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OS3 > Vascular Pathology > Flashcards

Vascular Pathology Flashcards

1
Q

Consequences of hyperplastic arteriolsclerosis

A

Reduced vessel caliber with end organ ischemia

Fibrinoid necrosis of the vessel wall with hemorrhage

Acute renal failure with a characteristic ‘flea-bitten appearance

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2
Q

When does an abdominal aortic aneurysm classically rupture?

A

When >5cm in diameter

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3
Q

Why is artherosclerosis not common in pre-menopausal females?

A

Estrogen is protective

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4
Q

Granulomatous vasculitis that classically involves the aortic arch at branch points

A

Takayasu Arteritis

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5
Q

What is the classical appearance of the thoracic aneurysm?

A

“Tree bark” appearance

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6
Q

What is the most common cause of aortic dissection?

A

Hypertension

*Also associated with inherited defects of connective tissue in younger individuals

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7
Q

Complications of thoracic aneurysm

A

Dilation of the aortic valve root, resulting aortic valve insufficiency (major)

Compression of mediastinal structures

Thrombosis/embolism

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8
Q

Complications of atherosclerosis

A
  • Impaired blood flow and ischemia:
    • Peripheral vascular disease
    • Angina
    • Ischemic bowel disease
  • Plaque rupture with thrombosis results in MI and stroke
  • Plaque rupture with embolization results in artherosclerotic emboli
  • Weaking of vessel wall results in aneurysm
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9
Q

Necrotizing granulomatous vasculities involving nasopharynx, lungs, and kidneys

A

Wegener Granulomatosis

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10
Q

What is an angiosarcoma?

A

Malignant proliferation of endothelial cells; highly agressive

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11
Q

Classic demographic for takayasu arteritis

A

<50

young asian females

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12
Q

Necrotizing granulomatous inflammation with eosinophils involving multiple organs, especially lungs and heart

A

Chrug-Strauss Syndrome

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13
Q

What is the pathology by which hypertension leads to aortic dissection?

A

Hypertension results in hyaline arteriolosclerosis of the vasa vasorum. Decreased flow causes atrophy of the media

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14
Q

How does polyarteritis nodosa present?

A

Hypertension

Abdominal pain with melena

Neurologic disturbances

Skin lesions

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15
Q

Takayasu Arteritis treatment

A

Corticosteriods

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16
Q

You have to have greater than _________ stenosis before you see complications.

A

70%

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17
Q

Low-grade malignant proliferation of endothelial cells

A

Kaposi Sarcoma

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18
Q

How does takayau arteritis present?

A

Visual and neurologic symptoms with a weak or absent pulse in the upper extremity

ESR is elevated

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19
Q

How does temporal arteritis present?

A

Headache (due to temporal artery involvement)

jaw claudication

Visual disturbances (due to opthalmic artery)

Flu-symptoms with joint and muscle pain (polymyaligia rheumatica)

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20
Q

Initimal plaque that obstructs blood flow

A

Atherosclerosis

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21
Q

__________ hypertension is due to an unknown etiology, while ________ hypertension is due to an identifiable etiolgy.

A

Primary; secondary

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22
Q

Causes of renal artery stenosis

A

Artherosclerosis (elderly males)

Fibromuscular dysplasis (young females)

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23
Q

Intimal tear with dissection of blood through media of the aortic wall

A

Aortic dissection

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24
Q

Pathogenesis of thoracic aneurysm

A

Endarteritis of the vasa vasurum results in luminal narrowing, decreased flow, and atrophy of the vessel

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25
Q

Classic demographic of abdominal aortic dissection

A

Male smokers >60 yrs with HTN

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26
Q

In conditions is thoracic aneurysm classically seen?

A

Tertiary syphillis

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27
Q

How is Wegener Granulomatosis treated?

A

Cyclophosphamide

Steroids

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28
Q

How does an abdominal aortic aneurysm present?

