Blood Vessels

Question 1

What are stages of hypertension?

Answer 1

Normal
Elevated
Stage 1
Stage 2
Crisis

Question 2

What is the normal range for blood pressure?

Answer 2

<120/< 80

Question 3

What is the range for elevated blood pressure?

Answer 3

120 - 129/<80

Question 4

What is the range for stage 1 hypertension?

Answer 4

130-139 or 80-89

Question 5

What is the range for stage 2 hypertension?

Answer 5

Greater than or equal to 140 or greater than or equal to 90

Question 6

What is the range for hypertensive crisis?

Answer 6

Greater than or equal to 180 and/or greater than or equal to 120

Question 7

What is RAAS?

Answer 7

Renin-angiotensin-aldosterone system

Question 8

What are is the trigger for RAAS?

Answer 8

Low blood volume, low PVR, or renal artery stenosis reduces RENAL blood flow and/or RENAL blood pressure, and sodium

Question 9

What are the steps once RAAS is activated?

Answer 9

1. Renin is secreted by the juxtaglomerular cells of kidneys
2. Angiotensinogen produced by the liver is converted to angiotensin I by renin in the bloodstream
3. Angiotensin I is converted to angiotensin II by angiotensin-converting enzyme (ACE) in the lungs
4. Angiotensin II increases blood pressure by stimulating the kidneys to secrete aldosterone and inducing vasoconstriction of smooth muscle cells
5. Angiotensin II stimulates adrenal glands to secrete aldosterone from the adrenal cortex
6. Aldosterone stimulates the kidneys to resorb sodium and water, raising blood pressure

Question 10

What does the body do when blood pressure or blood volume is too high?

Answer 10

1. Stretch receptors in the right atrium of the heart stimulate release of atrial natriuretic peptide (ANP)
2. ANP stimulates vasodilation of smooth muscle cells and stimulates the kidneys to excrete more sodium and water, decreasing blood pressure

Question 11

Who should be screened for hypertension?

Answer 11

All adults aged 18 or older

Question 12

How often should adults be screened for hypertension?

Answer 12

Adults aged 40 and above should be screen every year

Question 13

Who should be screened every year for hypertension before age 40?

Answer 13

Black people
Obese people
People with high-normal blood pressure

Question 14

How often should adults aged 18 to 39 with normal blood pressure be screened for hypertension?

Answer 14

Every 3 to 5 years

Question 15

What is arteriosclerosis?

Answer 15

Umbrella term for arterial wall thickening and loss of elasticity

Question 16

What are the major types of arteriosclerosis?

Answer 16

1. Arteriolosclerosis
2. Atherosclerosis
3. Monckeberge medial sclerosis

Question 17

What is arteriolosclerosis?

Answer 17

Thickening and stiffening of small arteries and arterioles

Two types:

1. Hyaline — accumulation of protein-rich material called hyaline due to leakage of walls of arterioles from hypertension; key features of nephrosclerosis (older adults, diabetes, hypertension)

Nephrosclerosis — hyaline deposition that narrows arterioles, leading to renal damage

2. Hyperplastic —proliferation of smooth muscle cells in walls of arterioles, often associated with malignant hypertension

Question 18

What is Monckeberg medial sclerosis?

Answer 18

Arteriosclerosis characterized by deposits of calcium in medium-sized muscular arteries, usually on internal elastic lamina; no luminal narrowing

Older adults, diabetes, CKD

Question 19

What is a mural thrombus?

Answer 19

A thrombus that adheres to the surface of the damaged arterial wall; can grow, resulting in stenosis and eventual occlusion of an artery

Question 20

What is an intraplaque hemorrhage?

Answer 20

A complication of atherosclerosis in which bleeding occurs within an atherosclerotic plaque

Question 21

What is an intramural hematoma?

Answer 21

A collection of blood within the wall of the aorta; a hemorrhage into the tunica media with a tear in the tunica intima, often caused by rupture of the vasa vasorum

If hematoma ruptures into lumen, it can tear tunica intima, producing dissection; thus, considered a precursor to dissection

Question 22

What is an intraluminal thrombus?

Answer 22

A blood clot that forms within a blood vessel but remains attached to the vessel wall, rather than completely blocking it, often seen in AAA

Question 23

What are the core symptoms of AAA?

Answer 23

Dull abdominal, flank, or low back pain

Pulsatile mass

Hypotension if it ruptures

Question 24

What are the core symptoms of TAA?

Answer 24

Chest or interscapular pain

Hoarseness

Dysphagia

Cough

Dyspnea

Stridor

Question 25

What are the core symptoms of AD?

Answer 25

Abrupt, maximal tearing chest and back pain that migrates BP and pulse asymmetry

Question 26

What are the determinants of blood pressure?

Answer 26

1. Cardiac output — determined by stroke volume (amount of blood heart pumps per beat), heart rate, blood volume (determined by sodium, aldosterone, ANP), myocardial contractility, cardiac afterload (resistance heart must overcome to eject blood into arteries) 2. Peripheral vascular resistance — determined by vasoconstrictors, vasodilators

Question 27

What are the 3 types of capillaries?

Answer 27

1. Continuous 2. Fenestrated 3. Discontinuous (sinusoidal)

Question 28

What is the structure of continuous capillaries?

Question 29

What is the structure of continuous capillaries? Where are they located?

Answer 29

Endothelial cells compose a tightly sealed tunica intima for strict control over blood-tissue exchange; use continuous (tight) junctions Blood-brain barrier, alveoli

Question 30

What is the structure of fenestrated capillaries? Where are they located?

Answer 30

Endothelial cells with tiny pores in the cytoplasm that facilitate filtration, absorption, and secretion Kidneys, small intestine, endocrine grands

Question 31

What is the structure of discontinuous (sinusoidal) capillaries? Where are they located?

Answer 31

Endothelial cells with large , leaky intercellular gaps that allow for the passage of large molecules Bone marrow, spleen, lymph nodes

Question 32

What are the subdivisions of ASCVD?

Answer 32

1. Coronary heart (artery) disease 2. Cerebrovascular disease 3. Peripheral artery disease 4. Aortic atherosclerosis

Question 33

What common conditions comprise coronary artery disease?

Answer 33

MI Angina pectoris Ischemic cardiomyopathy

Question 34

What common conditions comprises cerebrovascular disease?

Answer 34

Stroke TIA

Question 35

What common conditions comprise aortic atherosclerosis?

Answer 35

1. TAA 2. AAA

Question 36

What common conditions comprise peripheral artery disease

Answer 36

Critical limb ischemia Claudication