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Blood Vessels Flashcards

1
Q

Mutations in ENaC leading to inc tubular resorption by aldosterone

A

Liddle syndrome

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2
Q

Mechanisms of Essential Hypertension (4)

A

1 Reduced renal sodium ex
2 Inc vascular resistance
3 Genetics
4 Environment

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3
Q

Benign hypertension
Homo pink hyaline with thickening of arteriolar wall
Sometimes with nephrosclerosis

A

Hyaline arteriolosclerosis

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4
Q

Typical severe hypertension
Onionskin concentric laminated thickening and luminal narrowing
Necrotizing arteriolosclerosis

A

Hyperplastic arteriolosclerosis

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5
Q

Hardening of arteries

A

Arteriolosclerosis

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6
Q

Calcific deposits in muscular arteries
Older than 50
Do not encroach lumen not clinicially
significant

A

Monckeberg medial sclerosis

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7
Q

Presence of intimal lesions atheromas

A

Atherosclerosis

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8
Q

Strongly and independently predict risk of MI stroke PAD SCD even in healthy

A

CRP level

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9
Q

Atheroma development

A

Endothelial injury -> endothelial dysfunction and mac and smooth muscle activation ->mac and smooth ms engulf lipid -> smooth ms prolif collagen, ECM, lipid deposition

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10
Q

Minute yellow plaque macules that coalesce into elongated lesions made up of lipid filled foamy mac but do not cause significant flow disturbance
Forms as early as <1 yr

A

Fatty streak

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11
Q

Most involved vessels in atherosclerotic plaque formation:

A

Infrarenal abdominal aorta > coronary arteries > popliteal arteries > ICA > circle of Willis

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12
Q

Atherosclerotic plaque 3 principal components:

A 
1 cells (smooth muscle or foam cell, mac and T lymphocytes)
2 ECM (collagen, elastic fibers, proteoglycan)
3 intracellular and extracellular lipid
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13
Q

When plaque exposes highly thrombogenic constituents

A

Plaque rupture/fissuring

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14
Q

Thrombogenic subendothelial membrane exposed to blood

A

Erosion/ulceration

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15
Q

Expansion of volume by plaque

A

Hemorrhage into atheroma

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16
Q

Plaque inflammation induces

A

collagen degradation

reduced collagen synthesis

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17
Q

True aneurysms

A

Involve all three layers of artery

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18
Q

False aneurysm

A

Pseudoaneurysm

Wall defect becoming extravascular hematoma communicating with intravascular space (pulsating)

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19
Q

Pressured blood enters arterial wall through defect and pushes apart underlying layers

A

Arterial dissection

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20
Q

Discrete outpouchings 5-20cm with thrombus

A

Saccular

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21
Q

Circumferential dilations up to 20cm involving aortic arch, abd aorta and iliac arteries

A

Fusiform

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22
Q

Aneurysms occur bec (4)

A

1 inadequate abnormal CT synthesis
2 excessive CT degradation
3 loss of smooth muscle cell or change in smooth muscle cell synthetic phenotype

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23
Q

Abnormal sequestration of tgf b in wall leading to dilation and dysregulating signalling and loss of elastic tissue

A

Marfan syndrome

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24
Q

scaffolding protein defective in Marfan

A

fibrillin

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25
Q

Mutation in tgf b result in

A

1 defective elastin

2 defective collagen synthesis

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26
Q

Type IV Ehrlos Danlos results fr

A

Defective Type III collagen synthesis with aneurysm

skin
ligament
blood vessel

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27
Q 
Narrowing of aortic vasa vasorum fr sys HTN and ischemia
Smooth muscle cell loss
Aortic degenerative changes (fibrosis) 
Inadequate ECM synthesis
Inc amorphous proteoglycan
A

Cystic medial degeneration

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28
Q

Most important causes of aneurysm (2)

A

1 atherosclerosis

2 hypertension

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29
Q

Factor in abdominal aneurysm

A

Atherosclerosis

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30
Q

Ascending aortic aneurysms

A

Hypertension

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31
Q

Embolization of septic embolus fr infective endocarditis
Extension of suppurative process
Direct infection of wall

A

Mycotic aneurysm

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32
Q

Tertiary syphilis has predilection for

A

Vasa vasorum of ascending THORACIC aorta

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33
Q

Immune response to spirochetes attacking thoracic aorta

A

Obliterative endarteritis

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34
Q

Men
Smokers
More than 50
Plaques compromising diffusion of nutrients and waste bet lumen and wall compressing media leading to necrosis and thinning

