Path: HTN, Aorta, PAD

Question 1

What are the two causes of renal stenosis in secondary hypertension?

Answer 1

Atherosclerotic Plaque (90%)
Fibromuscular Dysplasia (10%)

Question 2

Common population associated with fibromuscular dysplasia.

Answer 2

Young women

Question 3

Two common conditions associated with coarctation of the aorta.

Answer 3

Marfans and Turners

any connective tissue disturbance in the aorta is associated with these two

Question 4

PE findings in patients with coarctation.

Answer 4

Typically high bp in upper extremities and low bp in lower.

Question 5

3 main organs or organ systems involved in Hypertensive Emergency (Malignant hypertension).

Answer 5

1. CNS
2. Kidney
3. Heart

Question 6

Gross appearance of the kidney resulting from malignant hypertension.

Answer 6

“Flea-bitten” appearance due to many small petechial hemorrhages.

(fibrinoid necrosis viewed on microscopy)

Question 7

Characteristic appearance of the retina resulting from malignant hypertension.

Answer 7

“Cotton Wool” appearance

Flame Hemorrhages

Question 8

What are Charcot-Bouchard microaneurysms?

Answer 8

Small vessel aneurysms seen near the basal ganglia in the brain due to malignant hypertension.

Question 9

What is the pathogenesis of hypertensive encephalopathy due to malignant hypertension?

Answer 9

High cerebral blood pressure leads to edema and increased intracranial pressure with fibrinoid necrosis of arterioles.

Question 10

What two physiologic components regulate blood pressure?

Answer 10

Cardiac Output and Total Peripheral Resistance

Question 11

What is a common microangiopathy of diabetics?

Answer 11

Hyaline Arteriolosclerosis

Question 12

Condition that occurs in malignant hypertension that leads to “onion skin” appearance.

Answer 12

Hyperplastic Arteriolosclerosis

-onion skin is due to replicating smooth muscle and basement membrane cells due to increased bp.

Question 13

What is a typical bp in patients that suddenly develop malignant hypertension?

Answer 13

~200/120

Question 14

Most common site of aortic aneurysms.

Answer 14

Abdominal aorta distal to renal artery branches.

Question 15

What is Cystic Medial Degradation?

Answer 15

All the microscopic changes that occur to lead to aneurysms in vessel walls.

• fibrosis
• loss of smooth muscle nuclei
• elastic fragmentation

Question 16

What is the difference between Type A and Type B aortic dissection?

Answer 16

Type A: involves ascending aorta

Type B: does not involve ascending aorta

Question 17

Complication of a very proximal aortic dissection that occurs near the origin of the aorta.

Answer 17

Cardiac Tamponade
-the fibrous pericardium blends with the adventitia of the aorta as it leaves the heart. Dissection here can lead to bleeding into the pericardial sac.

Question 18

What is Giant Cell Arteritis?

Answer 18

Vasculitis in the arteries in the head (temporal most common). Involves granulomatous inflammation including giant cells (fused WBCs, usually macrophages) along with elastic lamina fragmentation.

Question 19

Describe Takayasu Arteritis.

Answer 19

Granulomatous (giant cell) vasculitis of medium and large vessels. Most commonly affects main aortic arch branches leading to weakened upper extremity pulses.

Question 20

Location of Polyarteritis Nodosa.

Answer 20

Systemic small to medium sized artery vasculitis. Occurs in renal and most visceral vessels EXCLUDING the pulmonary vessels.

Question 21

What is Kawasaki Disease?

Answer 21

Autoimmune vasculitis usually in response stimulated by recent pathogen infection. Commonly affects the coronary arteries.

Question 22

What is Microscopic Polyangiitis?

Answer 22

Necrotizing or Leukoclastic vasculitis of the small arteries or capillaries. Commonly seen in the glomerulus and pulmonary circulation.

Question 23

What is Churg Strauss Syndrome?

Answer 23

Allergic granulomatosis and angiitis. Associated with asthma and allergic rhinitis. Granulomas often accompany eosinophils on microscopy.

Question 24

What is Wegener Granulomatosis?

Answer 24

A necrotizing vasculitis that presents in a triad:

1. Acute Necrotizing granulomas in URT and LRT
2. Granulomatous Vasculitis
3. Renal Disease showing crescentic glomerulonephritis on microscopy

Patients often have hemoptysis due to alveolar hemorrhage.

Question 25

How do patients with Thromboangiitis Obliterans (Buerger Disease) present?

Answer 25

Young male smoker that has pain in his legs when he walks.

Question 26

What is Buerger Disease?

Answer 26

Thrombosing and inflammation in medium sized arteries (commonly tibial and radial).

Question 27

What is Raynaud Phenomenon?

Answer 27

Exaggerated vasoconstriction of digital arteries and arterioles. Shows red, white, blue appearance.

Primary: caused by cold or emotional stress

Secondary: caused by vascular insuffieciency due to other disease (SLE, Buerger, atherosclerosis)