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2020 CPR II Cardio Exam 1 > Chapter 11: Vasculature > Flashcards

Chapter 11: Vasculature Flashcards

1
Q

What is the prognosis of gloms tumor aka glomangioma or paraganglioma

A

Benign

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2
Q

How are AAA typical found

A

Pulsating mass in the abdomen

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3
Q

What are the morphological features of the Lines of Zahn indicative of

A

Typically seen on AAA and are indicative of layers of thrombi

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4
Q

Which disease’s pathogenesis is linked to atherosclerosis

A

-Coronary, cerebral and peripheral vascular diseases

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5
Q

What are the immune cells characteristic of Behcet disease

A

Neutrophilic

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6
Q

What is the complication commonly seen as a result of churn-Strauss syndrome

A

Cardiomyopathy, accounting for 50% of the deaths seen with this syndrome

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7
Q

What are the clinical presentations in those with IVC syndrome

A

LE edema

Distention of the superficial collateral veins of the lower abdomen

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8
Q

What is generally occurring in Hyaline arteriolosclerosis

A

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

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9
Q

What is the common location of a glomus tumor

A

Distal finger

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10
Q

What are the common sites of an angiosarcoma

A
  • Skin
  • Soft tissue
  • Breast
  • Liver
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11
Q

Which patients are AAA commonly seen

A

60 year old males who smoked

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12
Q

What is a true aneurysm

A

Intact, but thin, muscular wall at the site of dilation
Saccular- on one side
Fusiform-both sides

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13
Q

Venous thrombosis in the form of thrombophlebitis is commonly seen in which neoplasms

A

-Mucin producing adenocarcinomas such as lung, pancreas, ovarian

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14
Q

What are the vessels most commonly involved in atherosclerosis in descending order

A

1) Abdominal aorta
2) Coronary arteries
3) Popliteal arteries
4) Internal carotid arteries
5) Circle of Willis

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15
Q

Which vasculitis is characterized by:

  • Medium and small vessels affected
  • Lymphocytes, macros, neutrophils
  • Eiosinophils*
  • Positive ANCA
  • History of atopy and asthma
A

Chung-Strauss syndome

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16
Q

Which vasculitis is characterized by:

  • Medium and small arteries affected
  • Granulomas*
  • Lymphocytes, macros, and neutrophils
A

Granulamatosis with polyangiitis

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17
Q

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
A

Granulomatous is with polyangiitis aka Wegener Granulomatosis

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18
Q

Which factors are involved in the inflammation process smooth muscle proliferation and matrix deposition in atherosclerosis

A
  • PDGF
  • FGF
  • TGF-alpha
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19
Q

Which patients are aortic dissections commonly seen

A

Hypertensive males between 40-60

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20
Q

What is the outcome in patients with untreated hypertension

A

50% die of ischemic heart disease or CHF

30% die of stroke

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21
Q

What are the complications seen with Behcet disease

A
  • Neurological involvement

- Rupture of aneurysms

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22
Q

What is the prognosis of lymphagiomas

A

Benign

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23
Q

What is the pathogenesis of superior vena cava syndrome

A

Neoplasms compress or invade the superior vena cava, resulting in the dilation of veins in the neck, head, and arms, along with cyanosis

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24
Q

What is a false aneurysm

A

Defect through the wall fo the vessel that communicated with an extravascular hematoma

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25
Q

What the mechanism of pathogenesis in Marfans

A

1) Results in the decreased synthesis of fibrillin
2) Decreased fibrillin results in increased TGF-Beta activity
3) Decreased activity results in weakened walls

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26
Q

Which vasculitis is characterized by:

  • Small arteries, capillaries, and veins
  • May or may not contain immune cels
A

Leukocytociastic vasculitis

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27
Q

What are the common complications seen as a result of Kawasaki disease

A

Aneurysms, leading to thrombosis/rupture, causing an acute MI

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28
Q

Which cells are primarily recruited in the inflammation of atherosclerosis

A

Macrophages and T cells

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29
Q

Which conditions can be caused by tertiary syphilis

A
  • Thoracic aorta aneurysms

- Aortic valve annulus aka regurgitation

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30
Q

Granulomatosis with polyangiits lesions are characterized by what

A
  • Geographic patterns of central necrosis, usually in the upper respiratory tract
  • Cavitation lesions and necrotizing granulomas in the lower tract
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31
Q

What is the main risk factor for aortic dissection

A

Hypertension

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32
Q

What is occurring during fibromuscular dysplasia

A

Focal irregular thickening of the medium and large muscular arteries

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33
Q

What is the complication seen with superior vena cava syndrome with regards to pulmonary vessels

