Devine

Question 1

What is the cause of increased pulse pressure in aging?

Answer 1

Pulse pressure is systolic blood pressure minus diastolic. It is widened in aging due to loss of elasticity of the aorta as might occur in atherosclerosis

Question 2

What vessel is primarily responsible for increased blood pressure (and peripheral blood pressure regulation)?

Answer 2

The arteriole. It constricts to elevate pressure; dilates to lower pressure.

Question 3

Endothelial cell properties and functions

Answer 3

Maintains permeability layer

Question 4

Endothelial cell consequences of activation: endothelial dysfunction.

Answer 4

When activated, promotes thrombosis; modulates blood flow; activated endothelium is proinflammatory and promotes cell growth; endothelium oxidizes LDL cholesterol

Question 5

Endothelial dysfunction

Answer 5

Consequence of prolonged activation. Hypercoagulable, atherogenic and impaired vasodilation. Endothelial dysfunction is a feature of hypertension and diabetes.

Question 6

Varicosities; complications

Answer 6

Abnormally dilated, tortuous veins. Result in stasis/brown induration of legs, skin ulcers

Question 7

Phlebitis; where is the most significant location and the risks associated with it?

Answer 7

Inflammation of a vein; usually associated with thrombus, ie thrombophlebitis. Deep veins of the legs are most significant due to source of pulmonary embolus

Question 8

Define lymphangiitis. What is the usual cause?

Answer 8

Acute inflammation of lymph vessels; most commonly due to group A beta hemolytic streptococcus. Painful, subcutaneous red streak. Risk for sepsis (systemic response).

Question 9

Define lymphedema and list causes

Answer 9

Edema due to malformation or obstruction of lymph channels. May be primary (hereditary malformation) or secondary to tumor, surgery, filarial (elephantisias, due to massive enlargement of an extremity).

Question 10

What is the most serious complication of edema?

Answer 10

Complications include orange peel skin (peau d’orang) and angiosarcoma

Question 11

Define AV malformation

Answer 11

Abdnormal communication between an artery and a vein, without intervening capillaries

Question 12

What are the complications: AV malformation

Answer 12

May rupture/hemorrhage; may cause heart failure, rupture and hemorrhage

Question 13

What are the major morphologic features and most frequent consequences of atherosclerosis?

Answer 13

Fatty streak: earliest arterial change; may be seen in infancy; no consequences

Atheroma/atheromatous plaque: fibrofatty plaque; at bifurcations; origins of branches. Intima thickened; lipid core.

Plaque may be soft (noncalcified) or hard (calcified). Fibrous cap is thick in stable plaque; thin in vulnerable plaque.

Narrowing of coronary artery produces angina; plaque change results in unstable angina and myocardial infarction.

Weakened artery wall (aorta) results in aneurysm.

Question 14

What are specific consequences of atherosclerosis: Coronary arteries:

Answer 14

MI

Question 15

What are specific consequences of atherosclerosis: Carotid & cerebral arteries

Answer 15

Strokes

Question 16

What are specific consequences of atherosclerosis: Abdominal aorta

Answer 16

Aneurysm

Question 17

What are specific consequences of atherosclerosis: Iliac, popliteal arteries

Answer 17

Gangrene of the leg

Question 18

Describe the response to injury theory of atherogenesis

Answer 18

Chronic endothelial injury (key event)- may be injured by oxidized LDL, cigarette smoke, hypertension and others
Endothelial activation leads to platelet, leukocyte adhesion and emigration into subendothelium. Macrophages, smooth muscle cells, proliferation of ECM accumulate in subendothelium

Question 19

Risk factors for atherosclerosis

Answer 19

Nonmodifiable: age, sex (males earlier than females); family history; familial hypercholesterolemia (LDL receptor defect and others)
Modifiable risk
Hyperlipidemia, especially hypercholesterolemia, especially LDL cholesterol (>130)
Hypertrigyceridemia
Hypertension
High carbohydrate intake
Diabetes mellitus
Cigarette smoking
Chronic inflammatory diseases such as rheumatoid arthritis
Renal insufficiency
Lesser: obesity; physical inactivity; type A personality

Question 20

What factors lower risk for atherosclerosis?

Answer 20

HDL, the higher the better; higher than 40 OK; >60 very good
Lower LDL
No smoking
Regular exercise (30 min aerobic/day)
Good control of blood pressure; diabetes mellitus
Weight reduction if overweight
Alcohol in moderation

Question 21

Describe, in sequence, retinal changes of atherosclerosis.

Answer 21

Hyaline thickening
Arteriovenous nicking
Copper wire arterioles
Silver wire arterioles

Question 22

Know the categories of hypertension. What is the most common type?

