Pathoma - Vascular Pathology

Question 1

Temporal (Giant Cell) Arteritis

Answer 1

large vessel vasculitis. most common form of vasculitis in older adults, pts > 50, usually females.

Question 2

Temporal (Giant Cell) Arteritis Pathology

Answer 2

• a granulomatous vasculitis with giant cells.

- intimal fibrosis (healing of chronic inflammation)

Question 3

Biopsy of Temporal (Giant Cell) Arteritis

Answer 3

Long piece needed for biopsy due to ‘skip lesions’.

Question 4

Temporal (Giant Cell) Arteritis Treatment

Answer 4

Steroids

Question 5

Takayasu’s Arteritis

Answer 5

Granulomatous vasculitis, large vessel vasculitis
Pts usually less than age of 50
- classic pt is young asian female.
Involves the aortic arch at branch points

Question 6

Clinical Signs

Answer 6

Visual and neurologic symptoms
Weak or absent pulses in the upper extremity.
ESR elevated
Treatment is corticosteroids

Question 7

Medium Vessel Vasculitis

Answer 7

• involves muscular arteries, supply organs

Question 8

Polyarteritis Nodosa

Answer 8

medium vessel vasculitis, necrotizing Vasculitis that involves most organs, but the lungs are spared.

Question 9

Polyarteritis Nodosa - Signs and Symptoms

Answer 9

• HTN (renal artery involvement)
• Abdominal pain and melena (mesenteric artery)
• Neruologic disturbances
• Skin lesions
• -> Associated with serum HepB surface antigen???

Question 10

Polyarteritis Nodosa classical finding on imaging

Answer 10

String of pearls appearance.

Question 11

Polyarteritis Nodosa Histology

Answer 11

fibrinoid necrosis - highlighter pink color of vessel wall.

Question 12

Polyarteritis Nodosa treatment

Answer 12

corticosteroid or cyclophosphamide

Question 13

Kawasaki Disease - Clinical Presentation

Answer 13

fever
conjunctivitis
rash of the palms and soles
enlarged cervical lymph nodes

Question 14

Kawasaki Disease Vessels involved

Answer 14

Involves coronary artery, medium vessel vasculitis

Question 15

Kawasaki Disease Vessels Involved

Answer 15

Aspirin - one of the only situations in which you would give a child aspirin.
IVIG

Question 16

Buerger Disease

Answer 16

Medium vessel vasculitis of the fingers and toes strong association with smoking.
Disease leads to ulceration of fingers and toes, autoamputation.
Cessation of smoking terminates disease.
Raynaud phenomenon is often present.

Question 17

Wegener Granulomatosis

Answer 17

Small vessel vasculitis. Necrotizing granulomatous disease involving the nasopharynx, lungs, and kidneys.

C-ANCA positive

Cyclophosphamide

Question 18

Wegener Granulomatosis - clinical presentation

Answer 18

Middle aged males
sinusitis, nasopharyngeal ulceration
hematuria due to RPGN
C-ANCA levels correlates with disease activity.

Question 19

Microscopic Polynagiitis

Answer 19

Small vessel vasculitis. Necrotizing vasculitis involves the lung and kidney
- distinct from wegeners in that you will not see necrotizing granuloma. You also will not see nasopharyngeal involvement.

• P-ANCA

Question 20

Churg-Strauss

Answer 20

Necrotizing granulomatous vasculitis with eosinophils.

• Asthma and peripheral eosinophilia.
• P-ANCA

Question 21

Henoch Schonlein Purpura - HSP

Answer 21

Vasculitis due to IgA immune complex deposition.
palpable purpura on the buttocks and the legs.
inflammation makes the purpura palpable.
can get GI pain and bleeding
can get hemturia (IgA nephropathy)

– occurs following an upper respiratory tract infection.

Question 22

Henoch Schonlein Purpura - HSP treatment

Answer 22

self limited, if severe can consider treatment with steroids.

Question 23

Arteriosclerosis - types

Answer 23

Atherosclerosis - intimal plaque, involving medium and large vessels

Arteriolosclerosis - narrowing of the small vessels either deposition of protein in the wall (hyaline) or hyperplasia of smooth of the wall.

Monkeberg medial calcific sclerosis (not as clinically significant)

Question 24

Atherosclerosis

Answer 24

intimal plaque. consists of necrotic lipid core in the intima with fibromuscular cap. obstructs blood flow in the vessel.