A

Pulsatile abdominal mass that grows with time

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29
Q

Which artery is involved in kawasaki disease?

A

Coronary artery, which leads to risk for thrombosis with MI and aneurysm rupture

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30
Q

Hyperpastic arteriolosclerosis is a consequence of __________.

A

Malignant hypertension

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31
Q

Modificable risk factors for artherosclerosis

A

HTN

Hypercholesterolemia (LDL increase, HDL decreases)

Smoking

Diabetes

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32
Q

Which vasculitis is associated with serum HBsAg?

A

Polyarteritis nodosa

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33
Q

3 pathologic patterns of arteriosclerosis

A

Atherosclerosis

Arteriolosclerosis

Monckeberg medial calcific sclerosis

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34
Q

Demographic for kawasaki disease

A

Asian children <4 yrs

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35
Q

Hyaline arteriolosclerosis is the consequence of …

A

Long standing benign hypertension or diabetes

36
Q

What is the hematuria seen in Wegener granulomatosis due to?

A

Rapidly progressive glomerulonephritis

37
Q

String of pearls

A

Polyarteritis nodosa

38
Q

Henoch-Schonlein Purpura is a vasculitis due to ____ immune complex deposition.

A

Henoch Schonlein Purpura

39
Q

Complications of aortic dissection

A
  • Pericardial tamponade
  • Rupture with fatal hemorrhage
  • Obstruction of branching arteries with resultant end-organ ischemia
40
Q

Pathogenesis of artherosclerosis

A
  • Damage to endothelium allows lipids to leak into the intima
  • Lipids are oxidized and then consumed by macrophages via scavenger receptors , resulting in foam cells
  • Inflammation and healing leads to deposition of extracellular matrix and proliferation of smooth muscle
41
Q

What is the cause of the hematuria seen in Henoch-Schonlein Purpura?

A

IgA nephropathy

42
Q

What is the characteristic appearance of acute renal failure due to hyperplastic arteriolosclerosis?

A

Flea-bitten

43
Q

When does Henoch-Schonlein purpura typically occur?

A

Following an upper respiratory tract infection

44
Q

Most common organs impacted by hemangioma

A

Skin and liver

45
Q

Where does an abdominal aortic aneurysm usually arise?

A

Below the renal arteries, but above the aortic bifurcation

46
Q

How does Henoch-Schonlein Purpura presnt?

A

Palpable purpura on buttocks and legs

GI pain and bleeding

Hematuria

47
Q

Ballon-like dilation of the thoracic aorta

A

Thoracic aneurysm

48
Q

How does malignant hypertension present?

A

Acute end-organ damage

49
Q

Necrotizing vasculitis involving multiple organs

A

Polyarteritis nodosa

50
Q

Which arteries are usually affected by artherosclerosis?

A

Large and medium sized arteries

  • Abdominal aorta
  • Coronary artery
  • Popliteal artery
  • Internal carotid artery
51
Q

______________ arteriolosclerosis involves thickening of vessel wall by hyperplasia of smooth muscle.

A

Hyperplastic

52
Q

Histo of polyarteritis nodosa?

A

Early

  • Transmural inflammation with fibrinoid necrosis

Late

  • Healing results in fibrosis producing a “string of pearls” apperance on imaging
53
Q

Pathology by atherosclerosis results in abdominal aortic aneurysm

A

Athreosclerosis increases the diffusion barrier to the media, resulting in atrophy and weakness of the vessel wall

54
Q

Necrotizing vasculitis involving the digits?

A

Buerger Disease

55
Q

Complications of abdominal aortic aneurysm

A

Rupture

Compression of local structures

Thrombosis/embolism

56
Q

Where does an aortic dissection typically occur?

A

In the proximal 10 cm of the aorta with pre-existing weakness of the media

57
Q

Which arteries are involved in polyarteritis nodosa?

A

Renal

Abdominal

58
Q

How is temporal arteritis treated?