A

Abdominal Aortic Aneurysm AAA

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35
Q

Distinct subtype of with dense periaortic fibrosis with lymphoplasmacytic inflammation mac giant cell

A

Inflammatory AAA

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36
Q

Risk of aneurysm rupture is determined by

A

Size

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37
Q

Never bursts

A

AAA =4cm diameter

38
Q

4-5cm

A

1% chance rupture

39
Q

5-6cm

A

11% per year

40
Q

> 6cm

41
Q

AAA Managed surgically

42
Q 
Encroachment of mediastinal structure
Cough fr irritation of recurrent 
Pain by erosion of bone
Cardiac from valvular insuff or narrowing of ostia
Aortic rupture
A

Thoracic Aortic Aneurysm

43
Q

Blood splays apart laminar planes of media forming blood-filled channel within wall

A

Aortic dissection

44
Q

Dissecting hematoma reenters lumen of aorta through second distal intimal tear creating second vascular channel

A

Double barreled aorta

Chronic dissection

45
Q

Ascending aorta isolated

A

DeBakey II

Proximal Type A dissection

46
Q

Ascending aorta with descending aorta

A

Debakey I

Proximal Type A

47
Q

Beyond sublavian

A

Debakey type III

Distal Type B

48
Q

Sudden excruciating tearing stabbing pain beginning on ant chest radiating between scapula moving downward as tearing progresses

A

Aortic dissection

49
Q

Most common cause of death in AD

A

Rupture of dissection into pericadial, pleural and peritoneal cavity

50
Q

Pathogenic mechanisms of vasculitis (2)

A

1 immune mediated

2 direct vascular invasion by pathogen

51
Q

Mech underlying non infectious vasculitis (4)

A

1 immune complex
2 antineutrophil cytoplasmic antibodies (ANCA)
3 anti-endothelial cell ab
4 autoreactive T cell

52
Q

Antibody production assoc in drug hypersensitivity vasculitis (penicillin) infection vasculitis

A

Immune complex assoc vasculitis

53
Q

ANCAs (antineutrophilic cytoplasmic antibodies) against enzymes of granules
Diagnostic markers that mirror severity

A

ANCA vasculitis

54
Q

Neutrophil azurophilic granule sharing homology of bacterial peptides

Assoc with

A

Antiproteinase-3
PR3 ANCA

Wegener granulomatosis

55
Q

Lysosomal granule involving free radical generation
Induced by PTU

assoc with

A

Anti-myeloperoxidase (MPO-ANCA)
P-ANCA

Microscopic polyangiitis
Churg Strauss syndrome

56
Q

ANCA Vasculitis are pauci immune bec

A

They do not contain antibody-complement in lesions

57
Q

Most common form of vasculitis in elderly

A

Giant cell Temporal arteritis

58
Q

Granulomatous inflammation of large to small sized arteries supplying head

Temporal
Vertebral
Opthalmic
Aorta

A

Giant cell Temporal arteritis

59
Q

Giant cell arteritis is caused by

A

T cell mediated immune response to vessel wall antigen
TNF and endothelial cell antibody
MHCII
Responds to steroids

60
Q

Patchy nodular granulomatous inflamm in inner media on INTERNAL ELASTIC MEMBRANE
multinucleated giant cell
fragmentation of IEL

A

Giant cell temporal arteritis

61
Q

Giant cell dx tx

A

Biopsy histology

Corticosteroids TNF

62
Q

granulomatous vasculitis of medium and large arteries with transmural scarring and thickening of aorta (pulseless)

Ocular disurbance
Weakening of pulse in UE

Less than 50, autoimmune etiology

A

Takayasu arteritis

63
Q

Takayasu classically affects

A

aortic arch and arch vessel

50% pulmonary artery, renal coronary

64
Q

Systemic vasculitis of small and medium muscular artery involving renal and visceral vessel sparing pulmonary circulation

Assoc with chronic hep B

Segmental transmural necrosis, inflammation and thrombosis

Kidney heart liver

65
Q

Acute phase transmural inflammation
infiltrate neutrophils and mononuclear cells accompanied by

All stages of activity in PAN COEXIST

A

Fibrinoid necrosis and thrombosis

66
Q

Rapidly accelerating HTN with renal involvement
Abdominal pain bloody stool
Diffuse muscular ache and pain
Peripheral neuritis of motor nerves

