Exam2, Blood vessels gomez Flashcards Preview

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Flashcards in Exam2, Blood vessels gomez Deck (99):
1

give examples of elastic arteries

large like aorta & large branches, pulmonary aa

2

give examples of muscular aa

medium sized branches from aorta

3

what are the vasa vasorum aa

feed medium and large arteries, found in the inter 1/2-2/3 media

4

what layer of arterioles change the lumen diamter

medial smooth muscle

5

what happens to resistance if you half the diameter in arteriole

resistance increases 16 fold

6

what aa have greets regulation affect on blood pressure

small muscular aa- arterioles

7

where dose leukocyte exudation and vascular leakage occur

in postcapillary venules

8

describe size and cell lining of a capillary

diameter of a RBC 7-8 um endothelial cell lining without media, has pericytes around it

9

describe the structure and function of lymphatics

endothelial, no media valves in larger lymph vessels return interstitial fluid and inflammarotyr cells to blood important pathway in disease dissemination

10

Where are weibel palade bodies found and what are they

found in endothelial cells they are membrae bound storage organelles with vWF

11

what are the 3 types of endothelial cells

fenestrated, discontinuous (sinusoidal) and continuous

12

what factors are expressed on endothelial cells

vWF, FVIII, CD34 and CD31(PECAM-1)

13

what are the anti-coagulant natural regulators

prostacyclin thrombomodulin heparin like molecules plasminogen activator

14

what are the natura prothrombotic regulators

vWF tisue factor plasminogen activator inhibitor

15

What are the ECM molecules that vasoconstrict and vasodilate

vasoconstrict: endothelin and ACE vasodilate: NO, prostacyclin

16

What are the natura regulators of inflammation and immunity in endothlium

IL1 IL6 chemokines adhesion: VCAM-1, ICAM, E-selectin, P-selectin histocompatability Ag

17

What molecules from endothelium stimulate growth? inhibit?

stimulators: PDGF, CSF, FGF inhibitors: heparin, TGF-beta

18

what are arteriovenous fistulas

rar abnormal communications between aa and vv most are congenital

19

What is fibromuscular dysplasia

focal irregular medial and intimal hyperplasia with thickening of walls of medium and large muscular aa most common in young women

20

What is HTN in adults >60

> 150/90

21

what are additional risks with HTN

coronary artery disease, cerebral vascular accidents, hypertensive heart disease aortic dissection, renal failure

22

What are the major factors that determine BP

age gender, BMI and diet genetic variation in genes of RAAS that increase Na retention

23

what is a hypertensive urgency

>220 / >120 with NO evidence of target organ damage

24

what is accelerated HTN

hypertensive emergency of significan increase in BP with organ damage

25

What is malignant HTN

target organ damage with papilledema

26

What are renal causes of secondary HTN

acute glomerulonephritis chronic renal disease polycystic disease renal artery stenosis renal vasculitis renin-producing tumors

27

What are the endocrine causes of secondary HTN

adrenocortical hyper function (cushing, primary aldosteronism, licorice ingestion) exogenous hormones pheochromocytoma acromegaly hypothyroidism hyperthyroidism pregnangyc induced

28

what are the cardiovascular causes of secondary HTN

coarctation of aorta polyarteritis nodosa increased intravascular volume increased CO rigidity of the aorta

29

what are the neurologic causes of secondary HTN

psychogenic increased intracranial pressure sleep apnea acute stress, including surgery

30

how does licorice ingestion cause HTN

molecule is similar structure to cortisol and aldosterone

31

what occurs in RAAS system with 11B-hydroxylase deficiency

increase mineralocorticoids

32

What is liddle syndrome

moderately severe salt sensitive HTN due to increased distal tubular reabsorption of Na with aldosterone stimulation

33

what are the 3 patterns of arteriosclerosis

monckeberg medial calcific sclerosis arterolosclerosis atherosclerosis

34

what is monckeberg medial calcific sclerosis

in muscular aa >50 y/o with no vessel umen narrowing

35

what is arterolosclerosis

in small arteries and arterioles

36

what is atherosclerosis

atheromas= atheromatous plaques develop in elastic aa and muscular aa

37

what systemid diseases is hyaline arterolosclerosis seen in

aging, DM, benign nephrosclerosis

38

what is hyperplastic arteriolosclerosis and what disease has this manifestation

cell death (onion skinning) sometimes necrotizing arteriolitis seen in malignant HTN