A

Corticosteroids

*High risk of blindness if not treated

59
Q

Morphologic stages of atherosclerosis

A
  • begins as fatty streaks (fatty yellow lesions of the intima consisting of lipid-laden macrophages
  • Progresses to atherosclerotic plaque
60
Q

Which organs are spared in polyarteritis nodosa?

A

Lungs

61
Q

Why does a negative biopsy not exculde temporal arteritis?

A

Lesions are segment. Diagnosis requires biopsy of a long segment of vessel.

62
Q

Characteristic of atherosclerotic emboli

A

Cholesterol crystals with in the embolus

63
Q

Liver angiosarcoma is associated with exposure to what substances?

A

Polyvinyl chloride

Arsenic

Thorortrast

64
Q

Common sites of angiosarcoma

A

Skin, breat, and liver

65
Q

Treatment for Buerger Disease

A

Smoking cessation

66
Q

How does a ruptured abdominal aortic aneurysm present?

A

Hypotension

Pulsatile abdominal mass

Flank pain

67
Q

Components of intimal plaque seen in atherosclerosis

A

Consists of a necrotic lipid core (mostly cholesterol) with a fibromuscular cap

*often undergoes dystrophic calcification

68
Q

Consquences of hylaine arteriolosclerosis

A

Reduced vessel caliber with end-organ ischemia

Glomerular scarring that slowly progresses to chronic renal failure

69
Q

What genetics conditions are related to aortic dissection and by what mechanism?

A

Marfan syndrome and Ehlers-Danlos syndrome classically lead to weakness of the connective tissue in the media (cystic medial necrosis)

70
Q

How does Wegener Granulomatosis presnt?

A
  • Middle aged male with sinusitis or nasopharyngeal ulceration
  • Hemoptysis with bilateral nodular lung inflitrates
  • Hematuria
71
Q

Abdominal aortic aneurysm is primary due to _____________.

A

Artherosclerosis

72
Q

How does buerger disease present?

A

Ulceration

Gangrene

Autoamputation of fingers and toes

Raynaud phenomenon

73
Q

Microscopic polyangiitis presents similar to wegener granulomatosis. How does it differ?

A

No nasopharyngeal involvement

Granulomas are absent

p-ANCA

74
Q

Most common vasculitis in children

A

Henoch-Schonlein Purpura

75
Q

What lung condition is often associated with churg-strauss syndrome?

A

Asthma

76
Q

How is Henoch-Scholein Purpura treated?

A

Disease is self-limited, but may recur; treated with steroids, if severe

77
Q

Common demographic for temporal arteritis

A

Females

>50

78
Q

How does renal artery stenosis result in secondary HTN?

A
  1. Stenosis decreases blood flow to glomerulus
  2. Juxtaglomerular apparatus responds by secreting renin, which converts angiotension to angiotension II
  3. ATII raised blood pressure by contracting smooth musclem increasing total peripheral resistance and promting adrenal release of aldosterone, which increases resorption of sodium in the distal convuluted tubule (expanding plasma volume)
79
Q

Temporal (giant cell) arteritis is a granulomatous vasculitis that classically involves branches of the _______ artery.

A

Carotid

80
Q

How does aortic dissection present?

A

Presents as sharp, tearing chest pain that radiates to the back

81
Q

How is polyarteritis nodosa treated?

A

Cyclophosphamide

Corticosteriods

82
Q

______________ is a developmental defect of the blood vessel wall, resulting in irregular thickening of large and emdium-sized arteries, especially the renal artery.

A

Fibromucular dysplasia

83
Q

How is Kawasaki treated?

A

Aspirin and IVIG

84
Q

Calcification of the media of muscular arteries; non obstructive

A

Monkerberg Medial Calcific Sclerosis

85
Q

Cause of hyaline arteriolosclerosis

A

Proteins leaking into the vessel wall, producing vascular thickening

OS3 (10 decks)

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