A

Respiratory distress

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34
Q

Which autoantibody is commonly seen in microscopic polyangitis

A

MPO-ANCA aka p-ANCA

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35
Q

Which vasculitis is characterized by a patient older than 40 with polymyalgia rheumatica

A

Giant cell arteritis

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36
Q

What is the prognosis of an angiosarcoma

A

Malignant endothelial tumor

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37
Q

What is the stereotypical response of a vessel wall to any injury/insult

A

Intimate thickening due to activation of smooth muscle cells

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38
Q

What conditions can cause secondary raynaud phenomena

A

SLE
Scleroderma
Thromboangiitis obliterans

*All make it worsen with time

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39
Q

Which patient population is seen to have takayasu arteries

A

Younger (<50)

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40
Q

Which vessels are commonly used for vascular intervention

A

Saphenous vein (50% patancy after 10 years) or left internal mammary artery (90% patency)

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41
Q

What are the factors that determine cardiac output

A

Heart rate and the stroke volume (determined by blood volume aka sodium excretion)

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42
Q

What are the characteristics of Kaposi sarcoma caused by: Endemic African from

A

Patients <40, involving the LN

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43
Q

What are the presenting features of Kawasaki disease

A
  • young child (<4)
  • Erythema of the conjunctiva, oral mucosa, palms and feet
  • Cervical lymph node enlargement
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44
Q

Hypertension causes ischemia in which portion of the vessel

A

Outer media

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45
Q

What is the common location for an aortic dissection

A

Ascending aorta, within 10cm of the aortic valve

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46
Q

What is vascular resistance influenced by

A
  • At the levels of arterioles

- By neural and hormonal inputs

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47
Q

Why is it important to distinguish between infectious and non-infections vasculitis

A
  • Non-infectious vasculitis is treated with immune suppression
  • Infectious is treatment of the underling cause
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48
Q

What is the size cut off for AAA that are managed surgically

A

5 cm

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49
Q

Which neoplasms tend to cause IVC syndome

A 
Hepatocellular carcinomas (HCC)
Renal cell carcinoma (RCC)
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50
Q

What is the treatment for Behçet’s disease

A

Immunosuppression with steroid or TNF antagonist

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51
Q

What are the characteristics of Kaposi sarcoma caused by: classic form

A

Older men from Middle eastern, Mediterranean or Eastern European descent

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52
Q

Which vessels are involved in Kawasaki disease

A

Coronary arteries

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53
Q

What is the histological finding in hyperplastic arteriolosclerosis

A

Concentric lamellations that give an onion skin appearance

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54
Q

What is the prognosis of a patient with Kawasaki disease

A

Self limiting, but given IVIg or aspirin for the lowered coronary risk

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55
Q

What is the heritability of Marfans

A

Autosomal dominant

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56
Q

Which autoantibody is commonly seen in polyangiitis

A

PR3-ANCA aka c-ANCA

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57
Q

What are the steps and components in process of fatty streaks and atherosclerotic plaque formation

A

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

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58
Q

What is generally occurring in hyperplastic arteriolosclerosis

A

Severe hypertension causes the smooth muscle cells to proliferate and form concentric lamellations that result in narrowing of the lumen

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59
Q

What are the locations that atherosclerotic plaques tend to accumulate

A
  • Openings of the exiting vessels
  • Branch points
  • Posterior abdominal aorta
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60
Q

What is the initial event following vascular injury

A

Activation of the endothelial cells

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61
Q

What is the pathogenesis of varicose veins

A

-Abnormal dilation of veins with valvular incompetence or secondary to sustained intraluminal pressure

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62
Q

Which vasculitis condition is characterized by:

  • Aphthous ulcers of the oral cavity
  • Genital ulcers
  • Uveitis
A

Behcets

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63
Q

What is the major cause of noninfectious vasculitis

A

Immune response, either local or systemic

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64
Q

What is the pathogenesis and cause of bacillary angiomatosis

A

Vascular proliferation in a response to the gram negative Bartonella bacilli

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65
Q

What is the mechanism of pathogenesis in fibromuscular dysplasia

A

Medial and intima hyperplasia leading to luminal stenosis

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66
Q

What is cystic medial degeneration and what is causing it

A
  • Loss of vascular wall elastic tissue by damage or decreased synthesis
  • increased proteoglycan deposition

*Leads to the increased risk of aneurysms

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67
Q

Which patient history is seen in Buerger disease, and thromboangiitis obliterans

A

Heavy smokers <35

68
Q

In the cause of vasculitis in a patient with hepatitis B, which condition should be considered

