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PCM Exam 2 > Cardiovascular Path 7 > Flashcards

Cardiovascular Path 7 Flashcards

1
Q

what kinds of end organ damage can you see with malignant HTN ?

A
  • renal failure
  • left ventricular failure
  • hypertensive encephalopathy
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2
Q

the homogenous pink thickening of the walls of the arterioles in _____ arteriolosclerosis is due to ______

A

hyaline;
leakage of plasma components across vascular endothelium and ↑’ing extracellular matrix production by smooth muscle cells

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3
Q

chronic hemodynamic stress in HTN or the metabolic stress in DM can cause ______ arteriosclerosis

A

hyaline

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4
Q

______ arteriolosclerosis is related to more acute or severe elevations of BP

A

hyperplastic

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5
Q

necrotizing arteriolitis is seen in _____ arteriolosclerosis

A

hyperplastic

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6
Q

describe the histology appearance of a hyperplastic arteriosclerosis

A

onion skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumen

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7
Q

depots of _______ and acute necrosis fo the vessel wall is seen in hyperplastic arteriosclerosis

A

fibrinoid material

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8
Q

what are two outcomes of the vessels in vasculitis?

A

stenosis or aneurysm

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9
Q

what are 3 main etiologies of vasculitis?

A
  • immunological
  • direct infection
  • unknown: giant cell (temporal), takayasu, PAN
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10
Q

what are some classes of immunological causes of vasculitis?

A
  • immune complex mediated: hep B/C, SLE/RA, drugs
  • ANCA mediated: Wegener’s granulomatosis and Churgg Strauss
  • direct antibody mediated: Kawasaki (anti endothelial cell ab’s)
  • cell mediated: allograft organ rejection
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11
Q

________ antibodies is the cause of Kawasaki’s disease

A

anti-endothelial cell antibodies

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12
Q

what are examples of immune complex mediated causes of vasculitis?

A
  • Hep B/C
  • SLE
  • Rheumatoid arthritis
  • drug induced
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13
Q

SLE is a type _____ cause of vasculitis

A

type 3: immune response against antigen-antibody complexes

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14
Q

pauci immune vasculitis is seen in _______

A

ANCA mediated even though there are antibodies (they are against the neutrophils)

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15
Q

what are the two main types of ANCA

A
  • c ANCA (PR3-ANCA)

- p ANCA (MPO- ANCA)

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16
Q

pr3 ANCA is the same as ____ ANCA

A

c- ANCA

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17
Q

___ ANCA is seen in microscopic polyangitis

A

P-ANCA

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18
Q

_____ ANCA is seen in Churgg Strauss and Wegener’s

A

C-ANCA

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19
Q

what arteries are mainly affected in giant cell arteritis?

A
  • aorta
  • temporal (most common)
  • vertebral
  • ophthalmic (can lead to blindness)
20
Q

what is the difference between takayasu arteritis and giant cell arteritis?

A
  • only the AGE;
    < 50 = takayasu
    > 50 = giant cell/temporal
21
Q

most symptoms in giant cell arteritis are vague, but there can also be _____ symptoms such as:

A

ocular; diplopia, progressive hazy vision, loss of vision

22
Q

fragmentation of internal elastic lamina is seen in the histology of what vasculitis disease?

A

giant cell vasculitis (along with giant cells in the intima and inner media)

23
Q

is there reduction of the lumen in giant cell arteritis?

A

yes; focal, nodular thickening with reduction of the lumen

24
Q

why must you take multiple sections in the temporal artery biopsy in diagnosing giant cell arteritis?

A

this disease has segmental narrowing so can get a segment that seem normal

25
Q

giant cell arteritis is associated with ________-

A

polymyalgia rheumatica (inflammatory disorder that causes muscle pain and stiffness)

26
Q

a 30 year old female patient complaining of visual disturbances, headaches and dizziness is found to have no pulse in her upper extremities and numbness in her fingers. what could this person have?

