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vavular disease/vasculitis Flashcards

1
Q

failure of a valve to open completely, obstructing forward flow

A

stenosis

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2
Q

acquired stenosis is usually due to _____

A

chronic (recurrent) rheumatic valvular disease

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3
Q

endothelial injury from a substance in cigarette smoke

A

thromboangiitis obliterans (Buerger disease)

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4
Q

clinical presentation of thromboangiitis obliterans

A

cigarette smoking, < 35 years, pain of extremities, ischemic ulcers, gangrene

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5
Q

pathology of thromboangiitis obliterans

A

vasculitis with thrombosis

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6
Q

Longitudinal tear of the aortic media which begins in the ascending aorta and extends variable distance proximal (toward the heart) and distal to the descending aorta

A

dissecting aortic hematoma

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7
Q

predisposing conditions to dissecting aortic hematoma

A

hypertension, inherited CT disorders (Marfan’s syndrom) with medial degeneration

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8
Q

mitral valve stenosis is a result of _____; mostly affects ____

A

acute rheumatic fever (ARF); children (20% adults)

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9
Q

clinical features of ARF

A
  • arthritis (often polyarthritis)
  • carditis
  • erythema marginatum (skin rash)
  • subcutaneous nodules
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10
Q

ARF produces ____, _____, ____, _____ and other manifestations

A

myocarditis; pericarditis (fibrinous); arthralgia or arthritis; endocarditis (sterile vegetations)

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11
Q

the myocarditis is characterized microscopically by ____ which are collections of _____ and _____

A

aschoff bodies; mononuclear inflammatory cells; fibroblasts (essentially granulomatous inflammation)

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12
Q

recurrent bouts of ARF lead to ____ and ____ of the mitral valve and possibly other heart valves

A

severe fibrosis; calcification

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13
Q

regurgitation may be caused by a variety of conditions including ____ and ____

A

IHD; infective endocarditis

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14
Q

_____ is a condition in which the leaflets balloon into the left atrium during left ventricular contraction (systole)

A

mitral valve prolapse

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15
Q

severe prolapse may be assoc with _____; some patients also experience ____ and ____

A

valvular regurgitation; chest pain; palpitations

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16
Q

____, ______, _____, and _____ are potential complications of severe prolapse

A

endocarditis; mitral regurgitation; thromboemboli; sudden death (rare)

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17
Q

in severe prolapse, also called _____, the valve cusps are large and microscopically show _____, ____, and loss of _____

A

floppy mitral valve; fragmentation; separation; collagen (myxomatous degeneration)

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18
Q

aortic valve stenosis caused by ____ and ____

A

fibrosis; calcification

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19
Q

aortic valve stenosis can be due to _____ or _____

A

chronic rheumatic valvular disease; advanced age (over 65 years)

20
Q

common congenital malformation which predisposes valves to fibrosis and calcification beginning at about 40 years

A

bicuspid aortic valve

21
Q

mechanisms of aortic valve regurgitation include _____, _____ and _____

A

valve cusp destruction (by endocarditis, rheumatic heart disease)
weakened valve cusps (myxomatous degeneration)
dilation of the aortic root (degeneration of the aortic media)

22
Q

infective endocarditis usually caused by a ____ in a heart valve, but may also be caused by ____ or other unusual infections

A

bacterial infection; fungus

23
Q

3 factors assoc with the pathogenesis of infective endocarditis

A
  1. endocardial or endothelial injury due to abnormalities in blood flow
  2. fibrin thrombi
  3. organisms in the blood (sepsis)
24
Q

complications of infective endocarditis

A
  1. rupture of chordae tendinae
  2. spread of infection into myocardium or aorta
  3. thromboembolism with infarction
  4. septic thrombi with metastatic abscesses
  5. valvular dysfunction and CHF
25
Q

differences in organism and tissue destruction between acute and subacute infective endocarditis

A

virulent organism in acute; organism of low virulence in subacute
prominent tissue destruction in acute, less tissue destruction in subacute

26
Q

causes of vasculitis

A 
infection (usually due to spread of adjacent infection)
mechanical trauma
toxins
caustic substances
radiation
immune complexes
27
Q

rare before age 50; visual disturbances; claudication of jaw; polymyalgia rheumatica

A

giant cell (temporal) arteritis

28
Q

pathology of giant cell (temporal) arteritis includes _____ with giant cells and _____

A

granulomatous inflammation; fibrosis

29
Q

called “pulseless disease” due to weak pulses in the arms; usually affects young women

A

takayasu arteritis

30
Q

pathology of takayasu arteritis includes _____ inflammation with ____ involving the ____ and ____

A

granulomatous ; fibrosis; aortic arch; arch branches

31
Q

suspected that a viral infection triggers a hypersensitivity reaction; affects infants and young children

A

kawasaki disease

32
Q

microscropic polyangiitis often due to _____; involves ____

A

antigen-antibody complexes; arterioles, capillaries, and venules

33
Q

involves abnormal expression of proteinase 3 on endothelial cell surface ; involves sinuses, lungs, and kidneys (glomerulonephritis)

A

wegener granulomatosis

34
Q

acute rheumatic fever is a systemic disease, usually in children, which follows a _______ pharyngitis

A

group A beta-hemolytic streptococcal

35
Q

ARF produces:

A
  • arthritis (often polyarthritis)
  • myocarditis/pericarditis
  • erythema marginatum (skin rash)
  • subcutaneous nodules
36
Q

predisposing factors to infective endocarditis

A

abnormal heart valves, prosthetic valves, IV drug use, intracardiac shunts, diabetes, and immunosuppression

37
Q

clinical manifestations of infective endocarditis include:

A

fever, heart murmur, fatigue, anemia, arthralgia, myalgia, splinter hemorrhages (nail bed), and roth spots (retinal hemorrhages)

38
Q

pathogenesis of immune-mediated vasculitis (noninfectious)

A
  1. immune complex formation
  2. anti-neutrophilic cytoplasmic antibodies (ANCAs)
  3. anti endothelial cell antibodies
  4. cell-mediated immunity (autoreactive T cells)
39
Q

type of ANCA with perinuclear localization ; found in microscopic polyarteritis

A

anti-myeloperoxidase (anti-MPO)

40
Q

type of ANCA with diffuse cytoplasmic distribution ; found in wegener’s granulomatosis

A

anti-proteinase-3 (anti-PR3)

41
Q

anti-endothelial cell antibodies found in _____

A

kawasaki disease

42
Q

immune complex formation is a reaction to ____ or ____

A

drugs; viruses

43
Q

haphazard and segmental involvement of medium and small muscular arteries; at one time, up to 30% with disease had hep B surface antigens in serum

A

polyarteritis nodosa

44
Q

acute lesions in polyarteritis nodosa show : _____

-healing involves progressive fibrous scarring

A

fibrinoid necrosis, thrombosis, neutrophils, aneurysms

45
Q

kawasaki disease is usually ____, but 1-2% die with _____

A

self-limited; coronary artery vasculitis

46
Q

clinical presentation of microscopic polyangiitis involves presence of ______

A

circulating anti-neutrophilic cytoplasmic antibodies (MPO-ANCA)

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