39

what type of flow dynamics are prone to atherosclerosis

turbulent flow and low shear stress

40

how does laminar flow protect you from atherosclerosis

induces endothelial genes for products that protect against atherosclerosis (superoxide dismutase)

41

what are the nonmodifiable risks for atherosclerosis

genetic abnormalities, family history, increasing age, male gender

42

what are the modifiable risks for atherosclerosis

hyperlipidemia hypertension cigarette smoking diabetes inflammation

43

If you have 3 of the risk factors for atherosclerosis what is your risk

ischemic heart disease

44

obesity increases risk for what syndromes

diabetes, HTN, hypertriglyceridemia

45

what metabolic syndromes are at increased risk from obesity

obesity, dyslipidemia, HTN, insulin resistance

46

What are the 2 major pathways for cholesterol metabolism

2/3 LDL receptor pathway 1/3 Scavenger R pathway

47

what apolipoproteins does LDL bind to

B-100 and E

48

cholesterol released from LDL suppresses cholesterol synthesis how

inhibits 2HMG coenzyme A reductase

activates cholesterol acyltransferase (storage of excess cholesterol)

down regulates synthesis of cell surface LDL R

49

oversupply of cholesterol inhibits what processes in the metabolism pathway

HMG CoA reductase

synthesis of LDL receptors

50

what decreases risk of hyperlipidemia

exercise and alcohol

increased HDL

51

what type of fats are okay

omega 3 beneficial

52

what are the effects of estrogen on HDL and LDL

increase HDL and LDL

however replacement therapy does not decrease risk of MI in post menopausal women

53

What causes familial hypercholesterolemia

mutations in LDL R gene

impair the intracell transport and catabolism of LDL

impair transport of IDL

cause elevated LDL cholesterol in the plasma

54

What is the scavenger R pathway for LDL

oxidized LDL R

found on macrophages, monocytes, smooth m and endothelial cells

55

amount catabolized by scavenger R pathway is directly related to what plasma level

cholesterol

56

how does oxidized cholesterol affect cells in body

in macrophages it contributes to atherosclerosis and xanthoma formation

endothelial  and smooth muscle cells

57

What is the most common mutation in cholesterol metabolism

class II R protein transport from ER to golgi apparatus is impaired from abnormal protein folding

58

What are the genetics behind familial hypercholesterolemia

Autosomal dominant

heterozygotes 2-3x elevation of plasma cholesterol levels

homozygotes 5x elevation of plasma cholesterol levels

59

what are symptoms and signs of homozygous familial hypercholesterolemia

develop severe atherosclerosis, mitral valve stenosis, corneal arcus, xanthomas

60

elevated plasminogen activator inhibitor 1 is a strong predictor of what

major atherosclerotic events

sedentary life style

stress

61

what is the role of C reactive protein

roles in opsonizing bacteria and activating complement

62

how does CRP contribute to atherosclerosis

involved in endothelial adhesion of WBCs and thrombosis

63

what is elevated CRP a strong independent predictor for

risk of MI, stroke, PAD, and sudden cardiac death

64

will lowering of CRP reduce cardiovascular risk

no

65

what is the pathogensis of arterial wall changes in response to injury hypothesis

chronic endothelial injury

accumulation lipoproteins with subsequent oxidation

adhesion of monocytes with migration into intima

adhesion and activation of platelets

migration os smooth muscle cells becoming neointimal smooth muscle cells

accumulation of lipids in macrophages (foam cells) smooth muscle cells and extracellular spaces

66

what infections can lead to atherosclerosis

chlaymydia pneumonia, herpesvirus and cytomegalovirus

67

what cellular process leads to aneurysms and rupture

macrophage matix metalloproteinases and inflammation induced smooth muscle apoptosis

68

What is celebrex or celexoib and what does in inhibit

Cox inhibitor, preferentially Cox 2 so prostacyclin, leads to prothormbotic state because COX2 not inhibited

69

What are the most important causes of abdominal aortas

atherosclerosis (aortic)

 HTN via medial cystic degeneration (thoracic)

