Ch. 7 vascular pathology

Question 1

large vessel vasculitis involve which vessels?

Answer 1

aorta and its major branches

Question 2

medium vessel vasculitis involve which vessels?

Answer 2

muscular arteries that supply organs

Question 3

small vessel vasculitis involve which vessels?

Answer 3

arterioles, capillaries and venules

Question 4

What are the two types of large vessel vasculitis?

Answer 4

Temporal (Giant cell) Arteritis and Takayasu Arteritis

Question 5

Name the vasculitis — granulomatous vasculitis; branches of carotid artery; older adults >50; females; presents as HA, visual disturbances and jaw claudication; flu-like symptoms with joint and muscle pain

Answer 5

Temporal (Giant Cell) Arteritis

Question 6

Biopsy of Temporal Arteritis reveals?

Answer 6

inflammed vessel wall with giant cells and intimal fibrosis

Question 7

What is the treatment for Temporal Arteritis?

Answer 7

Corticosteroids

Question 8

Name the vasculitis — granulomatous vasculitis; aortic arch at branch points; adults

Answer 8

Takayasu Arteritis

Question 9

What is the treatment for Takayasu Arteritis?

Answer 9

Corticosteroids

Question 10

What are the 3 types of medium vessel vasculitides?

Answer 10

Polyarteritis Nodosa, Kawasaki Disease, Buerger Disease

Question 11

Name the vasculitis — necrotizing vasculitis involving many organs but spares lungs; presents as HTN, abdominal pain with melena, neurologic disturbances and skin lesions; HBsAg; fibrinoid necrosis; “string of pearls”

Answer 11

Polyarteritis nodosa

Question 12

What is the treatment for polyarteritis nodosa?

Answer 12

corticosteroids and cylcophosphamide

Question 13

What is the MOA of cyclophosphamide?

Answer 13

Covalently x-link DNA at guanine N-7; require bioactivation by liver

Question 14

Name the vasculitis — Asian children

Answer 14

Kawasaki Disease

Question 15

What is the treatment for Kawasaki disease?

Answer 15

Aspirin and IVIG; disease is self-limited

Question 16

Name the vasculitis — necrotizing vasculitis involving digits; ulceration, gangrene, autoamputation of fingers and toes; Raynaud phenomenon; ASSOCIATED WITH HEAVY SMOKING

Answer 16

Buerger Disease

Question 17

What is the treatment for Buerger Disease?

Answer 17

smoking cessation

Question 18

What are the 4 types of small vessel vasculitides

Answer 18

Wegener Granulomatosis, Microscopic Polyangiitis, Churg-Strauss Syndrome, Henoch-Schonlein Purpura

Question 19

Name the vasculitis — necrotizing granulomatous vasculitis involving nasopharynx, lungs, kidneys; positive for serum c-ANCA

Answer 19

Wegener Granulomatosis

Question 20

Name the vasculitis — necrotizing vasculitis involving multiple organs esp. lung and kidney; no nasopharyngeal involvement and presence of granulomas; positive serum p-ANCA

Answer 20

Microscopic polyangiitis

Question 21

What is the treatment for Microscopic polyangiitis?

Answer 21

corticosteroids and cyclophosphamide

Question 22

Name the vasculitis — necrotizing granulomatous inflammation with EOSINOPHILS involving multiple organs eps. lungs and heart; asthma; positive serum p-ANCA

Answer 22

Churg-Strauss syndrome

Question 23

Name the vasculitis — due to IgA immune complex deposition; most common vasculitis in children; palpable purpura on buttocks and legs, GI pain, bleeding and hematuria (IgA nephropathy); occurs after URI

Answer 23

Henoch -Schonlein Purpura

Question 24

95% of cases of Primary HTN

Answer 24

HTN of unknown etiology

Question 25

What is secondary HTN?

Answer 25

HTN due to an identifiable etiology (5%)

Question 26

What is a common cause of secondary HTN?

Answer 26

renal artery stenosis

Question 27

Name this condition - developmental defect of blood vessel wall, resulting in irregular thickening of large and medium sized arteries, esp. renal artery

Answer 27

fibromuscular dysplasia

Question 28

What are the 3 patterns of arteriosclerosis?

