Card - Path (Part 6: Vascular Disorders) Flashcards Preview

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Flashcards in Card - Path (Part 6: Vascular Disorders) Deck (62):
1

What is Raynaud's phenomenon? What is the mechanism, and to what is it a response?

Decreased blood flow to the skin due to arteriolar vasospasm in response to cold temperature or emotional stress

2

Where is Raynaud's phenomenon most often found on the body? What type of vessels does it affect?

Most often in the fingers and toes; Affects small vessels

3

What are the 2 different names given to Raynaud's phenomenon, and in what contexts?

(1) Raynaud's disease: primary (idiopathic) (2) Raynaud's syndrome: secondary to a disease process (such as mixed connective tissue disease, SLE, or CREST [limited form of systemic sclerosis] syndrome)

4

What is Raynaud's syndrome? What are some disease processes with which it may be associated?

Raynaud's phenomenon (decreased blood flow to skin due to arteriolar vasospasm in response to cold temperature of emotional stress) secondary to a disease process (such as mixed connective tissue disease, SLE, or CREST [limited form of systemic sclerosis] syndrome)

5

Give 9 examples of vascular tumors.

(1) Strawberry hemangioma (2) Cherry hemangioma (3) Pyogenic granuloma (4) Cystic hygroma (5) Glomus tumor (6) Bacillary angiomatosis (7) Angiosarcoma (8) Lymphangiosarcoma (9) Kaposi sarcoma

6

What is a Strawberry hemangioma? When does it appear, and what is its incidence? How does it develop and/or resolve over time?

Benign capillary hemangioma of infancy. Appears in first few weeks of life (1/200 births); grows rapidly and regresses spontaneously at 5 to 8 years old

7

What is a Cherry hemangioma? Does it regress? How does it change with age?

Benign capillary hemangioma of the elderly. Does not regress. Frequency increased with age.

8

What defines a pyogenic granuloma? With what 2 conditions is it associated?

Polypoid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.

9

What is a cystic hygroma? With what condition is it associated?

Cavernous lymphangioma of the neck. Associated with Turner syndrome.

10

What is a glomus tumor? From where does it arise?

Benign, painful, red-blue tumor under fingernails. Arises from modified smooth muscle cells of glomus body.

11

What defines bacillary angiomatosis? What causes this? For what is this frequently mistaken?

Benign capillary skin papules found in AIDS patients. Caused by Bartonella henselae infections. Frequently mistaken for Kaposi sarcoma.

12

What is angiosarcoma? Where does it typically occur, and in what patient population?

Rare blood vessel malignancy typically occurring in the head, neck, and breast areas. Usually in elderly, on sun-exposed areas.

13

With what 2 exposures is angiosarcoma associated?

Associated with radiation therapy and arsenic exposure.

14

Briefly discuss the progression and resection of angiosarcoma.

Very aggressive and difficult to resect due to delay in diagnosis.

15

What is lymphangiosarcoma, and with what is it associated? Give an example of a context in which this may occur.

Lymphatic malignancy associated with persistent lymphedema (e.g., post-radical mastectomy)

16

What is Kaposi sarcoma, and where in the body is it most commonly found? Where else it found?

Endothelial malignancy most commonly of the skin, but also mouth, GI tract, and respiratory tract

17

With what 2 pathogens is Kaposi sarcoma associated?

Associated with HHV-8 and HIV

18

For what is Kaposi sarcoma frequently mistaken?

Frequently mistaken for bacillary angiomatosis

19

What are the 3 major categories of vasculitis?

(1) Large-vessel vasculitis (2) Medium-vessel vasculitis (3) Small-vessel vasculitis

20

What are 2 types of large-vessel vasculitis?

(1) Temporal (giant cell) arteritis (2) Takayasu arteritis

21

What is another name for temporal arteritis? What patient population is generally affected by it?

Temporal (giant cell) arteritis; Generally elderly females

22

What are 3 symptoms/signs in the presentation of Temporal (giant cell) arteritis? Where applicable, give the cause. With what other condition is Temporal (giant cell) arteritis associated?

(1) Unilateral headache (temporal artery), (2) Jaw claudication (3) May lead to irreversible blindness due to opthalmic artery occlusion.; Associated with polymyalgia rheumatica

23

Which vessels are most commonly affected by Temporal (giant cell) arteritis?

Most commonly affects branches of carotid artery

24

What are 2 histological/lab findings that characterize Temporal (giant cell) arteritis?

(1) Focal granulomatous inflammation (2) High ESR

25

How is Temporal (giant cell) arteritis treated, when, and why?

Treat with high-dose corticosteroids prior to temporal artery biopsy to prevent vision loss

26

What patient population does Takayasu arteritis affect?

Asian females < 40 years old

27

What are 7 signs/symptoms that characterize the presentation of Takayasu arteritis?

(1) "Pulseless disease" (weak upper extremity pulses), (2) fever, (3) night sweats, (4) arthritis, (5) myalgias, (6) skin nodules, (7) ocular disturbances

28

What are 2 histologic/lab findings that characterize Takayasu arteritis?

(1) Granulomatous thickening and narrowing of aortic arch and proximal great vessels (2) High ESR

29

How is Takayasu arteritis treated?

Treat with corticosteroids

30

What are 3 examples of medium-vessel vasculitis?

(1) Polyarteritis nodosa (2) Kawasaki disease (3) Buerger disease (thromboangiitis obliterans)

31

What patient population does polyarteritis nodosa affect?

