Atherosclerosis (Exam 2)

Initial Lesion

Stage in atherosclerosis that is histologically normal with macrophage infiltration and isolated foam cells

Fatty streak

Stage in atherosclerosis that is mainly intracellular lipid accumulation

Fibroatheroma

Stage in atherosclerosis with a single or multiple lipid cores + fibrotic/calcific layers

Complicated streak

Stage in atherosclerosis with a surface defect + hematoma hemorrhage + thrombosis

Atheroma

Stage in atherosclerosis with intracellular lipid accumulation + core of extracellular lipid

Intermediate Lesion

Stage in atherosclerosis with intracellular lipid accumulation + small extracellular lipid pools

A) Coagulation B) Fibrinolysis

The probability of a major thrombotic event depends on the balance between competing processes of __A__ and __B__

A) Media B) Intima

The transition from foam cell to fibrous plaque involves migrate of smooth muscle cells from the arterial __A__ to __B__

A) Lipid Metabolism B) Immune

The underlying pathology for atherosclerosis is an imbalance of __A__ and maladaptive __B__ response

1) Endothelial cells-for structure and signaling roles and exhibiting anticoagulant properties to prevent clots 2)Vascular Smooth Muscle Cells- contractile properties 3) Extracellular matrix- contains collagen for strength and elastin for flexibility and regulates cell growth

3 Elements found in the normal structure of the artery wall:

A) Fatty streaks B) Aorta C) Coronary arteries D) Cerebral Vessels

Accumulation of foam cells cause __A__ In the 1st decade of life fatty streaks can be seen in the __B__, In the 2nd decade of life seen in the __C__, In the 3rd + 4th decade of life in the __D__

A) Phagocytic Macrophages B) Foam cells

After monocytes adhere and penetrate the intima, they differentiate into __A__ and imbibe lipoproteins to form __B__

A) Necrotic B) BVs

As development of atherosclerosis occurs, __A__ regions develop and new __B__ form

Medium + large BVs

Atherosclerosis is an inflammatory process affecting ____ throughout the cardiovascular system

A) Inflammatory cells B) Smooth muscle cells C) Lipid D) Connective tissue

Atherosclerosis is characterized by the accumulation of __A__, __B__, __C__, and __D__ in the intima of BVs Atherosclerosis is also described as any hardening and loss of elasticity of the arteries

A) Decades B) Thickening

Atherosclerosis is clinically silent for __A__ and __B__ of BV walls begins in early life

Branch points (Bifurcations)

Atherosclerosis tends to form at arterial ____

ApoB/E

Chylomicron remnants are removed by the liver via ____ receptor mediated uptake

Lipoprotein Lipase (LPL)

Chylomicrons are rapidly cleared out by ____

1) Calcification-makes vessel walls more rigid 2) Rupture-leads to thrombus formation and more things incorporated into the plaque 3) Embolism (sudden block) 4) Hemorrhage-can cause further vessel obstruction

Complications of atherosclerotic plaque include: [4]

Matrix Metalloproteinases (MMP) (MMP is released from foam cells)

Degradation of the Extracellular matrix macromolecules is via

A) mLDLs B) Cytokines

Macrophages have scavenger receptors that bind and internalize __A__ and the accumulation of them are a source of proinflammatory __B__

A) ApoB-100 B) ApoE C) C-11 D) A-1

Each VLDL contains one __A__ molecule and other surface proteins including __B__, __C__, and __D__

Foam Cells

Early lesions of atherosclerosis are subendothelial accumulation of macrophages that ate cholesterol called ____

A) Necrosis B) Proteolytic Enzymes C) oxidized LDLs D) Angiogenesis

Eventually, deep parts of the intima are malnourished and undergo __A__ which is supplemented by __B__ and __C__ This initiates __D__

A) Smoking B) Abnormal Lipid levels C) Diabetes

Factors such as __A__, __B__, and __C__ promote endothelial dysfunction by production of ROS (reactive oxygen species)

A) Lipid rich necrotic debris B) Smooth muscle cells

Fatty streaks are insignificant but are precursors to more advanced lesions from the accumulation of __A__ and __B__

Innate

Foam cells have ____ immunity

A) Proliferate B) ECM macromolecules C) Apoptose

Smooth muscles that migrate into the plaque __A__, and secrete __B__ and then __C__

A) IL6 B) TNFalpha

Smooth muscle cells can also synthesize vasoactive and inflammatory mediators such as __A__ and __B__ that induce leukocyte proliferation and expression of adhesion molecules Further contributes to plaque formation

A) NO B) Superoxide Dismustase (SOD)

Laminar Flow (flow that is smooth and not turbulent) promotes production of __A__ and expression of __B__ (that protects against reactive oxygen species)

Injury to the endothelium

Primary event in atherogenesis is ____

A) Contracile B) Synthetic

Smooth muscle cells have __A__ and __B__ capability

A) Intermediate Density Lipoprotein (IDL) B) Low Density Lipoprotein (LDL)

