Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Semester 2 > MoD Session 6 > Flashcards

MoD Session 6 Flashcards

0
Q

What is atherosclerosis?

A

Thickening and hardening of arterial walls as a consequence of atheroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

What is atheroma?

A

Accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is arteriosclerosis?

A

Thickening of the walls of arteries and arterioles usually from hypertension or DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Is atherosclerosis or arteriosclerosis the same as atheroma?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the normal arterial structure?

A 
Endothelium
Subendothelial connective tissue
Internal elastic lamina
Muscular media
External elastic lamina
Adventitia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does the muscular media change as you move to arteries closer to the heart?

A

More elastin and less smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the fatty streak in atheroma?

A

Lipid deposits in the intima which give rise to a yellow, slightly raised tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is the relationship of the fatty streak not direct to the atheroma?

A

Location of lesions in intima is not identical to the most severe atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the simple plaque in atheroma formation?

A

Individual lesions enlarge and coalesce to form widely distributed, irregularly outlined, raised yellow/white tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the complicated plaque in atheroma formation?

A

Haemorrhage into the thrombotic plaque by invading BV from the adventitia can cause it to rupture
Calcification of the plaque can further stiffen arterial walls
Aneurysm forms if there is a loss of elastic tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Where are common sites of atheroma?

A 
Leg arteries
Aorta - below superior mesenteric and above renal arteries
Coronary arteries
Carotid arteries
Cerebral arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the severity of atheroma depend on?

A

Anatomical site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the three early microscopic features of atheroma?

A

Proliferation of smooth muscle cells
Accumulation of foam cells
Extracellular lipid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the later microscopic features of atheroma?

A 
Fibrosis
Necrosis
Cholesterol clefts from crystals
\+/- inflammatory cells
Disruption of internal elastic lamina
Damage through to media
Ingrowth of BV
Plaque fissuring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What leads to haemorrhage of plaque and subsequent occlusion of the artery?

A

Ingrowth of BV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do cholesterol clefts appear histiologically?

A

As gaps as cholesterol dissolves during fixation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the structure of atheroma?

A

Endothelium
Smooth muscle cell
Lipid
Matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is present in variable amounts in different atheromas?

A

Lipid - some hardly have any

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens over time to an atheroma?

A

Matures by fibrosis

Replaces smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the possible clinical effects of atheroma?

A 
Ischaemic heart disease
Cerebral ischaemia
Mesenteric ischaemia
Peripheral vascular disease
Abdominal aortic aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Name some consequences of ischaemic heart disease.

A 
Sudden death
Myocardial infarction
Angina pectoris
Arrhythmias
Cardiac failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is an old MI seen in the heart?

A

Pale tissue in heart wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does atheroma cause cerebral ischaemia?

A

Atheroma in carotid arteries causes turbulent flow –> thrombus –> embolism –> trapped in cerebral arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the sequelae of cerebral ischaemia?

A

Transient ischaemic attack
Cerebral infarction
Multi infarct dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can be a further complication of cerebral infarction?

A

Can haemorrhage causing extra damage to tissues which is visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which artery is mesenteric ischaemia particularly seen in?

A

Superior mesenteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can mesenteric ischaemia cause?

A

Ischaemic colitis
Malabsorption
Intestinal infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is mesenteric ischaemia hard to recover in the elderly which is where it is most commonly seen?

A

Due to loss of GI function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Can the superior mesenteric artery be removed if it has become ischaemic?

A

Yes if BP is normal, no if BP is high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is intermittent claudication?

A

Pain in calf upon exercise due to relative ischaemia which is relieved by rest but has a decreased claudication distance after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is intermittent claudication a type of?

A

Peripheral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What develops after intermittent claudication in the peripheral vascular disease pathway?

A

Ischaemic rest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What I s the final stage in the pathway of peripheral vascular disease?

A

Gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is Leriche syndrome?

A

Relative ischaemia in the iliac artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the S/S of Leriche syndrome?

A

Pain in buttock
Impotence
Decreased/absent femoral pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What happens to the collateral vessels in Leriche syndrome?

A

They increase in number to maintain oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does atheroma lead to abdominal aortic aneurysm?

