchange of metabolites (drugs etc) occurs [0.5] so absorbtion can occur

Question 19

How do you distinguish between vein and artery with regards to elastic lamina? [1]

Answer 19

Arteries: internal and external elastic lamina – fine black lines in the wall

Vein: one layer on elastic lamina - internal

Question 20

Name three places that you find specialised vascular structures [3]

Answer 20

1. Glomerulus
2. Placenta
3. Arachnoid granulations

Question 21

Label A-C [3]

Answer 21

A: medium sized veins
B: Medium sized artery
C: small vein

Question 22

Which of the following is C

Internal elastic lamina
Endothelium
Myocardium
External elastic lamina
Epicardium
Intima

Answer 22

Which of the following is C

Internal elastic lamina
Endothelium
Myocardium
External elastic lamina
Epicardium
Intima

Question 23

Which of the following is E

Internal elastic lamina
Endothelium
Media
External elastic lamina
Adventitia
Intima

Answer 23

Which of the following is E

Internal elastic lamina
Endothelium
Media
External elastic lamina
Adventitia
Intima

Question 24

Which of the following is A

Internal elastic lamina
Endothelium
Media
External elastic lamina
Adventitia
Intima

Answer 24

Which of the following is A

Internal elastic lamina
Endothelium
Media
External elastic lamina
Adventitia
Intima

Question 25

Which of the following is B Internal elastic lamina Endothelium Media External elastic lamina Adventitia Intima

Answer 25

Which of the following is A Internal elastic lamina Endothelium Media External elastic lamina Adventitia **Intima**

Question 26

Which of the following is D Internal elastic lamina Endothelium Media External elastic lamina Adventitia Intima

Answer 26

Which of the following is D Internal elastic lamina Endothelium **Media** External elastic lamina Adventitia Intima

Question 27

Which of the following is F Internal elastic lamina Endothelium Media External elastic lamina Adventitia Intima

Answer 27

Which of the following is F Internal elastic lamina Endothelium Media External elastic lamina **Adventitia** Intima

Question 28

Name 5 reasons may have CVS pathology

Answer 28

**Inflammation** Heart – myocarditis – inflammation of myocardium (viral – lymphocytic, rheumatoid – streptococcal infection, shows aschoff nodules), Vessels – vasculitis – variety of causes but you see either acute necrotizing inflammation (leukocytoclastic vasculitis) or granulomatous inflammation (temporal arteritis, churg strauss syndrome) etc.) or endothelial swelling and lymphocytes/neutrophils in the vessel wall. **Infection** Viral – myocarditis Bacterial – Endocarditis – inflammation of cardiac valves vasculitis etc. **Autoimmune**: Myocarditis, vasculitis **Congenital**: Structural disorders of heart or vessel structure **Multifactorial**: Atherosclerosis and myocardial ischaemia/infarction.

Question 29

Answer 29

**Fibrolipid plaque.** They contain lots of macrophages which have ingested lipids and have a fatty lipid core (foam cells). They can often rupture leading to lipid spilling out into the fibrolipid plaque core.

Question 30

What are the 3 main constituents of an atheromatous plaque? [3]

Answer 30

1. **Lipids** (intracellular & extracellular) 2. **Connective tissue** - collagen & fibrin 3. **Cells** - macrophages & smooth muscle

Question 31

This is a cross section through an aorta. Note the complicated atheromatous plaque on the left side of the image. Please label the picture (a) to (c).

Answer 31

A = thickened arterial wall. B = intraluminal haemorrhage. C = ulceration.

Question 32

This is a magnification of a fibrolipid plaque. Note the lumen in the top left corner. Label the picture A-C. Note A is part of the normal arterial wall.

Answer 32

A = adventitia. B = lipid core. C = fibrous cap.