A

takayasu arteritis: look at the age (<50), PULSELESS/low BP in upper limb, ocular changes

presents just like giant cell and same histo, just age is different

27
Q

what arteries are typically affected in PAN (polyarteritis nodosa)

A
  • renal, visceral, and coronary, but SPARES THE PULMONARY CIRCULATION and arterioles, capillaries and venules
28
Q

what type of inflammation in see in the small or medium sized arteries affected in PAN?

A

SEGMENTAL transmural necrotizing with fibrinoid necrosis at the inner half of the vessel wall ; (not like the segmental granulomatous type seen in giant cell or takayasu’s)

29
Q

are the lungs affected in PAN?

A

NO

30
Q

what are the most common sites of injury in PAN?

A

most frequent to least:

- kidney, heart, liver, GIT

31
Q

what is a characteristic feature of PAN?

A

all stages of activity may coexist in different vessel or even within the same vessel
(heterogenous)
DOES NOT AFFECT LUNGS

32
Q

what can you expect to see on histology of someone with PAN?

A

BOTH: transmural inflammation with fibrinoid necrosis AND inflammation that is replaced by fibrous thickening of the vessel wall

33
Q

_____ Infection is most often associated with PAN

A

hepatits B (immune complex mediated)

34
Q

Kawasaki disease presents and looks just like ______ except for pathogenesis and the invovlemtn of ______

A

PAN; Kawasaki is due to antibodies against the endothelial cells

Kawasaki involves the mucocutaneous lymph nodes

35
Q

patient comes in with fever, conjunctival and oral erythema, edema on hands and feet, skin rash with desquamation, and enlargement of cervical lymph nodes. what do they have and how would you treat?

A 
MCLNS (Kawasaki's) and treat with: aspirin and immunoglobulins 
CRASH and BURN 
C: conjunctival injetion 
R: rash (polymorphous → desquamating) 
A: adenopathy (cervical) 
S: strawberry tongue (oral mucositis) 
H: hand-foot changes (edema, erythema) 
BURN: fever
36
Q

MI in a young age group such as < 10 year olds, should start to think ______ disease

A

Kawasaki disease because of its involvement with the coronary vessels that can leading to contrary aneurysm formation and associated thrombosis with MI

37
Q

what vessels are mainly involved in Buerger disease

A

mainly the tibial and radial arteries and can sometimes secondarily extend to the veins and nerves of the extremities

38
Q

______ is the largest predisposing factor of Buergers disease

A

smoking; HS reaction to tobacco → direct endothelial injury

39
Q

what are some clinal symptoms of someone with Buerger disease

A
  • superficial nodular phlebitis
  • cold sensitivity aka Raynaud’s which is the the extremities go from pale to blue to red
  • claudication pain on instep
  • progressive pain on exercise and rest
  • ulceration of toes, feet or fingers followed by gangrene
40
Q

Raynaud’s phenomenon is a clinical feature of _______

A

Buerger’s disease, SLE, thromboangitis obliterans

41
Q

how can you tell the difference between thromboangitis and atherosclerosis?

A

the pain in atherosclerosis is associated with activity but twitch Buerger’s disease for example, it can also affect the nerves so can get claudication on rest

42
Q

thrombus that contains small micro abscesses marked by central focus of _____ surrounded by )____ inflammation is seen in the histology of ______

A

neutrophils surrounded by granulomatous inflammation is seen in Buerger’s disease

43
Q

what is a complication of kawsaki disease / Mucocutaneous lymph node syndrome?

A

may develop coronary aneurysm formation associated with thrombosis with MI → death;

Kawasaki’s disease often involves the coronary arteries

44
Q

how would you treat giant cell arteritis?

A

give high dose corticosteroids before temporal artery biopsy to prevent blindness

45
Q

Takayasu arteritis most commonly affects _________ and on gross image you will see ___________

A

arch of the aorta;

irregular thickening of the aorta or branch vessel wall with intimal wrinkling and narrowing of the lumen

46
Q

collagenous fibrosis involving all layers of the vessel wall and ____nuclear infiltrate of the media with granulomatous change with patchy necrosis of the media is seen in ______

A

mononuclear;

takayasu arteritis

PCM Exam 2 (32 decks)

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