A

Atheroma causes loss of elastic tissue –> abnormal BV wall and flow –> thrombus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When does an abdominal aortic aneurysm rupture?

A

When the wall stretches and is not thick enough to support the increased diameter of the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What can increase the risk of atheroma formation?

A 
Oral contraceptives
Age
Gender
Infection
Hyperlipidaemia
Cigarette smoking
Hypertension 
DM
Obesity
Alcohol
Stress and personality type
Lack of exercise
Soft water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Which gender has the higher risk of atheroma formation?

A

Male up until menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Which three pathogens have been linked with an increase in risk of atheroma formation?

A

Chlamydia pneumoniae
Helicobacter pylori
Cytomegalovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which lipid is most significant in the risk of atheroma formation?

A

LDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the suggested method by which cigarette smoking increases risk of atheroma formation?

A

Decreases prostaglandin 2 levels
Increases platelet aggregation
Causes hypercoaguable blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is a powerful risk factor for IHD?

A

Cigarette smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How may hypertension increase risk of atheroma formation?

A

Causes endothelial damage from high pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

By how much does having DM increase the risk of IHD?

A

2x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is lost in premenopausal women with DMD?

A

Protective effect against atheroma formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Why are all sizes of BV compromised in DM?

A

Small vessels are compromised by arteriosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Other than IHD, what else does DM increase the risk of?

A

Cerebro-vascular disease

Peripheral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How many units of alcohol per day increases IHD risk?

A

> 5 units per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What effect can small amounts of alcohol have on the pathogenesis of atheroma formation?

A

May be protective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How is lipid transported in the blood?

A

On lipoproteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What do lipoproteins carry?

A

Cholesterol

TAGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the structure of a lipoprotein?

A

Hydrophilic outer phospholipid layer and apolipoprotein (A-E) layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the function of chylomicrons?

A

Transport lipid from intestine to liver

55
Q

What is the function of LDL?

A

Rich in cholesterol to carry it to non-liver cells

56
Q

What is the function of VLDL?

A

Carry cholesterol and TAGs from liver so TAGs can be removed to leave LDL behind

57
Q

What is the function of HDL?

A

Carry cholesterol from periphery back to liver

58
Q

Genetic variations on what are associated with changes in LDL levels?

A

Apo E

59
Q

What allows there to be at least 6 Apo E phenotypes possible?

A

Polymorphisms of the genes involved

60
Q

What can be used as risk markers for atheroma?

A

Polymorphisms of Apo E genes

61
Q

What causes familial predisposition to atheroma?

A

Variations in apolipoprotein metabolism and/or receptors

62
Q

What is familial hyperlipidaemia?

A

Genetically determined abnormalities of lipoproteins leading to early development of atheroma

63
Q

How do the relative consequences for heterozygotes and homozygotes in familial hyperlipidaemia compare?

A

Heterozygotes are less severely affected

Homozygotes often have MI before 25 y.o.

64
Q

What are visible signs of familial hyperlipidaemia?

A

Corneal arcus
Xanthelasma
Xanthomas

65
Q

What forms xanthomas?

A

Foamy macrophages sitting in the dermis, especially on tendons

66
Q

What are the four possible mechanisms for atheroma formation?

A

Thrombogenic/encrustation theory
Insudation theory
Reaction to injury hypothesis
Monoclonal hypothesis

67
Q

How are atheroma formed in the thrombogenic/encrustation theory?

A

Plaques are formed by repeated thrombi and lipid from the thrombi forms an overlying fibrous cap

68
Q

How is atheroma formed by the insudation theory?

A

Endothelial injury causes inflammation which increases permeability of lipid through intima from plasma

69
Q

What are the two mechanisms proposed by the reaction to injury hypothesis in atheroma formation?

A

Hypercholesteroleamia causes endothelial injury stimulating platelet adhesion and increased permeability so plaque forms whilst monocytes penetrate endothelium causing smooth muscle cells to proliferate and migrate
LDL, especially oxidised causes visually undetectable endothelial injury

70
Q

What is the monoclonal hypothesis in atheroma formation?

A

Smooth muscle proliferation –> monoclonal tumour (plaque)

71
Q

What questions can be raised about the monoclonal tumour formed in the monoclonal hypothesis of atheroma formation?

A

Benign?
Abnormal growth control?
Viral aetiology?

