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MHD/Pharm Block 4 > MHD: Vascular disease > Flashcards

MHD: Vascular disease Flashcards

1
Q

What are the layers of the vascular wall from inside-out?

A

Intima, media, adventitia

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2
Q

Where are elastic lamina found in the vascular wall?

A

The IEL is found interior to the media layer and the EEL is found exterior to the media layer

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3
Q

What is the vaso vasorum?

A

Small vessels that provide oxygen to the vessel wall. Particularly important in large vessels.

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4
Q

What is the vascular response to injury?

A

Intimal thickening

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5
Q

Describe the mechanism of intimal thickening?

A

Smooth muscle cells enter intima, mitose to expand intimal layer.
Extracellular matrix production also increases

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6
Q

What is the general definition of arteriosclerosis?

A

Hardening of the arteries due to thickening and loss of elasticity

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7
Q

What are the morphologic variants of arteriosclerosis?

A

Atherosclerosis
Monckeberg’s medial calcific sclerosis
Arteriosclerosis (due to hypertension)

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8
Q

What vessels are mainly affected by atherosclerosis?

A

Large elastic arteries (aorta, carotid, iliac) and muscular arteries (coronary, popliteal)

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9
Q

What are the major risk factors for atherosclerosis

A

Non-modifiable: genetic, family history, age, male gender

Modifiable: hyperlipidemia, hypertension, cigarette smoking, diabetes mellitus, inflammation

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10
Q

What is the definition of atherosclerosis?

A

Chronic inflammatory response of the arterial wall to endothelial injury

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11
Q

What is an atheroma?

A

accumulation of degenerative material (cell debris, cholesterol crystals, foam cells, calcium) in the tunica intima with a fibrous cap

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12
Q

Describe the morphology of an atheroma

A

Atheromas only effect part of the circumference of the vessel wall, leading to decreased medial thickness and ischemia

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13
Q

What complications are associated with atheroma/plaque formation?

A 
Rupture/ulceration/erosion
Emobli
Hemorrhage
Weakened media --> aneurysm
Calcification
Thrombosis
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14
Q

On histology, how do you identify an atherosclerotic embolus?

A

Cholesterol crystals appear like white needles on histological slides

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15
Q

What are the clinical complications associated with atherosclerosis?

A

MI, cerebral ischemia, peripheral vascular disease, aneurysms

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16
Q

Describe the pathogenesis of Monckeberg’s medial calcific sclerosis

A

Calcific depositions form in the tunica media

Vessels are not obstructed, so lumenal size is preserved

17
Q

What is hyaline arteriolosclerosis?

A

Hypertension induced sclerosis of the arterioles often seen in brain and kidneys
-Seen as homogenous pink thickening of vessels with lumenal narrowing

18
Q

What is hyperplastic arteriolosclerosis?

A

Due to severe acute hypertension
Gives onion skin appearance of vessels due to smooth muscle cells with reduplicated membranes. Lumens narrow progressively.

19
Q

What is an aneurysm?

A

Localized abnormal dilatation of a blood vessel

20
Q

What is the difference between a true (saccular) aneurysm and a false aneurysm?

A

A true aneurysm involves the outpouching of a vessel wall whereas a false aneurysm is caused by a ruptured vessel wall leading to a hematoma

21
Q

What is a dissection?

A

A tear in the tunica intima leads to blood flowing into the media splaying apart layers to form a blood filled channel

22
Q

What genetic conditions are associated with increased risk for aneurysms due to poor intrinsic quality of vascular wall connective tissue?

A 
Marfan syndrome (fibrillin defect)
Ehlers Danlos (type III collagen defect)
23
Q

What conditions can cause ischemia leading to increased risk for aneurysm?

A

Atherosclerosis, hypertension, syphillis

24
Q

What is cystic medial degeneration?

A

Degradation of the elastin found within the tunica media and loss of smooth muscle cells

25
Q

What enzymes play a key role in the formation of abdominal aortic aneurysms?

A

Matrix metalloproteinases

26
Q

What is the classical location of an AAA?

A

Between the renal arteries and the aortic bifurcation

27
Q

How does diameter of AAA influence the risk of rupture?

A

Rupture risk increases with increasing diameter. There is a 25% chance of rupture per year with a diameter > 6cm

28
Q

What are the causes of an aortic dissection?

A

Hypertension, connective tissue disorders, bicuspid aortic valves

29
Q

What are the two classifications of aortic dissection?

A

A: in the Ascending (proximal) aorta
B: in the Bottom (descending) aorta

30
Q

Which type of aortic dissection is more serious?

A

Type A is more serious than B, usually requires surgical treatment

31
Q

What is vasculitis?

A

Inflammation of blood vessels

Can be due to infectious pathogen or immune-mediated

MHD/Pharm Block 4 (25 decks)

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