Lipolysis of VLDL leads to formation of __A__ and __B__

Extracellular Matrix

Smooth muscle cells synthetic role involves production of substances that form the ____

1) Dyslipidemia 2) Tobacco 3) Hypertension 4) Diabetes 5) Sedentary lifestyle (aka being lazy)

Modifiable risk factors for atherosclerosis: [5]

A) Vasodilator B) Inhibitor of platelet aggregation C) Antiinflammatory substance

NO is a potent __A__, __B__, and __C__

1) Being Old 2) Being Male 3) Heredity

Non-modifiable risk factors for atherosclerosis:

White Blood Cells

Normal arterial endothelial cells resist attachment of ____ that stream past

Impermeable

Normally endothelial cells are *[Permeable/Impermeable]* to large molecules

1) Fibrinogen 2) Apolipoproteins 3) Interleukins

Other biochemical markers of atherosclerosis are: [3]

A) Leukocyte Adhesion Molecules (LAM) B) Chemoattractant signals

Process of recruitment of leukocytes depends on __A__ and __B_ that direct cellular passage

A) Monocytes B) Neutrophils C) Dendritic Cells D) Mast cells E) T-lymphocytes

Recruitment of leukocytes such as __A__, __B__, __C__, __D__, __E__ are key in atherogenesis

A) Stable plaques B) Vulnerable plaques C) Shoulder region

Regions with thick fibrous caps are less likely to rupture and are known as __A__ and regions of thin fibrous caps are know as __B__ The most vulnerable region to rupture is between healthy tissue and plaque known as the __C__

1) LDL Accumulation 2) Monocyte recruitment 3) LDL trapping 4) Chemical modification of LDL

Steps that contribute to build up of plaque: [4]

A)Quantitative Coronary Angiography B) B-mode Ultrasound of Carotid Artery

The gold standard for detecting the severity of plaque progression is __A__ __B__ is another technique

A) Proteoglycans B) Collagen C) Smooth muscle cells D) Fibroblasts E) Smooth muscle cells

The intima of BVs contain __A__ and __B__ The media of BVs contains __C__ The adventitia of BVs contain __D__ and __E__

Thrombus (blood clot)

The most important clinical complication of lesions that lead to atherosclerosis is an acute occlusion due to the formation of a ____ that results in MI or stroke

A) Vasdilatory B) Anti-inflammatory

The normal endothelium provides a protective surface with homeostatic __A__ and __B__ properties

A) NO B) SOD

Turbulent flow reduces __A__ and __B__

A) LPL B) Hepatic Lipase (HL)

VLDL undergoes lipolysis via __A__ and __B__ that cause the release of free fatty acids and ApoA-1 and ApoC-11

Aneurysm

Weakening of BV wall can lead to ___

1) Foam cells 2) Activated Platelets 3) Endothelial Cells

What 3 things contribute to SMCs migrating and proliferating?

1) Fatty Streak 2) Plaque progression 3) Plaque Disruption

What are the 3 stages of plaque development called?

1) Immunoglobulins :VCAM1 and ICAM1 2) Selectin molecules such as P + E Selectin

What are the two major subsets of LAMs in plaques?

A) Increase B) Increase C) Decrease

When endothelial cells are activated and not acting normally, there is an __A__ in cytokine production, __B__ in expression of adhesion molecules, __C__ in vasodilatory and antithrombotic molecules

LDLs

When endothelium is activated, it allows entry of ____ to the intima and enhances high circulating levels of it

A) Lipoprotein B) Cholesterol C) TGs

__A__ are the carriers for lipids in the blood stream and carry __B__ and __C__

VLDL

___ carry cholesterol and TG from liver *once TG is removed it becomes LDL

HDL

____ carry cholesterol from periphery back to the liver and is protective

Smooth muscle cells (SMC)

____ cells migrate to the plaque in response to secretions (PDGF, TNFa, IL-1, TGFb) from foam cells

Proteoglycans

____ contribute to LDL and lipid accumulation by trapping them and causing them to undergo chemical modification

Modified LDLs (mLDLs)

____ in the fatty streak promotes leukocyte recruitment and foam cell formation

CRP

____ is an acute protein and a significant biochemical marker of atherosclerosis progression

Atheroma

____ is an atherosclerotic lesion and a fibro-inflammatory lipid plaque

Atherosclerosis

____ is one of the main underlying processes that lead to heart attacks (Coronary Heart Disease) and strokes (Cerebrovascular Disease)

LDL

____ is rich in cholesterol and carries cholesterol to non-liver cells and is most significant

Dyslipidemia

____ is the abnormally high lipid levels in blood and is a major risk factor for developing atherosclerosis

Chylomicrons

____ transport lipid from intestine (where it was made) to liver