72
Q

What processes are involved in atheroma?

A

Thrombosis
Lipid accumulation in lesions
Production of abnormal ECM (fibrosis)
Interactions b/w cell types

73
Q

What cells may interact at different stages of atheroma?

A 
Neutrophils
Lymphocytes
Macrophages
Smooth muscle
Platelets
Endothelial cells
74
Q

What do neutrophils do during atheroma?

A

Secrete proteases causing continued local damage and inflammation

75
Q

What do lymphocytes do during atheroma?

A

Secrete TNF which may affect lipoprotein metabolism

Stimulate proliferation and migration of smooth muscle cells

76
Q

What do macrophages do during atheroma?

A

Oxidise LDL
Take up lipid to form foam cells
Secrete proteases which modify matrix
Stimulate proliferation and migration of smooth muscle

77
Q

What do smooth muscle cells do in atheroma?

A

Take up LDL and other lipids to form foam cells

Synthesise collagen and proteoglycans

78
Q

What do platelets do in atheroma?

A

Haemostasis

PDGF stimulates proliferation and migration of smooth muscle cells

79
Q

What do endothelial cells do in atheroma?

A

Haemostasis
Altered permeability to lipoproteins
Secrete collagen
Stimulate proliferation and migration of smooth muscle cells

80
Q

What is the unifying hypothesis for atheroma formation?

A

Endothelial injury leads to:
Platelet adhesion
PDGF release
Smooth muscle cell proliferation, migration and production of matrix
Insudation of lipid by smooth muscle cells and macrophages

81
Q

What are the possible causes of endothelial injury in the unifying hypothesis of atheroma formation?

A

High LDL levels
Toxins e.g. cigarette smoke
Hypertension
Haemodynamic stress which varies in different areas of circulation

82
Q

What may macrophages possibly do in the unifying hypothesis of atheroma formation?

A

LDL oxidation

83
Q

What do the cytokines secreted by foam cells in the unifying hypothesis of atheroma formation do?

A

Cause further smooth muscle cell stimulation

Recruit other inflammatory cells

84
Q

Where do monocytes migrate to in the unifying hypothesis of atheroma formation?

A

Intima

85
Q

What can be done to try and prevent atheroma formation?

A 
Not too much alcohol
No smoking
Lower fat intake
Control weight w/regular exercise
Treat hypertension
86
Q

What interventions are used after a clinical event caused by atheroma?

A 
Statins to decrease lipid levels
Stop smoking
Modify diet
Treat hypertension
Treat diabetes
87
Q

Is atherosclerosis seen in veins?

A

Nope

88
Q

What percentage of lumen occlusion is required to significantly affect flow through an artery?

A

70-80%

89
Q

Which three diseases cause decrease in arterial elasticity thus causing arteriosclerosis?

A

Atherosclerosis
Arteriolosclerosis
Monkeberg’s disease

90
Q

Which arteries does atherosclerosis affect?

A

Medium and large sized

91
Q

How does atherosclerosis progress?

A

Begins in intima producing plaques filled with necrotic gruel-like material

92
Q

What is arteriolosclerosis?

A

Hardening of the arterioles affecting the small arteries

93
Q

Describe the connection b/w arteriolosclerosis and atherosclerosis.

A

Little or none

94
Q

What is arteriolosclerosis usually secondary to?

A

Severe hypertension

95
Q

Which arterioles does arteriolosclerosis particularly affect?

A

Those of the kidney

96
Q

What is Monkeberg’s disease?

A

Uncommon calcification of the media of large arteries

97
Q

What is the approximate diameter of the basic lesion (plaque) seen in atherosclerosis?

A

1 cm

98
Q

What causes the endothelium to bulge in the pathogenesis of atherosclerosis?

A

Crowded foam cells

99
Q

What happens in the final stage in the pathogenesis of atherosclerosis?

A

Necrosis in the plaque followed by development of cholesterol crystals, calcification and vascularisation from the adventitia

100
Q

What is the key event in the pathogenesis of atherosclerosis?

A

Focal accumulation of look and cells beneath the endothelium forming a raised, flat plaque 1-2 mm thick

101
Q

Where can plaque formation in atherosclerosis be a major obstacle to flow?

