Ch. 10 Intro, Clots, Aneurysms

Question 1

A 70 year old male comes in to your office complaining of lower leg claudication. The patient has type II DM, has a 60 pack year smoking history, and is morbidly obese. Upon checking the patient’s labs, you notice he also has hyperlipidemia. You’re quite confident that the cause of the patient’s leg discomfort is due to atherosclerosis/PVD. What types of arteries of most affected by this?

Answer 1

Dx: Peripheral Vascular Disease

Muscular arteries are the most significant sites of atherosclerosis. They are also known as “resistance vessels” and maintain systemic BP by regulating TPR. In other news, small arteries, particularly arterioles, are sites of hypertensive changes.

Question 2

vWF binds to:
GbIIb/IIIa binds to: 
Both of these contribute to: \_\_\_\_\_\_\_\_\_
2 chemicals that recruit Plt's: 
Inhibits plt aggregation:

Answer 2

GpIb receptors on Plt membrane
Fibrinogen
Platelet aggregation
ADP and thromboxane A2
Prostacyclin (PGI2)

Question 3

Thrombin activates protein C by binding to ________ at endothelial cell surfaces. Protein C inhibits coagulation factors ___ and ___.

Answer 3

Thrombomodulin; V; VIII

Question 4

A 64 year old female with a PMH significant for HTN, DMII, and hyperlipidemia presents with chest pain. ECG shows ST-segment elevation in the inferior leads. Unfortunately, the patient expires and on autopsy the LAD is found to be totally occluded by a thrombus. What are the 4 fates of a thrombus in vivo?

Answer 4

Dx: Myocardial Infarction due to complete thrombotic occlusion of LAD

A thrombus may undergo 1) lysis, 2) growth and propagation, 3) embolization, and 4) organization and canalization.

Question 5

A 73 year old male comes to your office for a routine check-up. You’re a bit concerned as his labs came back indicating elevated lipids. You ask the patient if he’s been regularly taking his statin, but he says he occasionally forgets. On exam you palpate a pulsatile abdominal mass in the midline. What is the most likely diaganosis, and what is this often a complication of?

Answer 5

Dx: Abdominal Aortic Aneurysm

AAA’s are usually the result of atherosclerosis occurring after the age of 50. Most occur distal to the renal artery and proximal to the aortic bifurcation. Those greater than 5cm often rupture within 5 years of discovery.

Question 6

A 32 year old female presents with what she describes as “the worst headache of her life”. Upon review of her chart you notice she has previously been diagnosed with Marfan’s syndrome. CT confirms your diagnosis of a subarachnoid hemorrhage. What type of vascular lesion is this most likely a result of and where?

Answer 6

Dx: Subarachnoid hemorrhage

Often caused by saccular (or berry) aneurysms located in the circle of Willis. They are bubble-like arterial wall outpouchings at a site of weakened media.

Question 7

A 64 year old male presents with “ripping” substernal chest pain that radiates to his back. Having paid attention in MLC as a MSI and remembering Dr. Kloss’s presentation, you immediately think to check the patient’s blood pressure in each arm; and miraculously you find a difference! You’re very confident in your diagnosis which is..? What changes are typically described in the pathology report of the affected vessel?

Answer 7

Dx: Aortic Dissection

The changes are usually described as cystic medial necrosis (of Erdheim), because focal loss of elastic and muscle fibers in the media leads to “cystic” spaces filled with a metachromatic myxoid material.

Question 8

While killing time before you have to present of rounds, you notice a pathology report at the nurse’s station that reads “gross changes = obliterative changes in vasa vasorum with focal medial necrosis and scarring”, followed by, “tl;dr = “tree-bark appearance”. Fortunately, you passed MSII via associations, so your guess at this unknown patient’s diagnosis is…? This disease most commonly affects what part of the affected vessel?

Answer 8

Dx: Syphilitic Aneurysm (due to inflammation of vasa vosorum)

Syphilitic Aneurysm’s are often seen affecting the ascending aorta. They are usually fusiform aneurysms which are ovoid swellings parallel to the long axis of the vessel (as opposed to saccular, dissecting, and arteriovenous aneurysms)

Question 9

A patient comes to the floor with an admitting diagnosis of sepsis. They are at risk for a _______ aneurysm due to their circulating infection.

Answer 9

Mycotic Aneurysm: result from weakening of a vessel wall by a microbial infection.