Pathology: Hypertension, Vascular, and Valves Flashcards
A 65-year-old man with a long history of poorly controlled hypertension presents with progressive dyspnea and decreased exercise tolerance. Echocardiography reveals a thickened left ventricular wall with preserved ejection fraction. Which of the following best describes the pathophysiological changes in his myocardium?
A) Myocyte hypertrophy with interstitial fibrosis
B) Myocyte atrophy with lipid accumulation
C) Subendocardial necrosis with neutrophilic infiltration
D) Patchy myocardial infarction with contraction band necrosis
E) Dilated cardiomyopathy with endocardial fibroelastosis
Question 1: Hypertensive Changes in the Heart
Answer: A) Myocyte hypertrophy with interstitial fibrosis
Chronic hypertension increases afterload, leading to concentric left ventricular hypertrophy due to pressure overload. Over time, fibrosis develops, leading to diastolic dysfunction.
A 56-year-old woman with a history of smoking and hyperlipidemia presents with uncontrolled hypertension despite being on three antihypertensive medications. Her blood pressure is 185/100 mmHg, and physical examination reveals an abdominal bruit. Laboratory tests show a mildly elevated serum creatinine. Which of the following is the most likely underlying cause of her hypertension?
A) Fibromuscular dysplasia
B) Atherosclerotic renal artery stenosis
C) Primary hyperaldosteronism
D) Pheochromocytoma
E) Chronic glomerulonephritis
Answer: B) Atherosclerotic renal artery stenosis
In an older patient with risk factors (smoking, hyperlipidemia), atherosclerosis is the most common cause of renal artery stenosis. It leads to renal ischemia, activation of the renin-angiotensin-aldosterone system (RAAS), and secondary hypertension.
Fibromuscular dysplasia (Choice A) is more common in young women.
A 47-year-old man presents to the emergency department with a severe headache, blurry vision, and confusion. His blood pressure is 220/130 mmHg. Fundoscopic examination reveals papilledema and flame-shaped hemorrhages. Renal biopsy shows fibrinoid necrosis and hyperplastic arteriolosclerosis. Which of the following best describes the vascular changes in benign hypertension?
A) Onion-skinning of small arteries
B) Fibrinoid necrosis of arterioles
C) Hyaline arteriolosclerosis
D) Necrotizing vasculitis with leukocytoclasia
E) Granulomatous inflammation of blood vessels
Answer: C) Hyaline arteriolosclerosis
Benign hypertension leads to hyaline arteriolosclerosis, which appears as homogeneous pink thickening of the vessel walls due to plasma protein leakage and smooth muscle cell proliferation.
Malignant hypertension leads to hyperplastic arteriolosclerosis (“onion-skinning”) (Choice A) and fibrinoid necrosis (Choice B).
A 32-year-old woman presents with progressive dyspnea and fatigue. She has no history of smoking, lung disease, or cardiac conditions. Physical examination reveals a loud P2 and a right ventricular heave. Right heart catheterization shows a mean pulmonary artery pressure of 32 mmHg. A mutation in which of the following genes is most commonly associated with her condition?
A) BMPR2
B) CFTR
C) TGF-β
D) KCNH2
E) NOTCH3
Answer: A) BMPR2
Idiopathic pulmonary arterial hypertension (PAH) is associated with BMPR2 gene mutations, leading to proliferation of vascular smooth muscle, increased resistance, and pulmonary hypertension.
CFTR (Choice B) is associated with cystic fibrosis.
A 60-year-old man presents with tearing chest pain that radiates to his back. His blood pressure is 190/110 mmHg. A chest X-ray shows a widened mediastinum. Which of the following is the most likely underlying histologic finding?
A) Cystic medial degeneration
B) Hyaline arteriolosclerosis
C) Fibrinoid necrosis
D) Granulomatous inflammation
E) Intimal thickening with foam cells
Answer: A) Cystic medial degeneration
Aortic dissection is associated with cystic medial degeneration, which involves loss of elastic fibers and accumulation of myxoid material in the tunica media.
This is commonly seen in Marfan syndrome and hypertension.
A 55-year-old man with a history of uncontrolled hypertension presents with sudden-onset severe chest pain that radiates to his back. He is diaphoretic and tachycardic. His blood pressure is 180/110 mmHg in both arms. What is the most likely cause of his condition?
A) Cystic medial degeneration
B) Atherosclerotic plaque rupture
C) Granulomatous inflammation of the aorta
D) Myxomatous degeneration of the aortic valve
E) Laminar necrosis of the vasa vasorum
Answer: A) Cystic medial degeneration
Hypertension and connective tissue disorders (e.g., Marfan syndrome) weaken the tunica media, predisposing to intimal tearing and dissection.
Laminar necrosis of the vasa vasorum (Choice E) is more associated with tertiary syphilis.
A 72-year-old man with a history of smoking and hypertension presents with pulsatile abdominal mass. CT scan reveals an aortic aneurysm measuring 6.5 cm. Which of the following best describes the pathogenesis of his condition?
A) Degradation of elastin and collagen by matrix metalloproteinases
B) Myxomatous degeneration of the aortic media
C) Immune-mediated destruction of the vasa vasorum
D) Deposition of immune complexes in the vessel wall
E) Granulomatous inflammation with multinucleated giant cells
Answer: A) Degradation of elastin and collagen by matrix metalloproteinases
Abdominal aortic aneurysm (AAA) is caused by chronic inflammation and degradation of elastin/collagen by metalloproteinases, leading to arterial wall weakening.
Myxomatous degeneration (Choice B) is associated with Marfan syndrome and affects the aortic root.
A 60-year-old man with a history of untreated syphilis presents with chest pain and a hoarse voice. Chest X-ray shows a dilated aortic root with aortic valve regurgitation. Which of the following best describes the underlying pathology?
A) Obliterative endarteritis of the vasa vasorum
B) Hyaline arteriolosclerosis
C) Granulomatous inflammation with multinucleated giant cells
D) Intimal thickening with foam cells
E) Myxomatous degeneration of the aortic valve
Answer: A) Obliterative endarteritis of the vasa vasorum
Tertiary syphilis affects the vasa vasorum of the ascending aorta, leading to aortic aneurysm and dilation.
This can cause aortic regurgitation and compress nearby structures (e.g., hoarseness due to recurrent laryngeal nerve involvement).
A 38-year-old woman with a history of childhood rheumatic fever presents with progressive exertional dyspnea. On auscultation, a diastolic rumbling murmur is heard at the apex. Echocardiography reveals mitral stenosis. Which of the following histopathologic findings is most characteristic of her condition?
A) Aschoff bodies with Anitschkow cells
B) Dystrophic calcification of the mitral valve
C) Fibrinoid necrosis of the valve leaflets
D) Thickening and fusion of chordae tendineae
E) Lambl’s excrescences on the mitral valve
Answer: A) Aschoff bodies with Anitschkow cells
Rheumatic heart disease (RHD) is characterized by Aschoff bodies (granulomatous inflammation) and Anitschkow cells (caterpillar-like macrophages).
Chronic RHD leads to mitral stenosis with thickening and fusion of chordae tendineae (Choice D).
