Pathoma - HTN, Arteriosclerosis, Vascular tumors

Question 1

What are the effects of ATII

Answer 1

(1) Promoting adrenal release of aldosterone
(2) Contracting arteriolar smooth muscle

Question 2

What is fibromuscular dysplasia and what population does it usually occur in?

Answer 2

Developmental defect of the blood vessel wall, resulting in irregular thickening of large- and medium-sized arteries, especially the renal artery

Is an important cause of stenosis in young female vs. atherosclerosis as a cause of stenosis in elderly males

Question 3

What are the 3 types of arteriosclerosis and describe them

Answer 3

(1) Atherosclerosis (intimal thickening in large vessels)
(2) Arteriolosclerosis (small vessels)
(3) Monckeberg medial calcific sclerosis (thickening of media)

Question 4

Describe the plaques of atherosclerosis

Answer 4

Necrotic lipid core (mostly cholesterol) with a fibromuscular cap

Question 5

What are the 4 most common arteries involved in athersclerosis?

Answer 5

Abdominal aorta

Coronary artery

Popliteal artery

Internal carotid artery

Question 6

What are the modifiable risks of atherosclerosis?

Answer 6

Smoking, HTN, diabetes, hypercholesterolemia

Question 7

Describe the components of a fatty streak

Answer 7

Collection of macrophages containing oxidized lipids (foam cells)

Question 8

What are the 4 consequences of atherosclerosis?

Answer 8

(1) Stenosis
(2) Plaque rupture with thrombosis
(3) Plaque rupture with embolization
(4) Aneurysm (due to plaque blocking blood flow to wall)

Question 9

What are the 2 types of arteriolosclerosis

Answer 9

(1) Hyaline arteriolosclerosis
(2) Hyperplastic arteriolosclerosis

Question 10

Describe hyaline arteriolosclerosis and the two causes

Answer 10

Vascular thickening due to proteins leaking into the vessel wall

Caused by:

(1) Benign HTN (high BP pushes protein into wall)
(2) Diabetes (non-ezymatic glycosylation of the basement membrane makes the wall leaky)

Question 11

Describe hyperplastic arteriolosclerosis and its cause

Answer 11

Thickening of vessel wall by hyperplasia of the smooth muscle (“onion-skin”)

Causes by malignant HTN

Question 12

What is Monckeberg medial calcific sclerosis and its clinical presentation

Answer 12

Calcification of the media of muscular (medium-sized) arteries

Is clinically insignificant (no luminal narrowing)

Seen as incidental findings on X-ray or mammography

Question 13

Describe the layers of the aorta affected by aortic dissection

Answer 13

Intimal tear with dissection of blood through the media

Question 14

What are the 2 necessary criteria for a dissection to occur?

Answer 14

High stress & pre-existing weakness of the media (e.g. Marfan’s or Ehlers-Danlos)

Question 15

Describe the defect and presentation of Marfan’s syndrome

Answer 15

Defect in fibrillin (scaffold for elastin)

Arachnodactyly, lens dislocation (upward), aortic dissection, hyperflexible joints

Question 16

Describe the defect and presentation of Ehler’s Danlos syndrome

Answer 16

Classical type (joint and skin) caused by defeciency in Type V collagen

Vascular type caused by deficiency in Type III collagen

Hyperextensible skin, hypermobile joints, tendency to bleed

Question 18

Describe the mechanism behind HTN as a risk factor for aortic dissection

Answer 18

HTN results in hyaline arteriolosclerosis of the vasa vasorum (blood supply running through the adventitia)

Decreased flow leads to atrophy and weakening of the media, which increases risk for dissection

Question 19

What is the classic disease associated with thoracic aneurysm?

Answer 19

Tertiary syphilis

Endartertitis of the vaso vasorum results in luminal narrowing, decreased flow, and atrophy of the vessel wall

Fibrosis secondary to inflammation results in a “tree bark” appearance of aorta

Question 20

Where along the aorta does an abdominal aneurysm usually occur?

Answer 20

Below the renal arteries but above the aortic bifurcation

Question 21

Major cause of abd aortic aneurysm

Answer 21

Atherosclerosis (increases the diffusion barrier to get O2 to the media)

Question 22

Triad of presentation in abd aortic rupture?

Answer 22

Hypotension

Pulsatile abd mass

Flank pain

Question 23

Hemangioma (benign/malignant; areas involved; treatment)

Answer 23

Benign tumor comprised of blood vessels (blanchable)

Most often involves skin and liver

Often regresses during childhood

Question 24

Angiosarcoma (benign/malignant; areas involved; risk exposures)

Answer 24

Malignant proliferation of endothelial cells

Common sites: skin, breast, and liver

Question 25

Common exposures causing hepatic angiosarcoma

Answer 25

Hepatic angiosarcoma associated with exposure to vinyl chloride and arsenic

Question 26

Cause and presentation of Kaposi sarcoma

Answer 26

Malignant proliferation of endothelial cells, associated with HHV-8

Purple patches, plaques, and nodules on the skin and visceral organs (mouth, GI tract)

Question 27

At-risk populations for Kaposi Sarcoma

Answer 27

Older Eastern European males

AIDS

Transplant recipients

Question 28

What disease is often mistaken for Kaposi sarcoma and how do ou differentiate the two?

Answer 28

Bacillary angiomatosis caused by Bartonella henselae

Bartonella will have neutrophilic infiltrate and Kaposi will have lymphocytic infiltrate