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Pathology > Vascular: Pathoma, BRS, First Aid > Flashcards

Vascular: Pathoma, BRS, First Aid Flashcards

1
Q

What is vasculitis?

A

Inflammation of blood vessel wall

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2
Q

BV wall has what 3 components?

A
  1. endothelial intima
  2. smooth muscle media
  3. CT adventitia
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3
Q

Etiology of vasculitis is usually what?

A

Unknown or immune mediated.

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4
Q

Clinical features of vasculitis? 2

A
  1. Nonspecific symptoms of inflammation

2. Symptoms of organ ischemia

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5
Q

Nonspecific symptoms of inflammation include? (4)

A
  1. Fever
  2. Fatigue
  3. Weight loss
  4. Myalgias
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6
Q

Symptoms of organ ischemia are due to what?

A

Luminal narrowing or thrombosis of inflamed vessels

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7
Q

Large-vessel vasculitis involves what?

A

Aorta and its branches

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8
Q

Medium vessel vasculitis involves what?

A

Muscular arteries that supply organs

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9
Q

Small vessel vasculitis involves what? (3)

A
  1. Arterioles
  2. Capillaries
  3. venules
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10
Q

Temporal Giant Cell arteritis is what?

A

Granulomatous vasculitis that classically involves branches of the carotid artery

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11
Q

Temporal giant cell arteritis is the most common vasculitis in what patients?

A

Older adults (especially females)

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12
Q

How does temporal giant cell arteritis present? 6

A
  1. Unilateral Headache: Due to temporal artery
  2. Visual distrubance: Ophthalmic artery (can go blind)
  3. Jaw claudication
  4. Polymyalgia rheumatica
  5. Elevated ESR
  6. Nodules along course of artery involved
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13
Q

Biopsy of temporal giant cell arteritis reveals what? 4

A

Inflamed vessel wall (fibrosis)
Giant cells
Lesions are segmental
Many granulocytes

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14
Q

Treatment of temporal giant cell arteritis is?

A

Corticosteroids

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15
Q

Takayasu arteritis is what?

A

Granulomatous vasculitis that involves aortic arch at branch points

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16
Q

What demographic has takayasu arteritis the most?

A

Young asian females

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17
Q

How does takayasu arteritis present?

A
  1. Visual symptoms
  2. Neurologic smptoms
  3. Weak or absent pulse in upper extremity
  4. ESR elevated
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18
Q

Treatment of takayasu arteritis?

A

Corticosteroids

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19
Q

What syndrome does takayasu arteritis produce?

A

Aortic arch syndrome

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20
Q

What are the two medium vessel vasculitises?

A

Polyarteritis Nodosa
Kawasaki Disease
Buerger Disease

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21
Q

Polyarteritis nodosa is what?

A

Necrotizing vasculitis involving muscular arteries that supply organs.

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22
Q

What organ is spared in polyarteritis nodosa?

A

Lungs

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23
Q

How does polyarteritis nodosa classically present?

A 
Young adult
Hypertension: Renal artery involvement
Abdominal pain with melena: Mesenteric artery
IHD: Coronary arteries
Neurologic dysfunction
Skin lesions
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24
Q

What serum antigen is associated with Polyarteritis nodosa?

A

Hepatitis B surface antigen

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25
Q

Early lesion of polyarteritis nodosa consists of what?

A

Transmural inflammation with fibrinoid necrosis

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26
Q

How do early lesions in polyarteritis nodosa heal?

What does this produce?

A

Fibrosis

String of pearls appearance

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27
Q

Treatment for polyarteritis nodosa? 2

What happens if not treated?

A
  1. Corticosteroids
  2. Cyclophosphamide

Fatal

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28
Q

Fibrinoid necrosis is clasically seen in what two scenarios?

A
  1. Malignant HTN

2. Vasculitis

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29
Q

Early lesions have what effect in polyarteritis nodosa?

What can result?

A

Weaken vessel wall

Aneurysm

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30
Q

What mediates polyarteritis nodosa?

A

Immune complexes

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31
Q

What organ causes most deaths in polyarteritis nodosa?

A

Kidneys: Vasculitis in arterioles and glomeruli and renal artery lesions

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32
Q

Kawasaki disease typically affects what demographic?

A

Asian children under 4 years old.

