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CV > 102014 peripheral vasc dis > Flashcards

102014 peripheral vasc dis Flashcards

1
Q

aneurysm

A

localized dilatation of blood vessel or heart

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2
Q

true aneurysm

A

involves all three layers of wall

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3
Q

false aneurysm

A

wall defect leading to extravascular hematoma

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4
Q

arterial dissection

A

blood enter the wall of the artery

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5
Q

in the setting of atherosclerosis/inflam, what can predispose to aneurysm formation?

A

polymorphisms of matrix metalloproteinase or tissue inhibitors of metalloproteinase genes

also increased MMP activity

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6
Q

pathogenesis of aneurysms

A

factors affecting collagen structure or fxn

loss of smooth muscle cells (due to atherosclerosis leading to thickening of intima and ischemia of inner media. or due to systemic HTN narrowing the vasa vasorum leading to ischemia of OUTER media)

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7
Q

common causes of anuerysms

A

atheroslcerosis –abodominal aorta

HTN – ascending aorta

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8
Q

uncommon causes of aneurysms

A 
congenital defects
infections (bacteria, fungi) -mycotic, syphilis
trauma
vasculitis
genetic defects in collagen
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9
Q

mycotic anueryms

A

septic emboli, direct extension, direct infec by circulating organisms

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10
Q

what is the most common location of aortic aneurysm

A

abdominal aorta-below renal arteries and above bifrucation

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11
Q

aortic aneuryms are more common in whom

A

men, smokers

most common cause is atherosclerosis

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12
Q

morphology of aortic aneurysm

A

thinning and destruc of media
mural thrombus
saccular or fusiform
variants are: inflammatory (unknown cause), mycotic (secondary infec of an atherosclerotic wall)

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13
Q

aggressive managment is done for AAA greater than

A

5 cm, as the risk of rupture is proportional to size

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14
Q

thoracic aortic aneurysms causes

A

HTN (most common)
Marfan’s syndrome
syphilis

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15
Q

aortic dissection

A

blood btwn and along laminar planes of media

causes a blood filled channel that easily ruptures

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16
Q

pathogenesis and etiology of aortic dissec

A

HTN in over 90% of cases
connective tissue abnormality in association with Marfan’s syndrome or Ehlers Danlos

ascending aorta is most commonly involved

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17
Q

morphology of aortic dissec

A

intimal tear within 10 cm of aortic valve
dissection plane btwn middle and outer thirds of wall in media

in HTN pts: vasa vasorum has hyaline arteriolosclerosis and media has loss of sm musc cells.

18
Q

cause of intimal tear in aortic dissec?

A

not usually known

19
Q

clinical course of aortic dissec

A

dependent on level of aorta involved

sharp pain of anterior chest
uneven pulses and widened mediastinum

20
Q

classic symptoms of aortic dissec

A

sudden onset of tearing or stabbing pain in anterior chest radiating to back

21
Q

pathogenesis of vasculitis

A

immune mediated processes
infectious
unknown

22
Q

pathogenesis of immune mediated vasculitis

A

immune complex mediated-SLE, hypersensitivity to drugs, viral infec like Hep B

ANCA associated

other mechanisms (antibodies to endothelial cells-Kawasaki’s)

23
Q

ex of vasculitis of infectious origin

A

direct invasion:
classic ex is syphilis
Aspergillus and mucormycosis

indirect:
immune mechanisms triggering cross-reactivity

24
Q

vasculitides of unknown origin

A

giant cell arteritis
Takayasu
PAN

25
Q

what is the most common systemic vasculitis in adults

A

giant cell temporal arteritis

26
Q

giant cell (temporal) arteritis

A

affects aorta and major branches, especially temporal artery, opthalmic, vertebral arteries

27
Q

clinical presentation of giant cell arteritis

A

greater than 50 years old
often painful superficial temporal artery, diplopia, visual loss, headache

increased ESR

28
Q

gross morphology of giant cell arteritis

A

nodular thickenings of artery with narrowed lumen

patchy (discontinuous) segments affected

29
Q

histology of temporal arteritis

A

granulomatous inflam of inner half of media around internal elastic lamina

30
Q

takayasu arteritis

A 
pulseless disease (upper extremities)
ocular disturbances

Japanese women younger than 40

granulomatou inflam of AORTIC ARCH AND ITS BRANCHES

pulmonary arteries are involved in 50%. coronary and renal arteries may be involved

31
Q

histology of Takayasu arteritis

A

lymphocytes
giant cells
collagenous fibrosis

32
Q

PAN

A

systemic SEGMENTAL, TRANSMURAL, NECROTIZING inflam of small or medium sized muscular arteries

renal and visceral arteries affected
SPARES LUNGS

young adults (30% with Hep B antigen)

33
Q

classic presentation of PAN

A

rapidly accelerating HTN (renal artery involvement)
abdominal pain and bloody stools
peripheral neuritis

34
Q

Kawasaki syndrome

A

large, medium and small arteries
OFTEN CORONARIES with aneurysm formation

mucocutaneous lymph node syndrome (mucous membrane inflam, enlarged lymph nodes)

80% under 4 years

35
Q

histology of Kawasaki’s

A

necrosis and inflam
aneurysms
resembles PAN

36
Q

MPA

A

arterioles, capillaries, venules

MPO-ANCA in 70%

37
Q

Wegener’s granulomatosis

A

necrotizing vasculitis
GRANULOMAS of lung and or upper resp tract
glomerulonephritis

PR3-ANCAs present in more than 95%

males more than females

38
Q

Churg Strauss syndrome

A

allergic granulomatosis with angiitis

small vessel vasculitis associated with asthma, allergic rhinitis, lung infiltrates, infiltration of vessels by EOSINOPHILS, EXTRAvascular necrotizing granulomas

MPO-ANCA is present in minority

39
Q

clinical symptoms of Churg Strauss

A

palpable purpura
GI bleed
renal impairement
cardiomyopathy

40
Q

Thromboangiitis obliterans/Buerger disease

A

inflam and thrombosis of medium to small sized muscular arteries and secondarily the veins and nerves

tibial and radial arteries

smokers
Israaeli, Indian, Japanese

painful ischemic disease
gangrene of limbs, requires amputation

41
Q

Raynaud phenomenon

A

paroxysmal pallor or cyanosis of fingers, toes, nose, ears

primary-recurrent vasospasm of unknown case (exaggerated response to cold)

secondary-arterial insufficiency due to narrowing and can be due to SLE, systemic sclerosis, atheroslcerosis, Buerger disease

CV (34 decks)

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