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Pathology > Blood Vessels > Flashcards

Blood Vessels Flashcards

1
Q

54/F, known hypertensive w/ rising BUN and creatinine. Impression - hypertensive nephrosclerosis.
Renal Biopsy: HOMOGENOUS, pink, hyaline material on the walls of ARTERIOLES w/ NARROWING of the lumen.

Vascular pathology seen

A

Hyaline Arteriolosclerosis

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2
Q

55/M, presented w/ SUDDEN ONSET OF OLIGURIA and BP 220/110 mmHg. Patient eventually died.
Autopsy: “ONION SKIN”, concentric, laminated thickening of the walls of arterioles w/ luminal narrowing and necrotizing arteriolitis

A

Hyperplastic Arteriolosclerosis

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3
Q

67/M known hypertensive and diabetic, presented w/ exertional retrosternal chest heaviness lasting for 5 mins, relieved by rest and sublingual nitroglycerin.
Angiography revealed 75% stenosis of the LAD.

Diagnosis and pathologic consequence of atherosclerosis

A

Chronic Stable Angina Pectoris

Atherosclerotic stenosis

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4
Q

67/M known hypertensive and diabetic, presented w/ retrosternal chest heaviness lasting for 30 mins at rest, NOT relieved by sublingual nitroglycerin.
ECG - ST segment elevation leads II, III, avF

Autopsy: LARGE INTRAPLAQUE HEMORRHAGE that OCCLUDED THE WHOLE VESSEL

Diagnosis and pathologic consequence of atherosclerosis

A

Inferior wall STEMI

Acute Plaque Change (Hemorrhage)

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5
Q

34/F known case of ADPKD presented w/ SEVERE HEADACHE and EVENTUAL COLLAPSE.

Antemortem plain CT scan: ENHANCEMENT of sulci
Autopsy: multiple saccular dilatations along the vessels of COW with ruptured one on the ACA-ACoA junction

A

Subarachnoid Hemorrhage (SAH) secondary to Ruptured Intracranial Berry Aneurysm

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6
Q

55/M, known HPN w/ previous CXR and plain abdominal films only showing ATHEROMATOUS AORTA presented w/ PULSATING ABDOMINAL MASS.

Autopsy: fusiform dilation of the abdominal aorta with a point of rupture

A

Ruptured Abdominal Aortic Aneurysm

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7
Q

34/M, 6’5 w/ LONG FINGERS presented w/ chronic nonproductive cough.
PE: 120/10.
Patient suddenly went hypotensive, w/ muffled heart sounds and neck vein distention.

Autopsy: 200 cc of blood in the pericardial cavity w/ fusiform dilation of the abdominal aorta w/ a point of rupture.

A

Ruptured Thoracic Aortic Aneurysm

Marfan syndrome

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8
Q

34/M, 6’5 w/ LONG FINGERS presented w/ chronic nonproductive cough.
Presented w/ sudden onset of exquisite chest pain, tearing in character, radiating to the back w/ sudden cardiovascular collapse and death.

Autopsy: Secondary lumen in the thoracic aorta w/ point of tear noted proximal to the formation of secondary lumen

A

Aortic Dissection

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9
Q

65/F, known case of polymyalgia rheumatica presented w/ severe headache and diplopia associated w/ fever and fatigue.
PE: tenderness over the course of superficial temporal artery
Biopsy: intimal thickening of the artery, granulomatous inflammation of the internal elastic lamina w/ infiltrate of T cells and macrophages

Diagnosis

A

Giant Cell Arteritis (Large Arteries)

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10
Q

38/F, with fatigue, weight loss and fever and REDUCED BLOOD PRESSURE, WEAK PULSES IN THE CAROTIDS and UPPER EXTREMITIES, OCULAR DISTURBANCES and NEUROLOGIC DEFECTS.

