Chapter 11-Vasculature Flashcards
What is the prognosis of gloms tumor aka glomangioma or paraganglioma
Benign
How are AAA typical found
Pulsating mass in the abdomen
What are the morphological features of the Lines of Zahn indicative of
Typically seen on AAA and are indicative of layers of thrombi
Which disease’s pathogenesis is linked to atherosclerosis
-Coronary, cerebral and peripheral vascular diseases
What are the immune cells characteristic of Behcet disease
Neutrophilic
What is the complication commonly seen as a result of churn-Strauss syndrome
Cardiomyopathy, accounting for 50% of the deaths seen with this syndrome
What are the clinical presentations in those with IVC syndrome
LE edema
Distention of the superficial collateral veins of the lower abdomen
What is generally occurring in Hyaline arteriolosclerosis
1) Hypertension causing damage of the epithelium in small blood vessels
2) Plasma proteins leaking across the damaged endothelium
3) Increased smooth muscle matrix synthesis resulting in thickening of the wall and narrowing of the lumen
What is the common location of a glomus tumor
Distal finger
What are the common sites of an angiosarcoma
- Skin
- Soft tissue
- Breast
- Liver
Which patients are AAA commonly seen
60 year old males who smoked
What is a true aneurysm
Intact, but thin, muscular wall at the site of dilation
Saccular- on one side
Fusiform-both sides
Venous thrombosis in the form of thrombophlebitis is commonly seen in which neoplasms
-Mucin producing adenocarcinomas such as lung, pancreas, ovarian
What are the vessels most commonly involved in atherosclerosis in descending order
1) Abdominal aorta
2) Coronary arteries
3) Popliteal arteries
4) Internal carotid arteries
5) Circle of Willis
Which vasculitis is characterized by:
- Medium and small vessels affected
- Lymphocytes, macros, neutrophils
- Eiosinophils*
- Positive ANCA
- History of atopy and asthma
Chung-Strauss syndome
Which vasculitis is characterized by:
- Medium and small arteries affected
- Granulomas*
- Lymphocytes, macros, and neutrophils
Granulamatosis with polyangiitis
Which vasculitis condition is characterized by:
- Necrotizing granulomas of the upper and lower respiratory tracts
- Necrotizing or granulomatous vasculitis of the respiratory tract
- Focal necrotizing, crescentic glomerulonephritis
Granulomatous is with polyangiitis aka Wegener Granulomatosis
Which factors are involved in the inflammation process smooth muscle proliferation and matrix deposition in atherosclerosis
- PDGF
- FGF
- TGF-alpha
Which patients are aortic dissections commonly seen
Hypertensive males between 40-60
What is the outcome in patients with untreated hypertension
50% die of ischemic heart disease or CHF
30% die of stroke
What are the complications seen with Behcet disease
- Neurological involvement
- Rupture of aneurysms
What is the prognosis of lymphagiomas
Benign
What is the pathogenesis of superior vena cava syndrome
Neoplasms compress or invade the superior vena cava, resulting in the dilation of veins in the neck, head, and arms, along with cyanosis
What is a false aneurysm
Defect through the wall fo the vessel that communicated with an extravascular hematoma
What the mechanism of pathogenesis in Marfans
1) Results in the decreased synthesis of fibrillin
2) Decreased fibrillin results in decreased TGF-Beta activity
3) Decreased activity results in weakened walls
Which vasculitis is characterized by:
- Small arteries, capillaries, and veins
- May or may not contain immune cels
Leukocytociastic vasculitis
What are the common complications seen as a result of Kawasaki disease
Aneurysms, leading to thrombosis/rupture, causing an acute MI
Which cells are primarily recruited in the inflammation of atherosclerosis
Macrophages and T cells
Which conditions can be caused by tertiary syphilis
- Thoracic aorta aneurysms
- Aortic valve annulus aka regurgitation
Granulomatosis with polyangiits lesions are characterized by what
- Geographic patterns of central necrosis, usually in the upper respiratory tract
- Cavitation lesions and necrotizing granulomas in the lower tract
What is the main risk factor for aortic dissection
Hypertension
What is occurring during fibromuscular dysplasia
Focal irregular thickening of the medium and large muscular arteries
What is the complication seen with superior vena cava syndrome with regards to pulmonary vessels
