final pt 5 draft Flashcards
what are 2 non-inflammatory vascular disorders?
- Monkeberg Medial Sclerosis
- Raynaud phenomenon
what are the inflammatory vascular disorders?
- takayasu arteritis
- polarteritis nodosa
- Allergic Granulomatous and angitis (Churg-Strauss)
- Temporal Arteritis
- Kawasaki disease
- Wegeners Granulomatosis
- Thromoangitis Obliterans (Buergers)
- Behcet
what refers to a degenerative calcification of the tunica media of large and medium sized muscular arteries?
Monkeberg medial sclerosis
what age is monkeburg usually seen in?
older individual
Mokeberg medial sclerosis usually occurs in what arteries?
arteries of the upper and lower extremities (may cause post. knee pain)
T/F: Monkeberg medial sclerosis is very similar to atherosclerosis
F
it is distinct from atherosclerosis
-ordinarily does NOT lead to a clinical presentation per se
atherosclerosis is of the tunica intima where monkeberg is of the tunica media
T/F: there is major luminal narrowing in Monkeberg medial sclerosis
F: there is none
what is the etiology of Monkeberg?
unknown
is Monkeberg inflammatory or non?
non inflammatory
what is paroxysmal pallor or cyanosis of the digits of the hands or feet?
Raynaud phenomenon
what is Raynauds usually caused by?
due to cold induced vasoconstriction
what is the color change sequence in Raynauds?
white- blue- Red
T/F: Raynauds reflects an exaggeration of normal central and vasomotor responses to cold or emotion
T
what is the prognosis of RP?
- usually benign
- long-standing cases may show signs of atrophy of skin, subcutaneous tissue and muscles
T/F: ulcerations and gangrene are rare for RP
T
what is the difference between primary and secondary Raynaud Phenomenon?
- primary = you just have it
secondary = some primary disease triggers RP
what refers to the inflammation of walls of vessels (all sizes and types)?
inflammatory vasculitides
how can we classify inflammatory Vasculitis?
based on pathogenesis or etiology
what are different ways you get vasculitis?
infection
immunologic
unknown
what is the clinical presentation of vasculitis?
often a result of vessel lumen narrowing/ obliteration/ dilation / thrombosis
what therapy is usually used to treat vasculitis?
Responsive to steroid/immunosuppressive-therapy
what kind of tests will suspected Vasculitis patients have performed?
inflammatory/ autoimmune panel
what is tested in an inflammatory/autoimmune panel?
ESR
CRP
RF
ANA
ANCA
Specific Ig’s
what does ESR stand for an what is it?
- Erythrocyte sedimentation rate
- non specific indication of inflammation when elevated
what does CRP stand for and what is it?
C- reactive protein
Non specific indicator of inflammation when elevated
what does RF stand for and what is it?
Rheumatoid factor
assess for inflammatory joint disease
what does ANA stand for and what is it seen in?
Anti nuclear antibody
seen in LUPIS
what does ANCA stand for what is it predictive for if elevated?
Anti- neutrophilic cytoplasmic antibodies
will have some type of inflammatory vascular disease if elevated
what are 2 other things that may be tested on an inflammatory panel?
anti glomerular basement membrane antibody
Anti thyroglobulin antibody
what disease is seen in females under 40 and a common sign is there BP is different by over 10 mmHG in either arm?
Takayasu arteritis
Takayasu arteritis classically involves ____ and its branches, and is characterized by what?
aortic arch
characterized by principally weakening of peripheral pulses
what would examination of a person with Takayasu arteritis show?
thickening of the aorta particularly the aortic arch and its branches
near obliteration of distal portions of aortic branches
what is necrotizing vasculitis of small and medium sized visceral arteries with no lung involvement?
polyarteritis nodosa
presentation of polyarteritis nodosa is common in which organs and which sex and age?
common in kidney and liver in young males
what would a patient with polyarteritis nodosa present with?
necrotizing of the vessel wall (fibroid necrosis)
what are the three phases that polyarteritis nodosa may present itself?
acute, healing, scarred (may co-present)
what are some complications that can happen in polyarteritis nodosa and is it corticosteroid responsive?
aneurysm
thrombosis
infarct
and yes
what is systemic vasculitis in young individuals with asthma?
allergic granulomatous and angitis (churg-strauss)
2/3 of patients with Churg-Strauss will have what?
C or P-ANCA (anti-neutrophilic cytoplasmic antibodies)
does C-ANCA clump or no?
doesn’t clump
where would you seen allergic granulomatosis and angitis?
small and medium sized arteries and arterioles of the lungs, spleen, kidney, heart, CNS and others
what WBC would be seen intensely in Churg-Strauss?
Eosinophils
what is the most common systemic form of vasculitis in patients over 50?
temporal arteritis (giant cell arteritis)
is temporal arteritis chronic or acute?
both chronic and acute in form
what arteries does giant cell arteritis affect?
large and small arteries particularly in the head
especially the temporal arteries- also vertebral and ophthalmic
if the ophthalmic artery is affect by temporal arteritis what could happen?
may lead to sudden permanent blindness
T/F: the pathogenesis suggests that immune reaction is generated towards components of the vascular wall- still putative; granulomatous nature suggests T-cell mediated mechanism and antigen driven injury
T
what are the clinical features of Giant cell arteritis?
facial pain, intense upon palpation
ocular symptoms- mild to severe
may lead to permanent blindness
what do you treat temporal arteritis with?
anti inflammatory
50% of patients with temporal arteritis also have ____, where patients present with pain and stiffness in neck, shoulders and hips with extreme exhaustion
Polymyalgia Rheumatica (PMR)
what do the WBC attack in polymyalgia Rheumatica?
the joints of the body
what disease is of the coronary arteries affecting young children less than 4?
kawasaki disease
what is the etiology of Kawasaki disease?
unknown
what syndrome is Kawasaki disease associated with?
mucocutaneous lymph node syndrome
- acute self limiting fever, rash, erythema, desquamation, and lymphadenopathy
20% of kids with Kawasaki disease develop what?
cardiac sequellae… aneurysmal formation
what are the clinical consequences of Kawasaki disease?
asymtomatic vasculitis
coronary artery ectasia
coronary artery aneurysm
thrombosis
MI
sudden death
what is the treatment of Kawasaki disease?
aspirin and intravenous gammaglobulin
what is necrotizing vasculitis that is dangerous and happens quickly?