Biopsy: intimal thickening of the artery, granulomatous inflammation of the internal elastic lamina w/ infiltrate of T cells and macrophages

Diagnosis

A

Takayasu Arteritis (Large Arteries)

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11
Q

56/M, known case of CHRONIC HEPA B, presented w/ RAPIDLY ACCELERATING HPN, ABDOMINAL PAIN, BLOODY STOOL and MYALGIA and eventually expired.

Biopsy: segmental TRANSMURAL necrotizing inflammation w/ EXTENSIVE fibrinoid necrosis and temporal heterogeneity lesions

A

Polyarteritis Nodosa (PAN)

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12
Q

4/F, presented w/ FEVER and MACULOPAPULAR RASH on trunk and extremities associated w/ CONJUNCTIVAL ERYTHEMA and CERVICAL LYMPH NODE ENLARGEMENT.

Biopsy: segmental TRANSMURAL necrotizing inflammation w/ LESS fibrinoid necrosis

A

Kawasaki Disease

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13
Q

45/M, presented w/ HEMOPTYSIS and HEMATURIA
Serology: p-ANCA/MPO-ANCA (+)

Biopsy: vasculitis pattern similar to PAN but lesions are of the same stage and with FRAGMENTED PMNs in post-capillary venules (leukocytoclasia)

A

Microscopic Polyangiitis

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14
Q

34/F, known case of BRONCHIAL ASTHMA
CBC: 62% eosinophils, (-) blasts
Serology: p-ANCA/MPO-ANCA (+)

Biopsy: Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis

A

Churg-Strauss Syndrome

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15
Q

54/M, (+) hemoptysis and hematuria w/ increasing BUN and creatinine
Serology: c-ANCA (PR3-ANCA) (+)

Biopsy: necrotizing granulomas of the respiratory tract, necrotizing vasculitis and CRESCENTIC GLOMERULONEPHRITIS
(-) findings on immunofluorescence

A

Granulomatosis w/ Polyangiitis (Wegener Granulomatosis)

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16
Q

30/M, smoker w/ INTERMITTENT CLAUDICATION with right leg

Biopsy: segmental thrombosing acute and chronic vasculitis w/ microabscesses

A

Thromboangiitis obliterans (Buerger disease)

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17
Q

45/M, CHRONIC ALCOHOLIC, known case of LIVER CIRRHOSIS
multiple, radial, pulsatile arrays of dilated submucosal arteries that blanch in pressure

A

Spider telangiectasia

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18
Q

4/M, with SEIZURES, MENTAL RETARDATION and HEMIPLEGIA

PE: port wine stain on the left

CT scan: extraaxial hyperdense lesion on the left parietal convexity

Biopsy: dilated venous vessels

A

Sturge Weber Syndrome

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19
Q

4/F with PINKISH, EXOPHYTIC lesion on the LIP since birth

Biopsy: small, endothelial-lined spaces filled w/ RBCs

A

Capillary Hemangiomas

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20
Q

4/F with PINKISH, EXOPHYTIC lesion on the LIP AFTER history of TRAUMA

Biopsy: small, endothelial-lined spaces filled w/ RBCs
granulating acute and chronic inflammation

A

Pyogenic Granuloma

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21
Q

43/F w/ LIVER MASS

Biopsy: Dilated vascular spaces filled w/ blood

A

Cavernous Hemangioma

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22
Q

15/F, SHORT STATURE and AMENORRHEA presented w/ a MASS on the NECK (10 cm in widest dimension)

Biopsy: dilated endothelial lined space WITHOUT RBCs

A

Cavernous Lymphangioma; Turner Syndrome

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23
Q

29/M, known case of HIV, developed PUPRLE PLAQUES on bilateral lower extremities

Biopsy: dermal accumulation of jagged vascular channels lined and surrounded by plump spindle cells

A

Kaposi Sarcoma

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24
Q

46/M, exposed to VINYL CHLORIDE presented w/ a LIVER MASS

Biopsy: sheets of spindle cells w/ occasional vessel formation

Immunohistochemistry: CD31, vWF (+)

