Blood Vessel Diseases

Question 1

Vascular inflammatory injury, with necrosis of blood vessels

Answer 1

vasculitides

Question 2

What type of vessels are affected in vasculitides?

Answer 2

any size or location

Question 3

Clinical manifestations of vasculitis depends on what?

Answer 3

level of ischemia caused by vasculitis

Question 4

Causes of vasculitides are unknown, but may include:

Answer 4

1) reaction to immune-complex deposition (type III hypersensitivity)
2) cell-mediated immunity mechanism

Question 5

Large vessel vasculitis

Answer 5

Temporal Arteritis

Takayasu Arteritis

Question 6

• occurs in >50 (esp of Nordin origin)
• arteries of the head (esp temporal and vertebral aa)
• nodular thickenings of vessel with reduction of lumen
• granulomatous inflammation (MHC-Class II)
• T-cell mediated

Answer 6

Temporal Arteritis (Giant cell)
- macrophages form multi-nucleated giant cell, not granulomas

Question 7

Symptoms of temporal arteritis

Answer 7

• vague, sometimes fever, fatigue, weight loss
• headache (along superficial temporal a), sometimes pain on palpation, facial pain
• vision problems if ophthalmic a is involved

Question 8

Granulomatous vasculitis of medium and large arteries (esp aortic arch and branches) also pulmonary (50%), coronary and renal arteries

• inflammation causes intimal thickening
• giant cell inflammation

Answer 8

Takayasu Arteritis “Pulseless disease”

Question 9

• Characterized by ocular disturbances and weakening of pulses in upper extremities
• Predominantly females under 40

Answer 9

Takayasu Arteritis

Question 10

Arteries mostly affected by Takayasu Arteritis

Answer 10

Aortic branch and pulmonary a

Question 11

Type III immune injury involving immune complexes (associated with Hep B and C)

Answer 11

polyarteritis nodosa

Question 12

characterized by necrotizing immune complex inflammation of small and medium sized arteries

Answer 12

polyarteritis nodosa

Question 13

Disease usually of young adults

Malaise, fever, weight loss, hypertension, abdominal pain and melena, myalgia, ulcers, infarcts, peripheral neuritis

Answer 13

polyarteritis nodosa

Question 14

• Renal arterial involvement often prominent and major cause of death
• 30% of patients with this disease have Hep B surface Ag/Ab complexes

Answer 14

polyarteritis nodosa

Question 15

Treatment for polyarteritis nodosa

Answer 15

steroids and cyclophosphamide

Question 16

Histological findings include presence of fibrinoid necrotizing vasculitis of medium and small arteries (neutrophils)

Answer 16

polyarteritis nodosa

Question 17

Angiographic findings include aneurysms or occlusions of the visceral arteries (looks beaded)

Answer 17

polyarteritis nodosa

Question 18

• Often affect Asian infants (

Answer 18

Kawasaki disease

Question 19

Kawasaki disease is aka

Answer 19

mucocutaneous lymph node syndrome

Question 20

Coronary a aneurysm

Answer 20

Kawasaki disease

Question 21

Diagnosis criteria for Kawasaki disease (mnemonic: CREAM)

Answer 21

4 ouf of 5:
Conjunctivitis
Rash
Edema
Adenopathy
Mucosal involvement

Question 22

Triad of:

1) necrotizing granulomas of upper respiratory tract
2) granulomatous vasculitis of medium and small vessels
3) necrotizing, often crescentic glomerulonephritis
- lungs and kidneys

Answer 22

granulomatosis with polyangitis (Wegener)

Question 23

Possible over reaction to allergens

Answer 23

Granulomatosis with Polyangitis (Wegener)

Question 24

Predominately signs and symptoms of respiratory tract, esp of paranasal sinuses and lungs, and necrotizing glomerulonephritis

Answer 24

Granulomatosis with Polyangitis (Wegener)

Question 25

PR3- ANCA + in 95% of cases

Answer 25

Granulomatosis with Polyangitis (Wegener)

