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USMLE: step 1 > Vascular path > Flashcards

Vascular path Flashcards

1
Q

3 vessel layers?

A
  1. Intima: endothelial / BM
  2. Media: muscle
  3. Adventitia: connective outer
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2
Q

TGA location?

A

Branches of carotic

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3
Q

Vasculitis in branches of carotid?

A

TGA

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4
Q

Signs of TGA?

A
  1. Headache: temporal
  2. Blurred vision: ophthalmic
  3. Jaw claudication
  4. Polymyalgia rheumatica: joint / muscle pain
  5. Elevated ESR
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5
Q

Elevated ESR and polymyalgia rheumatica?

A

TGA

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6
Q

Inflamed vessel wall with giant cells and intimal fibrosis?

A

TGA

- This is a granulomatous inflammation

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7
Q

Biopsy in TGA?

A

Must take very long piece of vessel as lesions can be small and segmental so easy to miss
*Negative biopsy does not exclude disease as would be easy to miss

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8
Q

TGA Rx?

A

Immediate corticosteroids to prevent blindness

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9
Q

Takayasu?

A
  • Granulomatous in asian female
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10
Q

Age in TGA and takayasu?

A

TGA: > 50
Takayasu:

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11
Q
  • Granulomatous in asian female
A

Takayasu

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12
Q

Takayasu presentation?

A
  1. Weak pulse in upper extremity “pulseless disease”
  2. Visual signs
  3. Neuro signs
  4. Elevated ESR
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13
Q

“pulseless disease”

A

Takayasu

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14
Q

Where are medium sized vessel vasculitides occurring?

A

Muscular arteries

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15
Q

Polyarteritis nodosa?

A
  • Necrotizing vasculitis involving most organs but sparing lungs
  • High association with HBV
  • Lesions of varying state: “string of pearls”
    • Fibrosis and altnerating aneurysm
  • Transmural inflammation with fibrinoid necrosis
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16
Q

Necrotizing vasculitis involving most organs sparing lungs?

A

Polyarteritis nodosa

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17
Q

Presentation of polyarteritis?

A
  1. HTN: renal artery
  2. Abdominal pain w/ melena: mesenterics
  3. Skin lesions
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18
Q

“string of pearls”

A

polyarteritis nodosa

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19
Q

Transmural inflammation with fibrinoid necrosis?

A

polyarteritis nodosa

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20
Q

Artery in kawasaki?

A

Coronary: MI in child

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21
Q

MI in young kid?

A

Kawasaki’s

22
Q

Only time to give ASA to kid?

23
Q

What is TXA2 important for?

A

Aggregation of platelets

24
Q

Buerger disease?

A
  • Necrotizing vasculitis of digits
  • Caused by smoking: cured if stopped
  • Smoking decreases Vitamin A causing this
25
Q

Necrotizing vasculitis of digits?

A

Buerger’s: stop smoking

26
Q

Wegener’s?

A
  • Necrotizing small vessel vasculitis of kidney, lung, nose
  • C-ANCA RPGN with crescents
  • Large necrotizing granulomas with adjacent necrotizing vasculitis
27
Q

Wegener’s Rx?

A

Cyclophosphamide

28
Q

Large necrotizing granulomas with adjacent necrotizing vasculitis in small vessel?

29
Q

Microscopic polyangiitis?

A
  • Small vessel necrotizing vasculitis of lung and kidney
  • Negative granulomas and involvement of nose
  • P anca
30
Q
  • Small vessel necrotizing vasculitis of kidney w/o granuloma?
A

Microscopic polyangiitis

31
Q

Churg strauss?

A
  • Necrotizing small vessel vasculitis with EOS and granulomas
  • Lungs and heart
  • Asthma and eosinophilia seen
  • P ance
32
Q

Necrotizing small vessel vasculitis with EOS and granulomas?

A

Churg strauss

33
Q

How to tell Churg strauss from microscopic?

A

Churg: EOS, granulomas, and asthma

***Both have p anca

34
Q

HSP?

A

“Henoch shuren purpura”

  • IgA IC vasculitis
  • Palpable purpura on butt / legs
  • Hematuria from IgA nephropathy
  • Post URI
35
Q
  • IgA IC vasculitis
  • Palpable purpura on butt / legs
  • Hematuria from IgA nephropathy
  • Post URI
36
Q

Renal artery stenosis in young female?

A

Fibromuscular dysplasia

37
Q

What thickens in atherosclerosis?

A

Intima of medium and large size vessels

38
Q

Composition of plaque?

A
  1. Necrotic lipid core: cholesterol
  2. Fibromuscular plaque
  3. Can become calcified
39
Q

Modifiable risk for atherosclerosis?

A
  1. High cholesterol
  2. HTN
  3. Diabetes
  4. Smoking
40
Q

Non Modifiable risk for atherosclerosis?

A
  1. Age
  2. Gender
  3. Genetics
41
Q

What happens to lipids in intima?

A

Becomes oxidized then taken up by macs which can’t digest it = fatty streaks

42
Q

Hallmark of atherosclerotic emboli?

A

Cholesterol clefts

43
Q

Hyaline arteriolosclerosis? Cause?

A
  1. Benign HTN
  2. TIIDM
    - Proteins leak into vessel wall = vascular thickening
    - Pink hyaline on microscopy
44
Q

Hyperplastic arteriolosclerosis? Cause?

A
  1. Malignant HTN
    - Thickening of small vessels from HYPERplasia of small vessels
    - Fibrinoid necrosis can occur
    “Onion skin appearance”
45
Q

“Onion skin appearance”

A

Hyperplastic arteriolosclerosis

46
Q

Acute renal failure with flea bitten appearance?

A

Hyperplastic arteriolosclerosis

47
Q

Where does blood go in dissection?

A

Tearing of intima allowing blood to access media

48
Q

Prognosis of hemangioma?

A

Present at birth usually regress in childhood

49
Q

How to tell hemangioma from purpura?

A

Hemangioma will blanch when pressure is applied

50
Q

Causes of liver angiosarcoma?

A
  1. PVC
  2. Thorotrast
  3. Arsenic
51
Q

Kaposi sarcoma?

A

Low grade proliferation of endothelial cells from HHV-8

- Purple but does not blanch as is not vascular

USMLE: step 1 (15 decks)

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