10. Vascular Disease

Question 1

Definition of an aneurysm?

Answer 1

Dilatation of vessel increasing lumen size. Both arteries and veins. Caused by any process that weakens vessel wall.

Question 2

Cystic medial necrosis: what is it? what disease can it be a sign of? what can it lead to?

Answer 2

o Disruption of elastic lamina by amorphous extracellular matrix material.
o Can be sign of Marfan’s syndrome where elastic fibers aren’t present in media.
o Can lead to aortic dissection.

Question 3

what is a Berry aneurysm?

Answer 3

o Occur in circle of Willis, lead to headaches, papilledema, nausea, vomiting, coma, and death. Can cause stroke due to turbulent flow. Polycystic Kidney Disease is a predisposing factor w/ HTN adding to the risk.

Question 4

Definition of aortic dissection? key clinical finding?

Answer 4

o Back Pain (key).
-Cause of MI (1-2%) if dissection travels back to coronaries. Intima gets filled w/ blood, decreases compliance of aorta. Blood forms a false lumen.

Question 5

in what congenital abnormality is aortic dissection more likely?

Answer 5

Marfan’s

Question 6

Type I aortic dissection means what?

Answer 6

Ascending and descending aorta

Question 7

Type II aortic dissection means what?

Answer 7

Ascending aorta only

Question 8

Type III aortic dissection means what?

Answer 8

Descending aorta only. can appear w diminished pulse pressures in L arm, b/c of involvement of Brachiocephalic/subclavian arteries.

Question 9

Vasculitis: definition, and what are:

• Arteritis, Phlebitis, Capillaritis, Angiitis?

Answer 9

• Inflammation directed against the vessel.

* Arteritis (arteries), Phlebitis (veins), Capillaritis (small vessels), Angiitis (vessels).

Question 10

what is ANCA? what might it indicate?

Answer 10

anti-neutrophil cytoplasmic antibody. circulating antibodies that react with neutrophil cytoplasmic antigen. useful diagnostic marker, titer may reflect level of inflammatory activity.

Question 11

P-ANCA?

Answer 11

perinuclear ANCA. characteristic pattern around the nucleus of a neutrophil

Question 12

C-ANCA?

Answer 12

cytoplasmic ANCA

Question 13

Large vessel vasculitis

Answer 13

• Temporal (giant cell) arteritis: Elderly females. Above 40yo. Unilateral headache. Temporal as in Temporal artery. Jaw claudication. Blindness due to ophthalmic artery occlusion. Granulomatous inflammation. Carotid artery.

Question 14

Takayasu’s Arteritis: features.

Answer 14

Large vessel vasculitis. Younger than 50. Pulseless disease. Weak upper extremity pulses, fever weight loss, headache. Aortic Arch, and proximal great vessels.

Question 15

Medium vessel vasculitis/polyarteritis nodosa: features?

Answer 15

• Polyarteritis nodosa: Immune complexes. Kidney and GI. Not in lungs. Associated w/ Hep B. Fever, weight loss.

Question 16

Kawasaki’s disease?

Answer 16

Asian children under 4. Multiple coronary aneurysms. Fever lymphadenitis, conjunctivitis, strawberry tongue. Hand desquamation.

Question 17

Small vessel vasculitis: P-ANCA-associated

Answer 17

• Microscopic Polyangitis: Immune glomerulonephritis. No granulomas. Kidney 90%
• Churg Strauss: Asthma, sinusitis, palpable purpura, peripheral neuropathy. Granulomatous vasculitis w/ eosinophilia.

Question 18

Small vessel vasculitis: C-ANCA-associated

Answer 18

• Wegener’s (polyangiitis) granulomatosis: Triad:
• Kidney: necrotizing glomerulonephritis. Hematuria
• Lung: granulomas. Hemoptysis cough
• Nose: perforation of nasal septum, sinusitis, otitis media.

Question 19

what is a false aneurysm?

Answer 19

rupture of vessel wall leading to hematoma