Answer 28

atherosclerosis, arteriolosclerosis, Monckeberg medial calcific sclerosis

Question 29

What type of arteriosclerosis is this? intimal plaque obstructs blood flow; necrotic lipid core with a fibromuscular cap; involves large and medium sized arteries

Answer 29

Atherosclerosis

Question 30

Describe the pathogenesis of atherosclerosis

Answer 30

damage to endothelium allows lipids to leak into intima => lipids are oxidized and consumed by macrophages forming foam cells => inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle

Question 31

How does atherosclerosis begin? at what stage in life does it begin? what does it progress to?

Answer 31

Begins as fatty streaks; arises early in life (teenage years); progresses to atherosclerotic plaque

Question 32

What type of arteriosclerosis is this? narrowing of small arterioles; divided into two types hyaline and hyperplastic

Answer 32

arteriolosclerosis

Question 33

This type of arteriolosclerosis is caused by proteins leaking into the vessel wall, producing vascular thickening, proteins are seen as pink hyaline on microscopy

Answer 33

Hyaline arteriolosclerosis

Question 34

What is hyaline arteriolosclerosis a consequence of and what results?

Answer 34

Consequence of long standing benign HTN or diabetes; results in reduced vessel caliber with end organ ischemia

Question 35

This type of arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle ("onion skin appearance")

Answer 35

hyperplastic arteriolosclerosis

Question 36

What is hyperplastic arteriolosclerosis a consequence of and what results?

Answer 36

Consequence of malignant HTN; results in reduced vessel caliber with end organ ischemia; may lead to fibrinoid necrosis of the vessel wall with hemorrhage

Question 37

Hyperplastic arteriolosclerosis causes acute renal failure with what type of characteristic appearance?

Answer 37

"flea-bitten" appearance

Question 38

What type of arteriosclerosis is this? calcification of the media of muscular arteries; non-obstructive; not clinically significant; incidental finding

Answer 38

Monckeberg medial calcific sclerosis

Question 39

Intimal tear with dissection of blood through media of the aortic wall; most common cause is HTN

Answer 39

Aortic dissection

Question 40

Aortic dissection is associated with what two conditions that are inherited defects of connective tissue?

Answer 40

Marfan syndrome and Ehlers-Danlos syndrome - weakness of connective tissue in media

Question 41

How does aortic dissection present?

Answer 41

sharp tearing chest pain that radiates to the back

Question 42

What is the most common cause of death with aortic dissection?

Answer 42

pericardial tamponade

Question 43

balloon like dilation of the thoracic aorta

Answer 43

Thoracic aneurysm

Question 44

What condition is thoracic aneurysm classically seen with and what appearance of the aorta results?

Answer 44

tertiary syphilis; tree-bark appearance

Question 45

Where do abdominal aortic aneurysms most commonly arise?

Answer 45

below the renal arteries but above the aortic bifurcation

Question 46

Abdominal aortic aneurysm is primarily due to what type of arteriosclerosis?

Answer 46

atherosclerosis

Question 47

Abdominal aortic aneurysm is classically seen in?

Answer 47

male smokers > 60 with HTN

Question 48

Name the vascular tumor --- benign tumor comprised of blood vessels; commonly present at birth; often regresses in childhood; most common in skin and liver

Answer 48

hemangioma

Question 49

Name the vascular tumor --- malignant proliferation of endothelial cells; highly aggressive; common in skin, breast, liver

Answer 49

angiosarcoma

Question 50

Liver angiosarcoma is associated with exposure to what chemicals?

Answer 50

polyvinyl chloride, arsenic, thorotrast

Question 51

Name the vascular tumor --- low grade malignant proliferation of endothelial cells; associated with HHV-8; presents as purple pataches, plaques, nodules on skin

Answer 51

Kaposi Sarcoma

Question 52

Kaposi sarcoma is classically seen in what populations?

Answer 52

older eastern European males; AIDs; transplant recipients