Respiratory distress
Which autoantibody is commonly seen in microscopic polyangitis
MPO-ANCA aka p-ANCA
Which vasculitis is characterized by a patient older than 40 with polymyalgia rheumatica
Giant cell arteritis
What is the prognosis of an angiosarcoma
Malignant endothelial tumor
What is the stereotypical response of a vessel wall to any injury/insult
Intimate thickening due to activation of smooth muscle cells
What conditions can cause secondary raynaud phenomena
SLE
Scleroderma
Thromboangiitis obliterans
*All make it worsen with time
Which patient population is seen to have takayasu arteries
Younger (<50)
Which vessels are commonly used for vascular intervention
Saphenous vein (50% patancy after 10 years) or left internal mammary artery (90% patency)
What are the factors that determine cardiac output
Heart rate and the stroke volume (determined by blood volume aka sodium excretion)
What are the characteristics of Kaposi sarcoma caused by: Endemic African from
Patients <40, involving the LN
What are the presenting features of Kawasaki disease
- young child (<4)
- Erythema of the conjunctiva, oral mucosa, palms and feet
- Cervical lymph node enlargement
Hypertension causes ischemia in which portion of the vessel
Outer media
What is the common location for an aortic dissection
Ascending aorta, within 10cm of the aortic valve
What is vascular resistance influenced by
- At the levels of arterioles
- By neural and hormonal inputs
Why is it important to distinguish between infectious and non-infections vasculitis
- Non-infectious vasculitis is treated with immune suppression
- Infectious is treatment of the underling cause
What is the size cut off for AAA that are managed surgically
5 cm
Which neoplasms tend to cause IVC syndome
Hepatocellular carcinomas (HCC) Renal cell carcinoma (RCC)
What is the treatment for Behçet’s disease
Immunosuppression with steroid or TNF antagonist
What are the characteristics of Kaposi sarcoma caused by: classic form
Older men from Middle eastern, Mediterranean or Eastern European descent
Which vessels are involved in Kawasaki disease
Coronary arteries
What is the histological finding in hyperplastic arteriolosclerosis
Concentric lamellations that give an onion skin appearance
What is the prognosis of a patient with Kawasaki disease
Self limiting, but given IVIg or aspirin for the lowered coronary risk
What is the heritability of Marfans
Autosomal dominant
Which autoantibody is commonly seen in polyangiitis
PR3-ANCA aka c-ANCA
What are the steps and components in process of fatty streaks and atherosclerotic plaque formation
1) Endothelial injury due to something, usually the hyperlipidemia
2) Epithelial dysfunction results in an inflammation process and immune cell recruitment
3) lipids accumulate in the intima and are taken up by macrophages, resulting in oxidation of lipids and damage
4) LDL accumulates within macrophages and smooth muscle cells forming foam cells and fatty streak
5) Smooth muscle cells proliferate and provide the fibrous cap, which forms the full atherosclerotic plaque
What is generally occurring in hyperplastic arteriolosclerosis
Severe hypertension causes the smooth muscle cells to proliferate and form concentric lamellations that result in narrowing of the lumen
What are the locations that atherosclerotic plaques tend to accumulate
- Openings of the exiting vessels
- Branch points
- Posterior abdominal aorta
What is the initial event following vascular injury
Activation of the endothelial cells
What is the pathogenesis of varicose veins
-Abnormal dilation of veins with valvular incompetence or secondary to sustained intraluminal pressure
Which vasculitis condition is characterized by:
- Aphthous ulcers of the oral cavity
- Genital ulcers
- Uveitis
Behcets
What is the major cause of noninfectious vasculitis
Immune response, either local or systemic
What is the pathogenesis and cause of bacillary angiomatosis
Vascular proliferation in a response to the gram negative Bartonella bacilli
What is the mechanism of pathogenesis in fibromuscular dysplasia
Medial and intima hyperplasia leading to luminal stenosis
What is cystic medial degeneration and what is causing it
- Loss of vascular wall elastic tissue by damage or decreased synthesis
- increased proteoglycan deposition
*Leads to the increased risk of aneurysms