Wegeners granulomatous
what is the triad of Wegner’s granulomatous?
acute necrotizing granulomas of upper respiratory tract
necrotizing granulomatosis of small to medium sized vessels
renal disease in the form of focal glomerulitis
the pathogenesis of Wegner’s granulomatous suggests some type of _______________ reaction?
hypersensitivity
what from the blood panel do people with Wegners granulomatous present with?
ANCA
what do you treat Wegners granulomatous with and what happens if you dont treat it?
cyclophosphamide and rapidly fatal if you dont treat
what is a distincitve disease leading to vascular insufficiency in distal arteries; it is characterized by segmental acute and chronic thrombosing of small and medium arteries?
Thromboangitis Obliterans (Buerger’s)
T/F you will have micro abscesses and granulomatous inflammation in Buergers disease
T
what arteries does buergers disease usually affect and what is a huge risk factor for this disease
principally in tibial and radial arteries
seen in heavy cigarette smoking men that are overweight
what are some other symptoms of Buergers disease
symptoms of claudication
may present with cold intolerance/ Raynauds
what is another name for Buergers disease
Thromboangitis Obliterans (Buerger’s)
what disease involves the mucous membranes and is characterized by oral apthous ulers, genital ulceration, ocular inflammation, and lesions in the CNS, cardiovascular, and GI
Behcet
what is the cause of Behcet
unknown cause however immune basis
what are enlarged tortuous blood vessels
varicose veins
what are varicose veins caused by
increased intraluminal pressure
what are some risk factors for varicose veins
being a women
familial predispositions
obesity
T/F: in varicose veins the vessel walls may be thinned due to dilation or thickened due to hypertrophy
T
T/F: you might also have stasis dermatitis and secondary ulceration
T
what are the other locations where you might have varicosities
rectum and anus
esophagus
scrotum
what is the most common type of varices
esphageal varices
what side are varicoceles’ more common on
left
what is a painful, red, swollen vein thrombosis
thrombophlebitis
what is a vein thrombosis that is not painful
phlebothrombosis
what are some major risk factors for DEEP VEIN THROMBOSIS
- prolonged bed rest
- reduced cardiac output
- surgery (major threat to life sudden death following post-op ambulation)
what is the cause of death in a deep vein thrombosis
pulmonary embolus
what does the pulmonary embolus result in
cor pulmonale - cant get blood to lungs
T/F: half of people with DVT have no symptoms
T
what are some of the symptoms of DVT
a general swelling of the calf, ankle, foot, or thigh
increased warmth of leg
redness
pain in the leg
night leg cramps
blueish discoloration of the skin on the leg or toes
what is the treatment for DVT
Cava filter treatment
what are 2 different vascular neoplasias
benign hemangiomas
capillary hemangiomas
what are common congenital vascular lesions; -most common on the skin but are also found on mucosal surfaces and visceral organs
benign Hemangiomas
T/F: benign hemangiomas are present at birth and grow, but remain limited in size
T
what kind of hemangiomas occur on skin (strawberry hemangioma) subcutaneous tissue and mucous membranes of mouth and lips
capillary hemangiomas
T/F: in capillary hemangiomas the vascular channels have the size and structure of normal capillaries
T
T/F: strawberry hemangiomas usually need to get removed with surgery
F: they usually fade at 1-3 years
what are lesions that consist of large vascular channels and the skin looks like port wine stains
cavernous hemangiomas
T/F: cavernous hemangiomas have raised spongy masses which do not regress spontaneously; they may undergo thrombosis, fibrosis, hemorrhage
T
in which disease is cavernous hemangiomas clinically significant in
Hippel Lindau disease
what is Hippel lindau disease
a rare, inherited genetic disorder that causes tumors and cysts to grow in various parts of the body.
what are the different kinds of malignant neoplasias
Angiosarcoma
Kaposi’s sarcoma
what is a rare highly malignant (50%) mortality rate and consists of neoplastic endothelial cells
angiosarcoma
what are the different locations of angiosarcoma and what is the most common location
MC: liver
skin
soft tissue
breast
bone
spleen
what is the liver involvement of angiosarcoma associated with
carcinogens (vinyl chloride, arsenic, thorotrast)
what is Kaposi’s sarcoma derived from
neoplastic endothelial and stromal cells
what disease is Kaposis sarcoma associated with
AIDS (1/3 of patients)
what is the appearance of someone with Kaposi’s sarcoma
painful purple/brown nodules/ plaques on hands, feet and face
histological appearance may vary
rarely the primary cause of death
in coronary artery bypass what are the grafts subject to
thrombosis, intimal thickening, atherosclerosis
what is thrombolysis
treatment to lyse thrombi and emboli
plasminogen activators used
what are the problems with thrombolysis
failure to lyse, reocclusion due to the persistence of original disorder
what is balloon angioplasty
luminal expansion of atherosclerotic arteries
atherosclerotic plaques become unstable
what are the complications of balloon angioplasty
plaque rupture
medial dissection
stretching of the media
proliferative restenosis