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33
Q

How does kawasaki disease present? 5

A
  1. Fever
  2. Conjunctivitis
  3. Red rash of palms and soles
  4. Enlarged cervical lymph nodes
  5. Strawberry tongue
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34
Q

What artery is dangerous for kawasaki disease?

Why?

A

Coronary artery

Can lead to:

  1. Thrombosis with MI
  2. Aneurysm with rupture
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35
Q

Treatment for kawasaki disease is what?

A
  1. Aspirin

2. IV immunoglobulin

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36
Q

Buerger disease is what?

A

Necrotizing vasculitis involving digits

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37
Q

How does Buerger disease present?

A

Ulceration
Gangrene
Autoamputation of fingers and toes
Raynaud phenomenon

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38
Q

What is Buerger’s disease heavily associated with?

Which leads into what is the best treatment for Buerger disease?

A

Smoking

Cessation of smoking

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39
Q

What demographic typically presents with Buerger’s disease?

A

Young Jewish men

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40
Q

What are the four small vessel vasculitis?

A

Wegener Granulomatosis
Microscopic Polyangiitis
Churg-Strauss syndrome
Henoch-Schonlein purpura

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41
Q

Wegener Granulomatosis is what?

A

Fibrinoid-Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys

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42
Q

Classic presentation of Wegener granulomatosis?

A
  1. Middle-aged male
  2. Sinusitis/nasopharyngeal ulceration
  3. Hemoptysis with bilateral nodular lung infiltrates
  4. Hematuria: Glomerulonephritis
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43
Q

Treatment of Wegener granulomatosis 2

What happens despite treatment

A

Cyclophosphamide
Steroids

Relapse

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44
Q

Wegener granulomatosis correlates with what serum level?

A

Circulating-Antineutrophil cytoplasmic antibodies (C-ANCA)

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45
Q

Biopsy of Wegener granulomatosis reveals what?

A

Large necrotizing granulomas (with giant cells) with adjacent necrotizing vasculitis

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46
Q

The TRIAD of Wegener granulomatosis?

A
  1. Focal necrotizing vasculitis
  2. Necrotizing granulomas in lung and URT
  3. Necrotizing glomerulonephritis
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47
Q

Microscopic polyangiitis is what?

A

Necrotizing vasculitis of multiple organs especially lung and kidney?

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48
Q

How do microscopic polyangiitis symptoms differ from wegener’s? 2

A

No nasopharyngeal symptoms

No granulomas

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49
Q

Treatment of microscopic polyangiitis? 2

A

Corticosteroids and cyclophosphamide

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50
Q

What serum level correlates with microscopic polyangiitis AND Churg-Strauss syndrome?

A

Serum p-ANCA

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51
Q

Churg-strauss syndrome is what?

A

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

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52
Q

How does Churg-strauss syndrome present? 4

A
  1. Asthma
  2. Peripheral eosinophilia
  3. Palpable purpura
  4. Glomerulonephritis
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53
Q

What is elevated in Churg-Strauss syndrome? 2

A
  1. p-ANCA

2. IgE

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54
Q

Henoch-Schoenlein Purpura is what?

A

Vasculitis due to IgA immune complex deposition

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55
Q

Henoch-Schoenlein Purpura is the most common vasculitis in what demographic?

A

Children

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56
Q

How does Henoch-Schoenlein Purpura present? 5

A
  1. Palpable purpura on buttocks and legs
  2. GI pain and bleeding
  3. Hematuria (IgA nephropathy)
  4. Follows URT infection (Causes excess IgA)
  5. Anthralgia
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57
Q

How to treat Henoch-Schonlein Purpura?

A

Usually goes away on own but steroids if needed

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58
Q

What is Raynaud’s disease?

A

Recurrent vasospasm of small arteries and arterioles

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59
Q

Symptom of Raynaud’s disease?

What precedes it

A

Pallor/Cyanosis especially fingers and toes

Chilling

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60
Q

Raynaud disease is most common in who?

A

Young, healthy women

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61
Q

What is Raynaud phenomenon?

A

Similar to Raynaud disease but is secondary to an underlying disorder

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62
Q

What is the underlying disorder in Raynaud’s phenomenon? 2

A

SLE = Lupus

CREST syndrome = Systemic sclerosis

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63
Q

Hypertension is what?

A

Increased blood pressure

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64
Q

Does hypertension involve pulmonary or systemic circulation?

A

Either

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65
Q

Systemic hypertension is defined how?

