Veins and Lymph Path

Question 1

Major complication of varicose veins.

Answer 1

Persistent edema that leads to stasis dermatitis and poor wound healing (prolonged ulceration).

Question 2

Main etiology and complication of esophageal varices.

Answer 2

Caused by liver cirrhosis and can rupture which, if untreated, can be fatal.

Question 3

What is thrombophlebitis, what is the primary cause and location?

Answer 3

Thrombophlebitis/Phlebothrombosis
-inflammation of the veins with thrombis formation caused by stasis due to prolonged bed rest or immobilization. Most often in deep leg veins.

Question 4

Systemic hypercoagulability is a primary cause of thrombophlebitis. What are 2 conditions associated with systemic hypercoagulability the increase risk of developing thrombophlebitis?

Answer 4

1. Carcinoma (mainly adenocarcinoma)
   - cancer leads to elaboration of pro-coagulant factors
2. Migratory Thrombophlebitis
   - clots appear in one site, disappear, then reappear in another site

Question 5

What is the biggest complication of thrombophlebitis?

Answer 5

Most common form of thrombophlebitis is Deep Venous thrombosis in the thigh. The DVT can embolize and go to the lungs causing pulmonary embolism.

Question 6

Most common organism to spread thru lymphatics.

Answer 6

Group A beta-hemolytic strep

Question 7

What are lymphatic “red streaks”?

Answer 7

Red and tender marks on the skin that follow subcutaneous lymph vessels that harbor an infectious agent. The redness comes from lymphangitis (inflamed lymph vessels).

Question 8

What is familial Milroy Disease?

Answer 8

Hereditary lymphatic agenesis or hypoplasia. Patients present with enlarged legs bilaterally due to improper lymph drainage. (primary lymphedema)

Question 9

What can cause secondary lymphedema?

Answer 9

-malignant tumor, surgical complication, filariasis, post irradiation fibrosis, thrombus obstruction

Question 10

Major complication of lymphedema.

Answer 10

Lymphatic rupture leading to chylous ascites, chylothroax, chylopericardium etc.

Question 11

Most common locations of hemangiomas.

Answer 11

Head and neck superficial skin. 1/3 are in the liver. They are benign and usually resolve during childhood.

Question 12

Most common type of hemangioma, where it forms and how to treat it.

Answer 12

Capillary hemangioma, forms in young children on skin, oral mucosa, liver, spleen, or kidney.

Do not treat it. It will resolve by itself.

Question 13

What are cavernous hemangiomas and which are the most problematic?

Answer 13

Vascular tumors of large dilated vascular channels. The brain hemangiomas are the biggest problems.

Question 14

Condition associated with cavernous hemangiomas. Where do these tumors often grow?

Answer 14

von Hippel Lindau disease. Mutation in the von Hippel Lindau tumor suppressor gene predisposes patients to developing tumors. These tumors often grow in the cerebellum, brain stem and retina.

Question 15

Capillary hemangioma that includes ulceration. Pedunculated red nodule.

Answer 15

Pyogenic Granuloma

Question 16

Location of simple capillary lymphangiomas.

Answer 16

Head, neck, axilla

Question 17

Type of lymphangioma that occurs in patients with Turner Syndrome.

Answer 17

Cavernous Lymphangioma (Cystic Hygroma)

Question 18

Patient presents with exquisitely painful growth under his fingernails.

Answer 18

Glomus Tumor (glomangioma)
-arise in the glomus body (group of cells found in the dermis layer involved in temperature regulation)

Question 19

Vascular Ectasia (dilation of vessels) that forms on the head and neck and is very common. Birthmark.

Answer 19

Nevus Flammeus

Question 20

Vascular Ectasia that has a CN V distribution and condition that it is associated with.

Answer 20

Encephalotrigeminal Angiomatosis (port wine stain)
-associated with Sturge-Weber syndrome

Question 21

Pregnant woman presents with focal subcutaneous vascular dilation that is red in color and blanches when pressure is applied.

Answer 21

Spider Telangeictasia

can also be seen in patients with cirrhosis

Question 22

Where does hereditary hemorrhagic telangiectasia present?

Answer 22

Osler Weber Rendu Disease-autosomal dominant

• commonly occurs in respiratory, GI, urinary tracts
• patients can have epistaxis, GI bleed, hematuria

Question 23

Patient just had a liver transplant and now has red nodules growing on his skin. What does he have, the cause and treatment.

Answer 23

Bacillary Angiomatosis (opportunistic in immunocompromised)

• caused by Bartonella Family
• treat with Macrolides: erythromycin

Question 24

Patient presents with many small red nodules on the skin that are asymptomatic. She is HIV (-) but did immigrate from southern Italy.

Answer 24

Chronic (or European) Kaposi Sarcoma

Question 25

Patient presents with small red nodules on the skin that are asymptomatic. He also has very swollen lymph nodes, HIV (-), born and raised in South Africa.

Answer 25

Endemic (or African) Kaposi Sarcoma

Question 26

Causative agent of AIDS associated Kaposi Sarcoma.

Answer 26

HHV-8

Question 27

What are the 3 stages of KS and which is neoplastic?

Answer 27

1. Patch
2. Plaque
3. Nodule (neoplastic)

Question 28

What is an epithelioid hemangioendothelioma?

Answer 28

vascular tumor of adults that affects medium and large vessels

Question 29

Type of lesion and most common population that develops angiosarcomas.

Answer 29

Anaplastic lesion (cells resemble dividing stem cells)

Older population

Question 30

3 common causes of Hepatic Angiosarcoma.

Answer 30

Carcinogen exposure

1. Arsenic in Pesticides
2. Thorotrast (radioactive X-ray contrast)
3. PVC

Question 31

Patient presents with unilateral arm lymphedema. What type of tumor can result and what is the cause?

Answer 31

Lymphangiosarcoma can arise. Caused by radical mastectomy.

Question 32

Most common site of hemangiopericytoma.

Answer 32

Lower extremity capillaries

-can metastasize to lungs, liver, or bone