Vessels UWorld 3

Question 0

Onion-like concentric thickening of arteriolar wall

Answer 0

Hyperplastic arteriosclerosis. Smooth muscle cells and reduplicated basement membranes. From very high blood pressures. Causes renal artery stenosis, which increases blood pressure more, can led to hypertensive crisis

Question 1

Small bluish lesion (tumor) under nail

Answer 1

Either glomus tumor or a subungal melanoma

Melanoma: composed of melanocytes (pigmentation)

Glomus tumor (glomangioma): modified smooth muscle cells. Glomus bodies are small encapsulated neurovascular organs in nailbed, Shunts blood to/from surface depending on temperature

Question 2

Recurrent nosebleeds pink spider like lesions on oral and nasal mucosa, face arms

Answer 2

Hereditary hemorrhagic telangiectsia, aka Osler-Weber-Rendu syndrome

Question 3

Hereditary hemorrhagic telangiectsia, aka Osler-Weber-Rendu syndrome

Answer 3

Autosomal dominant disorder of blood vessels. Thin walled, AVMs, telangiectasias in mucosa. Presents as recurrent epistaxis, skin discolorations. Can lead to GI bleed, hemauria, heart failure

Question 4

For each alpha and beta receptor, name the second messenger from stimulation and the clinical effect of an agonist

Answer 4

a1: increased IP3, peripheral vasoconstriction
a2: decreased cAMP, decreased norepi and insulin
b1: increased cAMP, increased contractility
b2: increased cAMP, bronchdilation and vasdilation

Question 5

Norepinephrine receptors, effects

Answer 5

alpha and b1 receptors. a1 vasoconstriction –> increased BP, b1 stimulation affects HR but reflex to a1 actually makes the HR decrease.

Question 6

Vascular lesions with IgA and C3 deposition in a child

Answer 6

Henoch- Schonlein purpura, most common childhood systemic vasculitis. Small vessel. Triad of skin (palpable purpura on buttocks/legs), arthralgias, and GI (abdominla pain, melana). Often follows URI. Usually self-resolves but can cause glomerularnephritis.

Question 7

Rare vascular tumor, associated with arsenic and polyvinyl chloride exposure, expresses CD 31

Answer 7

Hepatic angiosarcoma. CD31 is PECAM1, platelet endothelial cell adhesion molecule. Arsenic exposure can be from pesticides

Question 8

Which cholesterol drug increases trigycerides?

Answer 8

Cholestyramine (resins)

Question 9

Drug for hypertensive emergencies, causes arteriolar dilation and increases renal perfusion, promoting natriuresis.

Answer 9

Fenoldopam, selective D-1 agonist.

Question 10

How are statins metabolized?

Answer 10

cytochrome p-450

Question 11

Cytochrome p450 inducers (5)

Answer 11

Carbamazepine, phenobarbital, phenytoin, rifampin, griseofulvin

Question 12

Cytochrome p450 inhibitors

Answer 12

Cimetidine, ciprofloxacin, erythromycin, azoles, grapefruit juice, isoniazid, ritonavir (protease inhibitors)

Question 13

Tachyphylaxis

Answer 13

Rapidly declining effects of drug after a few days due to negative feedback. Happens with alpha agonist nasal decongestants and also nitroglycerine

Question 14

What 4 things can cause peripheral edema?

Answer 14

Elevated capillary hydrostatic pressure, decreased plasma oncotic pressure, sodium and water retention, and lymphatic obstruction

Question 15

Mechanism, most common side effect of streptokinase

Answer 15

Cleaves plasminogen, thrombolytic used with tPA

Hemorrhage