Renal major cause of death

67
Q

Arteritis of large and medium vessel with involvement of coronary artery causing aneurysms and MI

Infectious trigger
Delayed type hypersensitivity
Cytokine and B cell activation

A

Kawasaki Disease

68
Q

Transmural inflammation with less fibrinoid necrosis and accompanying aneurysm

69
Q 
Conjunctival oral erythema
Blistering edema of hands
Erythema of palms and soles
Desquamative rash
Cervical LN enlargement (mucocutaneous LN)
CV sequelae
70
Q

Necrotizing vasculitis affecting capillaries, small arterioles and venules characterized by segmental fibrinoid necrosis of media with focal transmural necrosis lesion
Also called hypersensitivity or leukocytoclastic vasculitis

A

Microscopic polyangitis

All lesions of the same age

Pauci immune

71
Q 
90% nec glomerulonephritis
Pulmonary capilitis
Hemoptysis
Hematuria
Proteinuria
Abd pain 
Bleeding
A

Microscopic polyangitis

72
Q

Wegener Granulomatosis triad:

A

Granuloma of lung URT
Vasculitis small to med in lungs
Glomerulonephritis

73
Q

PR3 ANCA +
Like PAN but with pulmo sx
Nec granulomatous vasc with surrounding fibroblast prolif
MAN 40 yrs with bilateral pneumonitis nodule and cavitary lesion, mucosal ulcer, renal disease
Mort of 80% 1 yr

A

Wegener Granulomatosis

74
Q

Wegener tx

A

Rituximab anti b cell
cyclophosphamide
Steroid

75
Q

Allergic granulomatosis and angiitis
Small vessel necrosis assoc with asthma, allergic rhinitis, lung infiltrate and eosinophil perivascular infiltration
MPO ANCA+
Granuloma and eosnophil

A

Churg Strauss syndrome

76
Q 
Heavy smoker
Before 35yrs 
Cold induced Raynaud phenomenon
Instep claudication
Superficial nodular phlebitis (venous inflamm)
Gangrene of extremities

Sharply segmental acute and chronic transmural vasc of medium sized and small arteries with microabscess

A

Thromboangiitis obliterans

Buerger disease

77
Q

Ischemic dilated myopathy assoc with emotional duress from cardiac raynaud

A

Takotsubo cardiomyopathy

Broken heart syndrome

78
Q

Evanescent thrombosis in diff vascular beds at diff times from hypercoagulable states

A

Trousseau syndrome
Migratory thrombophlebitis
Pancreatic cancer

79
Q

DVT risk factors

A 
CHF
pregnancy
OCP
Obesity
Malignancy
Post op immob
80
Q

Common serious clinical complication of DVT

A

Pulmonary embolism

81
Q

First manifestation of thrombophlebitis

A

Pulmonary embolus

82
Q

Neoplasm bronchogenic ca or mediastinal lymphoma obstructing SVC

Dilation of veins of head neck arms and lungs with cyanosis and respi distress

A

SVC syndrome

83
Q

IVC result from

A

Compression or invasion of IVC by renal or HCC

84
Q

Familial disease of agenesis or hypoplasia of lymphatics

A

Milroy

Heredofamilial congenital lymphedema

85
Q

Permanent dilation of preexisting small vessels in skin and mucous membrane forming discrete red lesions

A

Telangectasia

86
Q

Most common form of vascular ectasia

A

Nevus flammeus birthmark

87
Q

Lesions on childhood thickening skin surface and do not fade with time occuring on distribution of trigeminal nerve assoc w Sturge Webber (encephalotrigeminal angiomatosis)

A

Port wine stain

88
Q

AD by mutation of genes encoding TGF B

Dilated cap and veins and rupture

A

Hereditary hemorrhagic telangiectasia (Osler Weber Rendu disease)

89
Q

Cavernous hemangiomas constitute a component of

A

von Hippel Lindau disease

vasc lesions on cerebellum brainstem retina pancreas liver

90
Q

Benign painful tumors from smooth muscle cells of glomus bodies involved in thermoregulation

A

Glomus tumors

91
Q

Vascular proliferation in immunocompromised hosts caused by G- of Bartonella family

Cats
Homeless

A

Bacillary angiomatosis

92
Q

vascular neoplasm by KSHV or HHV8

most common in AIDS

A

Kaposi sarcoma

Pathology (24 decks)

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