Question 26

- small vessel necrotizing vasculitis - asthma, allergic rhinitis, lung infiltrates - marked peripheral eosinophilia - extravascular necrotizing granulomata

Answer 26

Churg-Stauss Syndrome

Question 27

MPO-ANCA + in 50% of cases

Answer 27

Churg-Stauss Syndrome

Question 28

Presence of eosinophils | Asthma

Answer 28

Churg-Stauss Syndrome

Question 29

Vascular insufficiency of tibial and radial arteries due to thrombosing acute and chronic inflammation - complete obstruction

Answer 29

Buerger's Disease (Thromboangitis Oliterans)

Question 30

Hypersensitivity to tobacco, typically in young adults

Answer 30

Buerger's Disease (Thromboangitis Oliterans)

Question 31

Immune Complex-mediated Vasculitides (4) - affects small vessels

Answer 31

1) Systemic lupus erythematosus 2) Rheumatoid arthritis (IgM) 3) Henoch-Schonlein purpura 4) Cryoglobulinemia (agglutinating)

Question 32

- Localized abnormal dilation of any vessel | - Vessel most affected is the aorta

Answer 32

Aneurysms

Question 33

Two types of aneurysms

Answer 33

True and false aneurysms

Question 34

Retain all 3 layers of vessel wall at affected site

Answer 34

True aneurysms - saccular (one side of artery) - fusiform (entire artery)

Question 35

Intima and media damaged, only adventitia remains

Answer 35

false aneurysms

Question 36

This form of aneurysm is deadly

Answer 36

fusiform

Question 37

Etiologic types of aneurysms

Answer 37

1) atherosclerotic 2) syphilitic 3) infective 4) berry

Question 38

This type of aneurysm is typically between renal a and bifurcation and it's the most common

Answer 38

atherosclerotic aneurysm

Question 39

This type of aneurysm affects thoracic aorta and arch, manifestation of tertiary syphilis

Answer 39

Syphilitic aneurysm

Question 40

This type of of aneurysm is from inflammatory damage

Answer 40

Infective aneurysm (false)

Question 41

This type of aneurysm is congenital, affects Circle of Willis, and hypertension is an important risk factor for rupture

Answer 41

Berry aneurysm

Question 42

False channel of blood coursing within vessel wall itself

Answer 42

aortic dissection

Question 43

Double barrel lumen

Answer 43

aortic dissection

Question 44

Disruption and fragmentation of elastic lamellae of the arterial media

Answer 44

Medial degeneration "cystic medial necrosis" | Ex. Erhlos Danlos, Marfan syndrome

Question 45

Benign tumors of blood vessels (4)

Answer 45

1) hemangioma 2) hereditary hemorrhagic telangiectasia 3) spider telangiectasia 4) glomus tumor

Question 46

Capillary hemangioma common in children

Answer 46

hemangioma

Question 47

malformations present from birth composed of dilated capillaries and veins in skin and oral cavity

Answer 47

hereditary hemorrhagic telangiectasia

Question 48

radiating subcutaneous arteries | - often associated with cirrhosis of liver

Answer 48

spider telangiectasia

Question 49

fingertips and toes; painful | - nail beds

Answer 49

glomus tumor

Question 50

malignant tumors of blood vessels (4)

Answer 50

1) hemangioendothelioma (low-grade) 2) hemangiopericytoma (from pericytes) 3) angiosarcomas (carcinogen exposure) 4) Kaposi's sarcoma (endothelial cells)

Question 51

- component of AIDS | - linked to Herpes virus type 8

Answer 51

Kaposi's sarcoma | - may be confused with bacillary angiomatosis

Question 52

- vascular proliferation in immunocompromised hosts - Rickettsiae like organisms - Red, purple, or blue edematous soft tissue lesions that may cause destruction of periodontal ligament

Answer 52

Bacillary angiomatosis | - clinical and histologic features similar to that of Kaposi sarcoma

Question 53

Complications of varicose veins (4)

Answer 53

phlebitis (infections) edema DVT leg ulcers