A

greater than 140/90

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66
Q

What is normal blood pressure?

A

less than 120/80

67
Q

Primary hypertension is of what etiology?

What percentage of hypertensions?

A

Unknown

95%

68
Q

Risk factors for primary hypertension? 6

A 
Age
Race (african americans higher, asians lower)
Obesity
Stress
Lack of physical activity
High-salt diet
Family history
Smoking
69
Q

What can primary hypertension lead to? 4

A
  1. Retinal changes
  2. Left ventircular hypertrophy –> Cardiac failure
  3. Benign nephrosclerosis
  4. IHD
70
Q

Secondary hypertension is due to what?

A

Secondary to a known cause (5% of HTN cases)

71
Q

What is most common cause of secondary HTN?

A

Renal disease

72
Q

2 causes of renal hypertension?

A
  1. Renal artery stenosis

2. Disorders of renal parenchyma

73
Q

Renal artery stenosis has what effect?

A

Decrease blood to glomerulus –> JGA secretes renin –>–> Ang II –>

  1. Vasoconstriction –> Increase peripheral resistance
  2. Renal release of aldosterone –> Increase Na+ resorption –> Increase plasma volume
74
Q

The effects of ATII leads to what?

A

HTN with increased plasma renin and unilateral atrophy (due to low blood flow)

75
Q

Important cause of renal artery stenosis in elderly males?

A

Atherosclerosis

76
Q

Important cause of renal artery stenosis in young females?

A

Fibromuscular dysplasia: Developmental defect of BV wall leading to thickening of large and medium arteries

77
Q

Endocrine disorders leading to hypertension? 6

A
  1. Primary aldosterone/Conn Syndrome
  2. Acromegaly
  3. Cushing syndrome
  4. Pheochromocytoma
  5. Hyperthroidism
  6. Diabetes
78
Q

Other causes of HTN? 4

A
  1. Coarctation of aorta (Upper body HTN)
  2. Toxemia of pregnancy
  3. CNS disorders: (brain tumors)
  4. Amphetamines and steroids
79
Q

What is benign HTN?

A

Mild or moderate elevation in blood pressure

80
Q

Clinical effects of benign HTN?

A

Silent, damage over looooong period

81
Q

What is most common HTN, benign or malignant?

A

benign (>95%)

82
Q

Malignant HTN is defined how?

A

Blood pressure of >200/120

83
Q

What demographic has malignant HTN the most?

A

Young black males

84
Q

How does malignant HTN present? 4

A
  1. Acute renal failure
  2. Headache
  3. Papilledema
  4. Retinal hemorrhages
85
Q

What does malignant HTN most likely result in? 3

A

CHF
Stroke
Renal failure

86
Q

What important renal change does malignant HTN produce?

A

Malignant nephrosclerosis in which glomeruli rupture forming a flea-bitten kidney

87
Q

What is arteriosclerosis?

A

Thickened blood vessel walls in arteries making them hard

88
Q

3 patterns of arteriosclerosis

A
  1. Atherosclerosis
  2. Arteriolosclerosis
  3. Monckeberg medical calcific sclerosis
89
Q

Atherosclerosis is what?

A

Intimal plaque that obstructs blood flow

90
Q

What does the plaque in atherosclerosis consist of? (3)

A
  1. Necrotic lipid core of choelsterol
  2. Fibromuscular cap
  3. Calcium
91
Q

What arteries are involved in atherosclerosis?

A

Large and medium size: abdominal, coronary, popliteal, carotid

92
Q

What are the modifiable risk factors for atherosclerosis? 4

A
  1. HTN
  2. Hypercholesterolemia
  3. Smoking
  4. Diabetes
93
Q

What are the nonmodifiable risk factors for atherosclerosis? 3

A
  1. Age (increase with age)
  2. Gender (Males and postmenopausal females)
  3. Genetics
94
Q

What is the pathogenesis of atherosclerosis?

A

Damage to endothelium –> Lipids leak into intima –> Lipids oxidized –> Consumed by macrophages –> Form foam cells –> Inflammation/healing leads to deposition of ECM and proliferation of smooth muscle.

95
Q

How does atherosclerosis begin and appear as?

When do these arise?

A

Fatty streaks: Yellow lesions of intima with lipid-laden macrophages

Early in life

96
Q

Complications of atherosclerosis are how important?

A

Greater than 50% of all disease in Western countries

97
Q

4 main complications of atherosclersosis?

A
  1. Stenosis of medium sized vessels –> Impaired blood flow and ischemia
  2. Plaque rupture with thrombosis –> MI/Stroke
  3. Plaque rupture with embolization
  4. Weakening of vessel wall results in aneurysm
98
Q

Impaired blood flow and ischemia in turn can lead to what? (3)

A
  1. Peripheral vascular disease
  2. Angina
  3. Ischemic bowel disease
99
Q

What are fibrous plaques also known as?

100
Q

What is difference in LDL and HDL in atherosclerosis?

A

LDL: Makes it worse
HDL: Makes it better

101
Q

What is arteriolosclerosis?

A

Narrowing of small arterioles

102
Q

Two divisions of arteriolosclerosis?

A

Hyaline

Hyperplastic

103
Q

Hyaline arteriolosclerosis is caused by what?

A

Proteins leaking into vessel wall –> Vascular thickening

104
Q

How does hyaline arteriolosclerosis appear on microscopy?

A

Pink hyaline

105
Q

Hyaline arteriolosclerosis is the result of what?

A
  1. Long standing benign HTN

2. Diabetes

106
Q

Why does diabetes cause hyaline arteriolosclersosis?

A

Non-enzymatic glycosylation of BM –> Leaky BV wall

107
Q

Hyaline arteriolosclerosis results in what? 2

A
  1. Organ ischemia

2. Glomerular scarring –> Chronic renal failure

108
Q

Hyperplastic arteriolosclerosis is what?

A

Thickening of vessel wall by hyperplasia of smooth muscle (concentric, onion-like)

109
Q

Hyperplastic arteriolosclerosis is the consequence of what?

A

Malignant HTN

110
Q

What does hyperplastic arteriolosclerosis result in?

A
  1. End organ ischemia
  2. Fibrinoid necrosis of vessel wall
  3. Acute renail failure –> Flea-bitten appearance
111
Q

What is Monckeberg medial calcific sclerosis?

A

Calcification of the media of muscular arteries; nonobstructure

112
Q

Is Monckeberg medial calcific sclerosis clinically significant?

113
Q

What arteries are most often affected in Monckeberg?

A

Radial and ulnar

114
Q

What is aortic dissection?

A

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

115
Q

Where does aortic dissection occur?

A

Proximal 10 cm of the aorta (high stress)

Place where weakness of media is

116
Q

Most common cause of aortic dissection?

What 3 things will also cause this?

A

Hypertension

Bicuspid aortic valve, Marfan and Ehlers-Danlos weaken CT in media

117
Q

Hypertension causes aortic dissection how?

A

Hyaline arteriolosclerosis of vasa vasorum –> Decrease flow –> Atrophy of media

118
Q

How does aortic dissection present?

A

Sharp tearing chest pain radiating to the back

119
Q

Complications of aortic dissection?

Which is most common cause of death

A
  1. Pericardial tamponade (most common)
  2. Rupture with fatal hemorrhage
  3. Obstruction of branching arteries –> Organ ischemia
120
Q

Thoracic aneurysm is what?

A

Balloon-like dilation of thoracic aorta

121
Q

What is thoracic aneurysm due to?

A

Weakness in aortic wall

122
Q

How does thoracic aneurysm typically present? 3

A
  1. Tertiary syphilis
  2. HTN
  3. Marfan’s
123
Q

What happens in thoracic aneurysm?

A

Endarteritis of vasa vasorum –> Luminal narrowing –> Decreased flow –> Atrophy of vessel wall

124
Q

Hwo does aorta appear in thoracic aneurysm?

125
Q

Major complication of thoracic aneurysm?

A

Dilation of aortic valve root –> Aortic valve insufficiency

126
Q

Other complications of thoracic aneurysm?

A
  1. Compression of trachea or esophagus

2. Thrombosis/embolism

127
Q

What is abdominal aortic aneurysm?

Where is it usually?

A

Balloon-like dilation of abdominal aorta?

Below renal arteries but above aortic bifurcation

128
Q

What is abdominal aortic aneurysm due to mainly? 4

A

Atherosclerosis
Males
Old
HTN

129
Q

How does abdominal aortic aneurysm present?