A

Hepatic Angiosarcoma

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25
Q

Vascular resistance is determined at the level of the

A

ARTERIOLES

26
Q

Homogenous, pink hyaline thickening with associated luminal narrowing

A

Hyaline Arteriolosclerosis

Essential HPN
DM

27
Q

Concentric, laminated thickening

“onion skin” lesions

A

Hyperplastic Arteriolosclerosis

Malignant HPN

28
Q

Fibrinoid deposition and vessel wall necrosis (NECROTIZING arteriolitis)

A

Malignant HPN

29
Q

Early lesions containing LIPID-FILLED FOAMY MACROPHAGES

A

Fatty streak

small flat yellow macules –> elongated streaks

30
Q

Fibrous cap + lipid core

(+) neovascularization at the periphery

A

Atheromatous plaque

yellow to tan

31
Q

MC sites of atherosclerosis

A

LOWER abdominal aorta and ILIAC arteries

32
Q

Most dangerous consequence of atherosclerosis

A

Acute Plaque Change

33
Q

THIN fibrous cap
LARGE lipid core
INCREASED inflammation

A

VULNERABLE PLAQUE

34
Q

Thickened and densely collagenous fibrous cap w/ minimal inflammation and atheromatous core

A

STABLE PLAQUE

35
Q

4 PRINCIPAL COMPONENTS OF ATHEROSCLEROTIC PLAQUES

A

cells – SMCs, macrophages and T lymphocytes
ECM – collagen, elastic fibers and proteoglycans
intracellular and extracellular lipids
calcifications in later stage plaques

36
Q

Clinical manifestations of ANEURYSMS

A

(+) mass and mass effect
erosion of bone
rupture - hemorrhage and cardiovascular collapse

37
Q

Abdominal aortic aneurysm (AAA) usually arise at the

A

INFRARENAL AORTA

fewer elastic fibers and collagen
more fragile vasa vasorum

38
Q

HPN
CT defects - Marfan, Loeys-Dietz syndrome
Inflammatory disorders (aortitis)

A

Thoracic Aortic Aneurysm

39
Q

40-60, M
HPN
young w/ CT defects - Marfan

A

Aortic dissection

sudden excruciating anterior chest pain radiating to the back

40
Q

MC site of aortic dissection

A

ASCENDING AORTA - w/n 10 cm of the aortic valve

41
Q

MC site of aortic dissection

A

ASCENDING AORTA - w/n 10 cm of the aortic valve

42
Q

MC form of vasculitis among OLDER population (>50)

TEMPORAL, OPHTHALMIC

headache, pain tenderness along SUPERFICIAL TEMPORAL a

diplopia or complete vision loss

associated with POLYMYALGIA RHEUMATICA

A

LARGE Vessel Vasculitis

GIANT CELL ARTERITIS (TEMPORAL CELL ARTERITIS)

43
Q

<50 y/o

AORTIC ARCH
great vessels
pulmonary, coronary, renal

ocular disturbances

PULSELESS DISEASE - weakening of pulses in the UPPER limbs

A

LARGE Vessel Vasculitis

TAKAYASU ARTERITIS

44
Q

Morphology of LARGE VESSEL vasculitis

A

intimal thickening
medial granulomatous inflammation w/ elastic lamina fragmentation
T cell infiltrate (CD4 > CD8), macrophages, multinucleated giant cells

45
Q

Associated w/ HEPATITIS B

RENAL and VISCERAL VESSELS EXCEPT - pulmonary

abdominal pain
HPN

A

MIDDLE Vessel Vasculitis

Polyarteritis Nodosa (PAN)