Answer 22

Hypertension: blood pressure > 140/90 mmHg.
Essential – most common; multifactoral pathogenesis
Secondary (120/80 < 140/90), hypertension, and malignant hypertension (>160/120)

Question 23

What are the two major categories of effects implicated in the pathogenesis of essential hypertension.

Answer 23

Reduced sodium and water excretion

Vascular constriction

Question 24

What environmental factors contribute to essential hypertension?

Answer 24

Environmental factors: obesity (insulin increased); stress, smoking; physical inactivity; high sodium-low potassium intake

Question 25

Name some hereditary causes of dysregulation of sodium.

Answer 25

Liddle syndrome: increased renal tubular reabsorption of sodium Bartter syndrome : defect in chloride resorption leads to increased serum sodium; BP normal

Question 26

Define malignant hypertension. What are the retinal changes?

Answer 26

Blood pressure rapidly rises to greater than 160/120; risk of immediate death: renal failure; Cerebral edema (headache, stupor); papilledema, retinal hemorrhages; cotton wool spots

Question 27

Describe the morphology and the complications of hypertension.

Answer 27

Morphology: arteriole changes – hyaline arteriolosclerosis (“benign” hypertension); hyperplastic arteriolosclerosis

Question 28

Complications of hypertension

Answer 28

Renal failure Stroke Myocardial infarction Congestive heart failure

Question 29

Hypertensive retinopathy

Answer 29

``` Narrowing of arterioles Hemorrhages Cotton wool spots (infarcts of nerves) Macular star Papilledema ```

Question 30

Define aneurysm. What are the types, associated with locations and causes?

Answer 30

Dilation of an artery- fusiform or saccular Syphilic aneurysm: thoracic aorta Berry aneurysm (Circle of Willis) : hypertension + smoking Abdominal aortic aneurysm: atherosclerosis + smoking- below kidneys; more common in males over 50. Prone to rupture resulting in death.

Question 31

Aortic dissections

Answer 31

Wall of an artery is split longitudinally by blood accumulating between the layers. Aortic dissection/dissecting aneurysm of the thoracic aorta is due to hypertension; Marfan’s disease. Cystic medial degeneration (necrosis) of elastic tissue permits dissection Clinical: sudden, excruciating pain in anterior chest radiates to back and moves downward. Fatal, due to vessel rupture, without treatment

Question 32

What infections cause vasculitis?

Answer 32

Syphilis; meningococcemia (Neisseria meningitides); Rocky Mountain spotted fever; aspergillus Most manifest as a rash. Some (syphilis) lead to aneurysm, rupture or occlusion (aspergillus).

Question 33

Define Behçet disease

Answer 33

Vasculitis that involves the mucosa; uveitis Thrombosis, aneurysms, hemorrhages Aphthous ulcers of mucosa

Question 34

Describe Raynaud phenomenon. List causes

Answer 34

Pallor/cyanosis of hands, feet, nose, ears on exposure to cold Causes: primary, young women; secondary: autoimmune disease, eg Lupus, Scleroderma; Cryoglobulinemia (increased IgM)

Question 35

What are the two microscopic types of hemangiomas? Which is most common in infants? Which does not regress?

Answer 35

Capillary hemangioma. Juvenile/strawberry, most common on skin of head/neck; regresses spontaneously Cavernous: Deep; larger vascular channels; does not regress

Question 36

What is the nature and location of the “pregnancy tumor”? What is the same lesion called at other locations?

Answer 36

Granuloma pyogenicum. Occurs at the gum line of pregnant women or elsewhere. Bleeds, rapid growth of granulation (reactive proliferation) tissue.

Question 37

What are two types of lymphangiomas?

Answer 37

Simple, capillary | Cystic hygroma: occurs in neck, axilla

Question 38

What are the features of port wine stain including the pathology? Describe Sturge-Weber syndrome

Answer 38

Dilated – ecstatic vascular channels. Most commonly involves the face; does not regress. Sturge-Weber involves trigeminal distribution and is associated with vascular malformation w/in the eye that leads to glaucoma, cataract.

Question 39

What are telangiectasias? What are associations of : common telangiectasias?

Answer 39

Dilated small blood vessels. Commonly due to sun-damage of skin; radiation

Question 40

Spider telangiectasia (“angioma”)?

Answer 40

Spider shape; chest; due to excess estrogen, eg liver failure

Question 41

What are the causes and clinical features of Bacillary angiomatosis and Kaposi sarcoma?

Answer 41

Both occur in HIV. Bacillary angiomatosis due to infection with Bartonella- treat with antibiotics; KS due to Herpes virus 8

Question 42

What is the nature and what are three clinical scenarios in which angiosarcoma occurs?

Answer 42

Angiosarcoma is aggressively malignant, usually fatal, metastasizes early Arises in: chronic lymphedema, eg following mastectomy liver in polyvinyl chloride occupational exposure radiation exposure