A

Polyarteritis nodosa, as commonlt seen in HBsAg

69
Q

What is the most common vascular hemangioma

A

Capillary

70
Q

What is the step by step process of response to vascular injury

A

1) Activation of the endothelium
2) Recruitment of the smooth muscles cells to the intima
3) Smooth muscle cells under mitosis and proliferation
4) The extracellular matrix is elaborated

71
Q

What are the baseline blood pressure reading that are considered hypertensive and lead to increased with of atherosclerosis

A

139/89

72
Q

What is the finding on the appearance of the kidney in the case of essential hypertension

A
  • Granular appearance due to the chromic increased BP

- Renal afferent arteriole is hyalinzed

73
Q

What is the relation between the ANCA titer and severity of disease

A

Generally correlate

74
Q

What condition are large cavernous lymphangiomas of the neck commonly seen in

A

Turner syndrome

75
Q

Which patients are commonly seen to have bacillary angiomatosis

A

Immunocompromised

76
Q

What are the clinical presentations in someone with Raynaud phenomenon

A

-Young women, usually as a result of cold, or stress

77
Q

Which patient gorup is commonly affected by Giant cell arterietis

A

Older population

78
Q

Which conditions commonly are seen with immune complex vasculitis

A
  • SLE
  • Drug hypersensitivity
  • Secondary exposure to infectious agent (polyarteritis nodosa with HepB)
79
Q

What are the complications seen with Takayasu arteritis

A

Aortic arch and major branch vessel involvement leading to dilation and valve insufficiency
(Ex. Narrowing of the brachiocephalic, carotid, and subclavian arteries)

80
Q

Tertiary syphilis causes ischemia to which portions of the vessel

A

Outer media

81
Q

What is the common cause leading to angiosarcomas

A

Radiation

Hepatic form is due to toxins such as pesticides, thorotrast, polyvinyl chloride

82
Q

What is the angiographic findings in a patients with fibromusclar dysplasia

A

String of beads

83
Q

Which antibody is commonly associated with microscopic polyangiitis

A

MPO-ANCA

84
Q

Which conditions are commonly seen with churg-Strauss syndrome

A

Asthma, allergic rhinitis, hypereosinophilia

85
Q

The endothelial marker CD31 is indicative of which vascular tumor

A

Angiosarcoma

86
Q

What is the treatment of a patient with microscopic polyangiitis

A

Immunosuppression increased long term survival

87
Q

What is the pathogenesis of immune complex vasculitis

A

Autoantibody production and formation of immune complexes that deposit in the vascular wall

88
Q

Thoracic aortic aneurysms are commonly caused by which conditions

A

Hypertension, but can be from Marfans

89
Q

Marfan is caused by a defect in which component

A

Fibrillin synthesis

90
Q

What is a common condition seen in as a result of fibromuscular dysplasia

A
  • Renovasular hypertension due to stenosis of the renal arteries
  • Anearysms that may rupture
91
Q

What is the correlation of blood pressure with age

A

Are age increases, the blood pressure increases due to loss of elastic components of the arteries

92
Q

What is the treatment for granulomatosis with polyangiitis

A

Steroids, cyclophosphamide, TNF antagonists

93
Q

What is the prognosis of hemangiomas

A

Benign vascular tumors

94
Q

Which vasculitis condition is characterized by:

  • T cell mediated damage
  • Inflammation of temporal arteries
A

Giant cell arteriitis and aortitis

95
Q

Which cytokine is released in the inflammation of atherosclerosis

A

IL-1

96
Q

What are the lesions seen in bacillary angiomatosis

A

Localized red papules due to the proliferation of capillaries with plump endothelial cells

97
Q

Which vasculitis condition is characterized by:

  • Ocular disturbances
  • Weakening pulses and BP of the upper extremities
  • Granulomatous of the medium and large arteries
A

Takayasu arteritis

98
Q

Which type of necrosis is involved in microscopic polyangiitis

A

Segmental Fibrinoid necrosis

99
Q

What is the finding on the appearance of the kidney during malignant hypertension

A
  • Nutmeg appearance with tiny Hemorrages

- Onion skinning appearance in the renal arteriole

100
Q

What are the characteristics of the appearance of lesions in Churg-Strauss

A

Necrotizing as seen in PAN and microscopic polyangiitis, but with the addition of eosinophils and granulomas