46
Q

Morphology of MEDIUM VESSEL vasculitis

A

segmental, transmural necrotizing inflammation

FIBRINOID NECROSIS AND LUMINAL THROMBOSIS
*PAN - PROMINEN fibrinoid necrosis
*KAWASAKI - LESS prominent fibrinoid necrosis

temporal heterogeneity of lesions

46
Q

Important cause of MI in CHILDREN

CORONARY ARTERIES

fever >5 days
conjunctival injection
mucosal erythema
cervical lymphadenopathy
polymorphous exanthem

A

MIDDLE Vessel Vasculitis

Kawasaki Disease

47
Q

Seen in vasculitis associated with HSP and CT disorders

KIDNEY and LUNGS

hemoptysis
hematuria and proteinuria

A

SMALL Vessel Vasculitis

MICROSCOPIC POLYANGIITIS
MPO-ANCA/p-ANCA

PAN but temporally homogenous

leukocytoclastic vasculitis

48
Q

Allergic granulomatosis and angiitis

Associated w/ asthma, allergic rhinitis and eosinophilia

Cutaneous
GIT
Renal

palpable purpura
GI bleed
FSGS
cardiomyopathy

A

SMALL Vessel Vasculitis

CHURG STRAUSS SYNDROME (Eosinophilic Granulomatous with Polyangiitis)
MPO-ANCA/p-ANCA

PAN + extravascular necrotizing granulomas and eosinophils

49
Q

PROMINENT PULMONARY INVOLVEMENT

necrotizing granuloma
necrotizing vasculitis
necrotizing glomerulonephritis

A

SMALL Vessel Vasculitis

GRANULOMATOSIS W/ ANGIITIS (WEGENER’s GRANULOMATOSIS)
PR3-ANCA (c-ANCA)

acute necrotizing granulomas of respiratory tract
necrotizing or granulomatous vasculitis
crescentic G

50
Q

Highly associated with HEAVY TOBACCO SMOKING

small to medium - TIBIAL AND RADIAL

Raynaud phenomenon
intermittent claudication
superficial nodular phlebitis

A

THROMBOANGIITIS OBLITERANS (BUERGER DISEASE)

focal acute and chronic vasculitis
thrombosis w/ micro abscesses

51
Q

Small to medium

NEUTROPHILIC VASCULITIS

precipitated by HSV and parvovirus

recurrent oral aphthous ulcers
genital ulcers
uveitis

PATHERGY TEST

A

BEHCET SYNDROME
HLA-B51

neutrophilic infiltration of vessels

52
Q

Exaggerated vasoconstriction of arteries and arterioles in response to cold or emotion

A

Raynaud Phenomenon

RED - WHITE - BLUE

53
Q

Primary Raynaud

A

NON-progressive
SYMMETRIC

54
Q

Secondary Raynaud

A

PROGRESSIVE
ASYMMETRIC
ASSOCIATIONS:
SLE, scleroderma, Buerger disease, atherosclerosis

55
Q

Cancers associated with production of PROTHROMBOGENIC substances that cause the body to be in hypercoagulable state

A

LUNGS and PANCREATIC cancer

56
Q

MC vascular ectasia

Regress spontaneously

A

NEVUS FLAMMEUS (birthmark)

57
Q

MC HIV related malignancy worldwide

patch – plaque – nodule

A

Kaposi sarcoma - HHV-8

58
Q

Benign tumor

THIN WALLED capillaries with scan stroma

A

Hemangioma

59
Q

Benign tumor

UNENCAPSULATED, infiltrative borders

Large, cavernous blood filled vascular spaces

DEEP structures

A

Cavernous

60
Q

VHL - chromosome 3 – loss of function – increased HIF-1 – increased VEGF – EXCESSIVE VESSEL GROWTH

A

VON HIPPEL LINDAU DISEASE
*AD

COMPONENTS:
CNS hemangioblastomas
cavernous hemangiomas
pancreas, kidneys, liver cysts
Renal cell ca
pheochromocytomas

61
Q

Benign tumor

thin, endothelial lined spaces w/o RBC

A

Lymphangioma

Pathology (24 decks)

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