A

Coronary arteries

102
Q

How long does the process of plaque formation in atherosclerosis in humans take?

A

Many years

103
Q

What favours lipid deposition and plaque formation?

A

Areas of disturbed flow

104
Q

How can a plaque in atheroma formation become ulcerated?

A

Fibrous cap eroded from underneath exposing core

105
Q

What can cause spasm at the site of a plaque?

A

Thrombi releasing vasoconstrictors

106
Q

What can happen if the exposed atheroma in a plaque complication breaks up?

A

It can shed atheromatous emboli

107
Q

What can develop in and around a plaque making the artery even stiffer?

A

Calcification

108
Q

What plaque complication is seen in cerebral arteries and is especially associated with hypertension?

A

Rupture of the atherosclerotic artery and bleeding secondary to weakening of the medial layer

109
Q

What are dilatations in veins called?

A

Varices

110
Q

What is a saccular aneurysm?

A

Weakening of an artery wall shaped like a sac

111
Q

What can prevent the bursting of a saccular aneurysm?

A

Lining/filling by thrombus

112
Q

What diameter can saccular aneurysms reach in the aorta?

A

10-15 cm

113
Q

What are fusiform anuerysms?

A

Aneurysms shaped like a spindle

114
Q

How do dissecting aneurysms occur?

A

Inner layer of arterial wall tears open –> blood enters tear –> media separates into two layers –> blood sometimes reenters lumen through second tear

115
Q

Where do dissecting aneurysms occur?

A

Virtually only in aorta and its major branches

116
Q

What is the survival of dissecting anuerysms like?

A

Rare

117
Q

At what point does atherosclerosis stop being a totally silent disease?

A

Symptoms secondary to plaque comic actions arise

118
Q

How do macrophages cause oxidation of LDL?

A

Produce toxic oxygen species

119
Q

What stage of the morphological appearance of atheroma is seen in children?

A

Fatty streaks

120
Q

In which type of arteries are atherosclerotic plaques seen?

A

Elastic

Medium and large sized muscular

121
Q

What range of diameter do atheromatous plaques occupy?

A

0.3-1.5 cm

122
Q

Where do symptoms of severe atherosclerosis usually occur?

A

Heart
Brain
Kidney
Legs

123
Q

How do statins reduce risk of atheroma formation?

A

Inhibit HMG CoA reductase which is required for cholesterol biosynthesis in the liver

124
Q

Why is premature vascular disease seen in homocystinuria?

A

Due to high levels of circulating homocysteine

125
Q

Why can low folate or vitamin B intake cause premature vascular disease?

A

Causes raised levels of homocysteine

126
Q

How can geography be linked to atheroma development?

A

Ubiquitous among developed nations
Lower incidence in South America, Africa and Asia
Migrants who immigrate to high risk locations and adopt new lifestyles and diet have same risk as the new location

127
Q

How can genetic variations causing higher levels of angiotensin converting enzyme be a risk marker for atheroma formation?

A

Higher levels result in hypertension

128
Q

What is the difference between primary and secondary prevention in atherosclerosis?

A 
Primary = in people who have never had complications
Secondary = in people who have had events
129
Q

What interventions can be used in atherosclerosis?

A 
Lipid lowering drugs
Aspirin prophylaxis
Thrombolysis
Angioplasty
Stents
CABG
Control of arrhythmias
130
Q

What level of anti-oxidant intake should be avoided to decrease risk of atherosclerosis?

A

Low

131
Q

What is found in vegetable and seed oils, soya beans, saffron, sunflower, cereal and nuts which has a possible protective role?

A

Vitamin E (antioxidant)

132
Q

What oils should be used for cooking to decrease the risk of a high atherosclerosis-risk patient?

A

Monounsaturated (olive) and polyunsaturated (sunflower, soya)

133
Q

Which foods can be avoided to reduce dietary cholesterol?

A

Liver
Offal
Fish roes

134
Q

What type of sugar should be consumed to reduce atherosclerosis risk?

A

Unrefined not simple

135
Q

Which foods high in soluble fibre reduce circulating lipid?

A

Pulses
Legumes
Root/leafy vegetables
Unprocessed cereals

136
Q

What produces secondary hyperlipidaemia?

A

Excess alcohol intake

Semester 2 (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions