Vascular specifically

Question 1

What are the 5 main causes of vascular disease?

Answer 1

Gradual obstruction (Atherosclerosis/arteriolosclerosis)
Sudden obstruction (thrombosis, embolus)
Aneurysm/dissection
Vasculitis
Extrinsic vascular compression

Question 2

What type of vessel is most often atherosclerotic?

Answer 2

Larger vessels (aorta, medium/large arteries)

Question 3

What is meant by “essential” HTN?

Answer 3

Basically, nobody knows the precipitating factor…which also means nobody knows how to cure (treat)

Question 4

What percentage of HTN cases are deemed “essential”?

Answer 4

95%

Question 5

What is a big risk of a diabetic with HTN?

Answer 5

Both arteries and arterioles become obstructed

Arteriolosclerosis is a non-bypassable disease

Question 6

What is the most common cause of life-threatening vascular events?

Answer 6

Sudden luminal occlusion

Question 7

What is the most common cause of sudden luminal occlusion?

Answer 7

Unstable atheromatous plaques

Question 8

What is always considered the source of an embolus?

Answer 8

Heart until proven otherwise

Question 9

Besides thrombosis/embolus what else can cause a sudden occlusion?

Answer 9

A dissection can occlude orifices of exiting arteries (think about an aortic dissection)

Question 10

What is the typical site of a DVT?

Answer 10

Iliofemoral veins

Question 11

What are some general causes of DVT?

Answer 11

Surgery/trauma/sepsis

Congenital/acquired hypercoagulable state

Question 12

What is the concern of a DVT?

Answer 12

PE and sudden death

Question 13

How can a DVT be screened for?

Answer 13

D-dimer

CT angiography

Question 14

What can cause a bowel infarct or Budd-Chiari syndrome?

Answer 14

Splanchnic venous thrombosis

Question 15

What is almost always the underlying cause of unexplainable thrombi in atypical locations (mesenteric, portal, hepatic, cerebral)?

Answer 15

Congenital/acquired systemic hypercoagulable state

Question 16

What are the two primary causes of wall weakening leading to an aneurysm?

Answer 16

Atherosclerosis

HTN

Question 17

Besides HTN and atherosclerosis, what else can lead to a weakened wall and eventually an aneurysm?

Answer 17

Inherited connective tissue disease (Marfan’s)
Vasculitis (Takayasu’s and giant cell)
Connective tissue/autoimmune diseases
Infection of aortic/arterial wall

Question 18

Where is atherosclerosis most likely to cause an aneurysm in smokers?

Answer 18

Infra-renal abdominal aorta

Question 19

Where is HTN most likely to cause an aneurysm?

Answer 19

Ascending aorta

Question 20

What are the concerns with an aneurysm?

Answer 20

Rupture

Exsanquination (fancy word for draining)

Question 21

What type of aortic dissection involves the descending aorta and/or the aortic arch?

Answer 21

Type B

Question 22

What does a type A aortic dissection involve?

Answer 22

Ascending aorta +/- distal aorta

Question 23

What is the most likely pre-disposing factor in a patient over 40 with an aortic dissection?

Answer 23

HTN

Question 24

What is the most likely pre-disposing factor in a patient under 40 with an aortic dissection?

Answer 24

Inherited connective tissue disorder (Marfan’s)

Question 25

What arteries can be occluded by an aortic dissection?

Answer 25

``` Coronary Arch vessels Celiac Mesenteric Renal ```

Question 26

Besides arterial occlusion, what are other possible complications of an aortic dissection?

Answer 26

Rupture into pericardial sac or left thorax | Acute aortic valve regurgitation/CHF

Question 27

What does ANCA stand for?

Answer 27

Anti-Neutrophil Cytoplasmic Antibody

Question 28

Are ANCA-associated vasculitides bad?

Answer 28

Very bad, high mortality | Very aggressive visceral vasculitic disease

Question 29

What are two non-adult causes of vasculitis?

Answer 29

``` Henoch-Schnolein Purpura (IgA-related vasculitis) Kawasaki disease (risk of coronary vasculitis) ```

Question 30

What is most commonly affected in vasculitis of middle-aged/elderly?

Answer 30

External carotid

Question 31

What is the usual cause of vasculitis in middle-aged/elderly?

Answer 31

Giant cell (temporal) arteritis

Question 32

What is a risk of vasculitis of middle-aged/elderly?

Answer 32

Vision loss

Question 33

How is external carotid vasculitis diagnosed?

Answer 33

Temporal artery biopsy

Question 34

How is external carotid vasculitis treated?

Answer 34

Corticosteroids (it is an immune response)

Question 35

What are two examples of ANCA-associated vasculitides?

Answer 35

``` Wegener's (Anti-PR3 Abs; c-ANCA) Microscopic polyangiitis (Anti-myeloperoxidase Abs; pANCA) ```

Question 36

Besides Wegener's and Microscopic Polyangiitis, what are some other examples of life-threatening vasculitis in adults?

Answer 36

Goodpasture's syndrome SLE Polyarteritis Nodosa (PN) Churg-Strauss syndrome

Question 37

What is the differential with a pulmonary-renal syndrome?

Answer 37

ANCA-associated vasculitis Goodpasture's SLE

Question 38

What should be done if suspicion of Wegener's or pulmonary-renal syndrome?

Answer 38

CXR or chest CT

Question 39

What is the most common benign form of a vascular neoplasm?

Answer 39

Hemangioma

Question 40

Where is a hemangioma most likely to form?

Answer 40

Skin (cherry/purple papules)

Question 41

Besides the skin, where else might a hemangioma form?

Answer 41

Any visceral organ but usually liver, spleen, or soft tissue

Question 42

What is a pyogenic granuloma?

Answer 42

Capillary hemangioma secondary to trauma | Rapidly growing and friable (crumbles?)

Question 43

What are lymphangiomas?

Answer 43

Benign vascular neoplasms in the neck/axilla of children

Question 44

What is a glomus tumor?

Answer 44

Glomus cell proliferation associated with vascular channels

Question 45

Where are glomus tumors and are they noticed?

Answer 45

In the distal digits | They are PAINFUL

Question 46

What form of benign vascular neoplasm is associated with a cat scratch species (Bartonella infection)?

Answer 46

Bacillary angiomatosis

Question 47

What are vascular ecstasies?

Answer 47

Descrete lesions with dilated pre-existing vessels resembling hemangioma but a flat/non-papular Sturge-Weber syndrome is an extreme form

Question 48

What is a systemic vascular ecstasia syndrome with risk of serious bleeding?

Answer 48

Osler-Weber-Rendu (hereditary hemorrhagic telangiectasia)

Question 49

What are arteriovenous malformations?

Answer 49

Tangled mass of arteries and veins without an intervening capillary bed

Question 50

What is the risk of arteriovenous malformations?

Answer 50

High output heart failure | In brain, a rupture with fatal cerebral hemorrhage

Question 51

What forms from a penetrating vascular injury?

Answer 51

An arteriovenous fistula

Question 52

What are examples of low-grade malignant vascular neoplasms?

Answer 52

Kaposi's sarcoma | Epitheliod hemangioendothelioma

Question 53

What does a Kaposi's sarcoma affect?

Answer 53

Skin +/- visceral involvement

Question 54

What infections are Kaposi's sarcoma associated with?

Answer 54

HHV-8 | HIV

Question 55

Where does an epitheloid hemangioendothelioma form?

Answer 55

Normally liver or soft tissue

Question 56

What is an example of a high-grade malignant sarcoma?

Answer 56

Angiosarcoma

Question 57

Where is an angiosarcoma likely to form in the elderly?

Answer 57

Skin of head/neck

Question 58

What does an angiosarcoma look like?

Answer 58

An aggressive reddish/purple lesion in skin

Question 59

What chronic diseases has an increased risk of developing an angiosarcoma?

Answer 59

Chronic lymphedema | Stewart-Treves Syndrome

Question 60

Who has Stewart-Treves syndrome?

Answer 60

Post-mastectomy/radiation/axillary dissection patients