101
Q

Which vessels are commonly involved in Microscopic polyangiits

A

Necrotizing vasculitis of the arterioles, capillaries and venules*

102
Q

What is the histological finding in Hyaline arteriolosclerosis

A

Homogenous pink (hyaline) thickening of the vessel walls

103
Q

Which specific vessels in particular are affected in fibromuscular dysplasia

A

Renal, carotid, Splanchnic and vertebral vessels

104
Q

What are the characteristics of Kaposi sarcoma caused by: Transplant form

A

Assocaited with T cell suppression following transplantation

105
Q

What condition is characteristics of the features:

  • 40 year old male
  • Persistent pneumonitits and sinusitis
  • Renal disease
  • Nasopharyngeal ulcerations
A

Granulomatosis with polyangiitis

106
Q

What is the stain and test run to identity the cause of bacillary angiomatosis

A

-Warthin-starry stain or PCR

107
Q

What are the characteristics of an atherosclerotic plaque

A
  • Necrotic center with cell debris, cholesterol crystals, calcium and foam cells
  • Fibrous cap (contains smooth muscle cells, macrophages, ECM components, foam cells), overlying the necrotic center
108
Q

What is the complication seen when there is renal vein involvement in IVC syndrome

A

Massive proteinuria

109
Q

What are the characteristics of the cell types involved in Giant cell arteritis

A

Lymphocytes and macrophages

110
Q

What are the conditions that commonly cause secondary hypertension

A
  • Primary hyperaldosteronism
  • Cushing
  • pheochromacytoma
  • renal artery stenosis leading the increased Renin
111
Q

What is the pathogenesis of inferior vena cava syndrome

A

-Neoplasms compress or invade the IVC or thrombosis of the hepatic renal or LE

112
Q

In the case of secondary hypertension due to renal artery stenosis, what can be found

A
  • Increased renin production

- Bruit on the side of the renal stenosis

113
Q

What are the clinical results of varicose veins

A

Stasis, congestion, thrombus, emboli and ischemia overlying skin resulting in stasis dermatitis

*Very rare for the superficial veins to cause an embolism like one from a deep vein

114
Q

What are the vessels involved in polyarteritis nodosa

A

Small and medium sized vessels

115
Q

Which patient group is seen to have Kawasaki disease

A

Young children (<4)

116
Q

If the diameter of an arteriole increases by two, was is the corresponding change in blood pressure

A

Increases by 16 due to the change in resistance to the fourth power

117
Q

What are the characteristics of a epithelioid hemangioendothelioma

A
118
Q

What is the mechanism that syphilis can cause aneurysms

A

1) Late state syphilis leads to obliterative endarteritis in small vessels, including the vasa vasorum of the thoracic aorta
2) This causes ischemia of the aorta, leading to weakening of the walls and formation of an aneurysm

119
Q

What is the histological finding in Kaposi sarcoma

A

Sheep’s of spindle cells

120
Q

What is the histological finding with microscopic polyangiitis

A

Apoptotic neutrophils aka fragmented PMN

121
Q

What are the characteristics of the lesions seen in polyarteritis nodosa

A

Segmental transmural necrotizing inflammation (neutrophils, eosinophils, lymphocytes, and macros) at the branch points
*Lesions typically not circumferential

122
Q

What is the prognosis of epithelioid hemangioendothelioma

A

Intermediate grade vascular tumor

123
Q

What is the pathogenesis of raynaud phenomenon

A

Vasospasms of the small arteries and arterioles in the fingers and toe, especially in the cold

124
Q

What is the treatment for bacillary angiomatosis

A

Macrolides

125
Q

How can primary and secondary raynaud phenomenon be differentiated

A

Primary- symmetrical involvement

Secondary- asymmetrical involvement

126
Q

Which characteristic is required fro churn-Strauss syndrome

A

Eosinophils

127
Q

What are the characteristics of Kaposi sarcoma caused by: AIDs associated

A

-Most common form in the US, usually spread through lymph nodes

128
Q

What is the immune cell type seen in granulomatosis with polyangiitis

A

T cell mediated hypersensitivity

129
Q

What is unique about the pauci immune ANCA mediate process

A

Does not form circulating immune complexes, and the vasculitis lesions do not contain the antibody and complement

130
Q

Which vasculitis condition is characterized by:

  • Multiunucleated giant cells
  • Fragmentation of the elastic lamina and thickening
  • Patchy and focal inflammation of vessels
A

Giant cell arteritis

131
Q

What are the two conditions of small vessels that can be caused by hypertension

A

1) Hyaline arteriolosclerosis

2) Hyperplastic arteriolosclerosis

132
Q

What are the places that mycotic aneurysms can originate from

A
  • Septic emboli (usually from infective endocarditis)