A

Pulsatile abdominal mass that grows with time

130
Q

What are the complications of abdominal aortic aneurysm? (3)

A
  1. Rupture: Greater than 5cm
  2. Compression of local structures (ureter)
  3. Thrombosis/Embolism
131
Q

What are Berry aneurysms?

A

Small saccular lesions seen in small arteries of brain, especially circle of Willis

132
Q

Where do berry aneurysms grow?

A

Weakness at bifurcations of cerebral arteries?

133
Q

Berry aneurysms are the most common cause of what?

A

Subarachnoid hemorrhage

134
Q

Venous thrombosis/phlebothrombosis most commonly arises where?

A

Deep veins of lower extremities

135
Q

What is Venous thrombosis/phlebothrombosis if it becomes inflamed?

A

Thrombophlebitis

136
Q

Predisposing factors of Venous thrombosis/phlebothrombosis include?

A
  1. Venous circulatory stasis

2. Obstructed venous return

137
Q

Main result of Venous thrombosis/phlebothrombosis?

A

Embolism –> Pulmonary infarct

138
Q

What are varicose veins?

A

Abnormally dilated and tortuous veins in superficial veins of lower extremeties.

139
Q

Predisposing factors to varicose veins? (2)

A
  1. Increased venous pressure (Pregnant, obese)

2. People that stand a lot.

140
Q

What are five benign vascular tumors?

A
  1. Spider telangiectasia
  2. Hereditary hemorrhagic telangiectasia (OWR)
  3. Hemangioma
  4. Glomangioma/Glomus tumor
  5. Cystic hygroma
141
Q

What is spider telangiectasia?

What is it associated with?

A

Dilated small vessel surrounding radiating fine channels

Hyperestrinism: Chronic liver or pregnant

142
Q

What is heredtiary hemorrhagic telangiectasia?

A

Autosomal dominant condition with localized dilation and convolution of venules and capillaries of skin and mucous membranes.

143
Q

When do hemangiomas present?

A

At birth, but regress through childhood.

144
Q

Hemangioma is the most common tumor of what demographic?

145
Q

Hemangioma has what characteristic symptom?

A

Port-wine stain birthmarks

146
Q

Strawberry/Capillary hemangioma is what?

Who is it seen in?

A

Closely packed capillary-like channels

Infants (1/200 births)

147
Q

Cavernous hemangioma consist of what? Cherry

A

Large cavernous vascular spaces in skin, mucosal surfaces, and organs

148
Q

What disease usually causes cavernous hemangioma?

A

von Hippel-Lindau disease

149
Q

What is a cherry hemangioma?

A

Benign capillary hemangioma of elderly

150
Q

What is Sturge-weber disease?

A

Congenital vascular disorder that affects capillaries

151
Q

How does sturge-weber disease manifest? 4

A
  1. Port wine stain
  2. Leptomeningeal angiomatosis
  3. Seizures
  4. Glaucoma
152
Q

What is glomangioma/glomus tumor?

A

Small purple painful subungual nodule in a finger or toe

153
Q

What is a cystic hygroma?

What disease is it associated with?

A

Cavernous lymphangioma that occurs in neck or axilla.

Turner syndrome

154
Q

What is bacillary aniogmatosis?

A

Benign capillary skin papules in AIDS patients

155
Q

What are the 4 malignant vascular tumors?

A
  1. Hemangioendothelioma
  2. Hemangiopericytoma
  3. Angiosarcoma
  4. Kaposi sarcoma
156
Q

What is hemangioendothelioma?

A

Intermediate between benign and malignant

157
Q

What is hemangiopericytoma?

A

Tumor from pericytes and can be benign or malignant

158
Q

What is a angiosarcoma?

A

Malignant proliferation of endothelial cells

159
Q

What is angiosarcoma associated with? 2

A
  1. Arsenic

2. Radioactive Thorotrast

160
Q

What is liver angiosarcoma associated with?

A

Polyvinyl chloride

161
Q

What is Kaposi sarcoma?

A

Low-grade malignant proliferation of endothelial cells.

162
Q

What disease is kaposi sarcoma associated with?

A

Herpes HHV-8

163
Q

How does kaposi syndrome present?

A

Purple patches
Plaques
Nodules on skin

164
Q

What three populations is Kaposi syndrome seen in?

A
  1. Old eastern european males: Tumor in skin
  2. AIDS: Spreads fast
  3. Transplant recipients

Pathology (36 decks)

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