70

What are some syndromes that are associated with AAA

marfan syndrome

loeys dietz syndrome

ehlers danlos syndrome

scurvy

trauma

congenital defects

syphilis and vasculitides

71

what are mycotic aneurysms caused by

septic embolus (infective endocarditis)

extension of an adjacent suppurative process

circulating organisms infecting the arterial wall

72

what are the types of true aneurysms

saccular aneurysm-apears rounded

fusiform aneurysm- involves long segment of artery and is not rounded

73

what is a pseudoaneurysm

false aneurysm

hematoma secondary to transmural rupture

74

what is the demographic distribution of AAA

 

M>F

smokers and age>50

 

 

75

What are inflammatory AAA

rich in lymphocytes, plasma cells and macrophages

often giant cells

cause uncertain

occur at younger age

76

What infects mycotic AAA

salmonella gastroenteritis

77

at what size are AAA surgically repaired

5 cm

78

what are they types of syphilitic (Luetic) aneurysms

obliterative endarteritis-- tertiarty stage syphilis with the arterioles of thoracic aorta

syphilitic aortitis-- obliterative endarteritis of vasa causing ischemic injury of media causing loss of the medial elastic fibers and muscle cells

79

how does syphilitic aortitis lead to aortic valve incompetence

can lead to aneurysmal dilation that can include aortic annulus

can involve coronary ostia

80

What is an aortic dissection

dissection of blood between planes of the media

81

What population are aortic dissections most common in

>90% in men 40-60 with HTN

82

what procedure can cause iatrogenic aortic dissection

arterial cannulation

83

How do you Tx an aortic dissection

antiHTN therapy and aortic plication

84

what is characteristic symptoms onset of aortic dissection

sudden onset of excrutiatin pain, usually involves anterior chest, radiating to the back, and moving downard as the dissection progressesl

85

where do aortic dissections usually occur

within 10 cm aortic valve

86

what is the genetic basis of marfan syndrome

loss of function mutation of fibrillin

>500 mutations of FBN1 gene for fibrillin 1

prevents normal assemly of microfibrils

87

what is the genetic inheritance of marfan syndrome usually

autosomal dominant. familial

88

why does loeys dietz syndrome have similar signs to marfan

because fibrillin decrease leads to increase TGF beta

Loeys Dietz syndrome involves mutations in TGF beta R

89

What are the skeletal manifestations of marfan syndrome

slender with abnormally long legs, arms and fingers. high arched palate, hyperextensibility of joints, spinal deformities

pectus excavatum or pigeon breast

90

what are they eye manifestations of marfan syndrome

bilateral dislocation of lens from wekaness suspensory ligaments

91

what are the CV manifestations of marfan syndrome

aneurysmal dilation and aortic dissection, dilation of the aortic valve ring (aortic incompetence)

mitral and tricuspid valve floppy calce syndrome giving rise to congestive cardiac failure

92

What does marfan look like on cross section of aortic media

areas devoid of elastin that resemble cystic spaces that are filled with proteoglycans

93

What are types of ANCA mediated vasculitis

wegener granulomatosis (PR3-ANCA/c-ANCA)

Microscopic polyangiitis/polyarteritis (MPO-ANCA/p-ANCA)

Churg-Strauss syndrome (MPO-ANCA/p-ANCA)

94

What are the direct Ab mediated vasculitis

Goodpastures syndrome (anti-glomerular basement membrane Ab)

Kawasaki disease (anti-endothelial Ab and also anti smooth muscle cell Ab)

95

What are the immune complex mediated causes of vasculitis

infection induced (Hep B or C)

Henoch-Schonlein purpura

SLE and RA

polyarteritis nodosa

Drug induced HS reactions

cryoglobulinemia

serum sickness

96

what are the nonspcific Sx with vasculitis

fever

weight loss

myalgia

arthralgia

malaise

fatigue

97

what are the types of large vessel vasculitis

giant cell (temporal ) arteritis: polymyalgia, usually patients older than 50

takayasus arteritis: grnaulomatous inflammation in patients younger than age 50

98

What are types of medium vessel vasculitis

polyarteritis nodosa: necrotizing inflammation typically involving renal aa but sparing pulmonary vessels

kawasaki disease: arteritis with mucocutaneous lymph nodes. occurs in children

99

what are types of small vessel vasculitis

wegener granulomatosis- PR3 ANCA

churg strauss syndrome- MPO ANCA, eos rich granulomatous inflammation

microscopic polyangiitis- MPO ANCA, necrotizing