Young adults

32

What kind of seropositivity is associated with polyarteritis nodosa, and what percentage of polyarteritis nodosa patients have it?

Hepatitis B seropositivity in 30% of patients

33

What are 10 signs/symptoms that characterize the presentation of polyarteritis nodosa?

(1) Fever, (2) Weight loss, (3) Malaise, (4) Headache. GI: (5) Abdominal pain, (6) Melena. (7) Hypertension, (8) Neurologic dysfunction, (9) Cutaneous eruptions, (10) Renal damage.

34

What vessels does polyarteritis nodosa typically involve versus not involve?

Typically involves renal and visceral vessels, not pulmonary arteries

35

What is the underlying mechanism of polyarteritis nodosa?

Immune complex mediated

36

What are 2 histologic/imaging findings associated with Polyarteritis nodosa?

(1) Transmural inflammation of the arterial wall with fibrinoid necrosis (2) Innumerable microaneurysms and spasm on arteriogram

37

How is Polyarteritis nodosa treated?

Treat with corticosteroids, cyclophosphamide

38

What patient population does Kawasaki disease affect?

Asian children < 4 years old

39

What 6 signs/symptoms characterize the presentation of Kawasaki disease?

(1) Fever, (2) Cervical lymphadenitis, (3) Conjunctival injection, (4) Changes in lips/oral mucosa ("strawberry tongue"), (5) Hand-foot erythema, (6) Desquamating rash

40

What cardiac complication(s) may arise from Kawasaki disease?

May develop coronary artery aneurysms, thrombosis => MI, rupture.

41

How is Kawasaki disease treated?

Treat with IV immunoglobulins and aspirin

42

What is another name for Buerger disease? What patient population does it affect?

Buerger disease (thromboangiitis obliterans); Heavy smokers, males < 40 years old

43

What are 3 main sign/symptoms/consequences of Buerger disease (thromboangiitis obliterans)? What is the underlying pathophysiology leading to these? What other condition is often present?

Intermittent claudication may lead to (1) gangrene, (2) autoamputation of digits, (3) superficial nodular phlebitis; Raynaud phenomenon is often present

44

Besides it being a medium-vessel vasculitis, what else characterizes the kind of vasculitis that occurs in Buerger disease?

Segmental thrombosing vasculitis

45

How is Buerger disease (thromboangiitis obliterans) treated?

Treat with smoking cessation

46

What are 4 examples of small-vessel vasculitis?

(1) Granulomatosis with polyangitis (Wegener) (2) Microscopic polyangitis (3) Churg-Strauss syndrome (4) Henoch-Schonlein purpura

47

What is another name for Granulomatosis with polyangitis?

Granulomatosis with polyangitis (Wegener)

48

What are 3 broad areas affected by Granulomatosis with polyangitis (Wegener)? What are the 9 signs/symptoms spread across these broad areas that characterize the presentation of Wegener?

UPPER RESPIRATORY TRACT: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis; LOWER RESPIRATORY TRACT: hemoptysis, cough, dyspnea; RENAL: hematuria, red blood cell casts

49

What is the triad that characterizes Granulomatosis with polyangitis (Wegener)?

Triad: (1) Focal necrotizing vasculitis (2) Necrotizing granulomas in the lung and upper airway (3) Necrotizing glomerulonephritis

50

What are 2 histologic/imaging findings that characterize Granulomatosis with polyangitis (Wegener)?

(1) PR3-ANCA/c-ANCA (anti-proteinase (2) CXR: large nodular densities

51

How is Granulomatosis with polyangitis (Wegener) treated?

Treat with cyclophosphamide, corticosteroids

52

What is microscopic polyangitis? What 3 organs does it commonly involve, and how so?

Necrotizing vasculitis commonly involving lung, kidneys, and skin with pauci-immune glomerulonephritis and palpable purpura

53

To what other vasculitis does microscopic polyangiitis present similarly? What distinguishes it from this other vasculitis?

Presentation similar to granulomatosis with polyangiitis but without nasopharyngeal involvement. Also, No granulomas.

54

What histologic finding characterizes microscopic polyangiitis?

MPO-ANCA/p-ANCA (anti-myeloperoxidase)

55

How is microscopic polyangiitis treated?

Treat with cyclophosphamide and corticosteroids

56

What are 4 major signs/symptoms of Churg-Strauss syndrome? What are 3 other organs that it can also involve?

Asthma, Sinusitis, Palpable purpura, Peripheral neuropathy (e.g., wrist/foot drop); Can also involve heart, GI, kidneys (pauci-immune glomerulonephritis).

57

How does Churg-Strauss syndrome impact the kidneys?

Kidneys (pauci-immune glomerulonephritis)

58

What are 3 histologic/lab findings that characterize Churg-Strauss syndrome?

(1) Granulomatous, necrotizing vasculitis with eosinophilia (2) MPO-ANCA/p-ANC (3) High IgE level

59

What is the most common childhood systemic vasculitis?

Henoch-Schonlein purpura

60

What condition does Henoch-Schonlein purpura often follow?

Often follows URI

61

What is the classic triad of Henoch-Schonlein purpura?

Classic triad: (1) Skin: palpable purpura on buttocks/legs (2) Arthralgias (3) GI: abdominal pain, melena, multiple lesions of same age

62

To what is the vasculitis in Henoch-Schonlein purpura secondary? With what condition is HSP associated?

Vasculitis secondary to IgA complex deposition; Associated with IgA nephropathy