- Circulating organisms infecting the arterial wall

133
Q

What is the antibody seen with granulomatosis with polyangiitis

A

PR3-ANCA (95%)

134
Q

What is the major risk factors of atherosclerosis

A

Hypercholesteremia

*Is significant to cause lesion development without any other factors

135
Q

What are the common causes of cystic medial degeneration leading to aneurysms, and what are the two most important

A
  • Atherosclerosis
  • Hypertension
  • Elastin decreased diseases (Marfan)
  • Mycotic
136
Q

What is the cause of small bore artery replacement failure

A

Thrombosis or intima hyperplasia

137
Q

What is the common location of AAA

A

Below the renal arteries, usually involving the iliac arteries

138
Q

What is the typical cause of abdominal aortic aneurysm

A

Atherosclerosis

139
Q

In a patient with arteriovenous malformations, which outcome is of most concern

A

High output cardiac failure due to the shunting of blood from the arterial side to the venous side, resulting in the increased workload of the heart

140
Q

What are the outcomes of the activated endothelial cells following injury

A
  • Procoagulants
  • Adhesion molecules
  • Growth factors
  • Vasoactive factors
141
Q

What is the overall concern with atherosclerosis and at which point does it get reach

A

Stenosis leading to ischemia, which is known as critical stenosis, aka 70% occlusion

142
Q

Which vasculitis condition is characterized by:

-Segmental, thrombosing vasculitis of small and medium vessels, especially the tibial and radial arteries

A

Buerger disease

143
Q

What is the significance of multiple risk factors in the cause of atherosclerosis

A

They are synergistic rather than just additive

144
Q

During thromboangiitis obliterans aka Buerger disease, what is the common histological finding

A

Thrombus with small microabscesses composed of neutrophils surrounded by granulomatous inflammation

145
Q

What are the factors in metabolic syndrome that go to increase the risk of atherosclerosis

A
  • Insulin resistance
  • Hypertension
  • Hypercoagulobility
  • dyslipidemia
146
Q

What is occurring in Monckeberg medial sclerosis

A

Calcification of internal elastic membrane in muscular arteries of patients older than 50

*There is no narrowing of the lumen or clinical significance

147
Q

What type of necrosis is commonly seen in polyarteritis nodosa

A

Fibrinoid necrosis

148
Q

Which vasculitis is characterized by:

  • Small and medium sized arteries
  • Capillaries
  • Veins
  • Neutrophils*
  • May contain lymph, macros, or eosinophils
  • Congenital ulcers*
A

Behcet disease

149
Q

What are the characteristics of glomus tumor

A

Smooth muscle in origin, usually in the distal fingers

-Benign and painful

150
Q

Which patient population is at higher risk for essential Hypertension

A

Older patients

African Americans

151
Q

Which autoantibody is commonly seen in Churg-Strauss

A

MPO-ANCA aka p-ANCA

152
Q

Which lipids tend to be present in atherosclerotic plaques and what is their location

A

Cholesterol and cholesterol esters located in the intima

153
Q

IN the case of vasculitis due to drug hypersensitivity, what is the next step

A

Stop administering the drug, as it will resolve the vasculitis

154
Q

Polyarteritis nodosa is commonly seen in assocaited with which condition

A

Hepatitis B

155
Q

Which condition or form of vasculitis is present if the aorta is involved

A

Giant cell arthritis

156
Q

Which patient population is more readily affected by fibromuscular dysplasia

A

Young women, with first degree relatives increasing chances

157
Q

What locations of vessels are commonly seen to be affected by microscopic polyangiitis

A

Renal glomeruli and lung capillaries

158
Q

What is the cause of Karposi sarcoma

A

HHV8

159
Q

Atherosclerosis causes ischemia of which portion of the vessel

A

Innermedia

160
Q

Which halotype is associated with Behcet disease

A

HLA-B51

161
Q

What is the prognosis of a patient with untreated granulomatosis with polyangiitis

A

80% mortality at 1 year

162
Q

What is the secondary complication seen with Giant cell arteritis

A

Double vision or damage to the ophthalmic artery leading to vision loss

163
Q

Which vasculitis is characterized by:

  • Medium and small sized arteries
  • Veins
  • Thrombosis*
  • Usually a young male smoke
A

Buerger disease

164
Q

Which vessels are commonly affected in polyarteritis nodosa (PAN)

A

Renal, heart, liver, and GI

Pulmonary vessels are spared

165
Q

What is the classical presentation of aperitif dissection

A

-Sudden onset of chest pain that readiates to the back between the scapulae, while moving downward as the dissection progresses

2020 CPR II Cardio Exam 1 (31 decks)

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