Pathology of peripheral vascular disease

Question 1

True aneurysm

Answer 1

Involves all 3 layers of the artery (intima, media and adventitious) or the attenuated wall of the heart)

Question 2

False aneurysm

Answer 2

Is a wall defect leading to the formation of an extra vascular hematoma that communicates with the intramuscular space “pulsating hematoma)

Question 3

In a pseudo aneurysm involving the arterial dissections we see pressurized blood gains entry to the arterial wall through

Answer 3

A surface defect and then pushes apart underlying layers

Question 4

Aneurysms are classified by macroscopic shape and size

Answer 4

1. Secular aneurysm

2. Fusiform aneurysm

Question 5

Spherical outpouchings, ranging from 5 to 20 cm in diameter, involving only a portion of the vessel wall and often contain thrombus

Answer 5

Saccular aneurysm

Question 6

Diffuse, circumferential dilutions of long vascular segment, put to 2o cm in diameter; these most commonly involve the aortic arch, the abdominal aorta or the iliac arteries

Answer 6

Fusiform aneurysm

Question 7

The most important predisposing conditions are for an aortic aneurysm:

Answer 7

1. Atherosclerosis
2. Cystic medial degeneration
3. Other conditions that weaken vessel wall such as trauma, congenital defects, vasculitis and infection

Question 8

Vascular disease develops through two principal mechanisms:

Answer 8

1. Narrowing or complete obstruction though either a progressive process like atherosclerosis or an acute event like thrombosis or embolism
2. Weakening of vessel walls such as in a dilation or rupture

Question 9

Diseases of the arterial system

Answer 9

1. Atherosclerosis

2. Aneurysms and dissections

Question 10

Progressive narrowing of the carotid arteries by atherosclerosis leads to Carotid stenosis

Answer 10

Carotid atherosclerosis

Question 11

Where is the most common site of plaque build up

Answer 11

Bifurcation

Question 12

carotid stenosis increases the risk of stroke by

Answer 12

1. narrowing the artery and reducing blood flow to the brain
2. blood clot formation
3. plaque deposits rupture and become lodged on a downstream smaller artery

Question 13

carotid stenosis is asymptomatic or what?

Answer 13

it is asymptomatic and usually the first symptom is a TIA

Question 14

TIA typically last a couple of minutes and then resolve completely thus they can be ignored

Answer 14

NOOO!

warning sign of an ischemic stroke and permanent brain injury

Question 15

ischemic stroke symptoms

Answer 15

1. drooping face
2. vision problems
3. difficulty speaking
4. paralysis of one side of body
5. weakness/numbness in an arm/leg

Question 16

medications for carotid stenosis

Answer 16

1. antiplatelet
2. statin
3. HTN

Question 17

surgery for carotid stenosis

Answer 17

endarterectomy, angioplasty and bypass

Question 18

AAA pathogenesis:

1. men or women
2. lifestyle risk
3. onset
4. major cause
5. microscopically
6. other contributing factors
7. positioned
8. saccular or fusiform
9. frequently contains

Answer 18

1. men
2. smoking
3. 50 yr
4. atherosclerosis major cause
5. microscopically–> atherosclerosis with destruction and thinning of the underlying aortic media
6. hereditary defect or alter balance of collagen degradation and synthesis
7. positioned below the renal arteries and above bifurcation of aorta
8. either
9. contains a laminated mural thrombus

Question 19

clinical consequences of AAA

Answer 19

1. rupture
2. obstruction leading to tissue ichemic injury
3. embolism
4. impingment and compression

Question 20

syphilitic aneurysm:

1. caused
2. complication
3. tertiary stage
4. consequences

Answer 20

1. caused by spirocheted T. palladium
2. rare complication due to early recog. and tx. of syphilis
3. tertiary stage causes obliterative endarteritis of the small vessels
4. results in ischemia and dilatation of aorta/aorta annulus and eventually to valvular insufficiency

Question 21

aortic dissection

Answer 21

blood dissects apart the media to form a blood-filled channel within the aortic wall leading to massive hemorrhage and cardiac tamponade

Question 22

cardiac tamponade

Answer 22

hemorrhage into the pericardial sac

Question 23

aortic dissection pathogenesis:

1. occurs in older pt. (40-60yr) due to
2. occurs in younger patients where they have a
3. classifications

Answer 23

1. older pt. HTN
2. younger pt. connective tissue abn.
3. a. type A dissection (proximal) more common and dangerous b/c involves the ascending aorta. DeBakey type I (involves descending aorta) DeBakey type II ( does not involve the descending aorta)
   b. Type B dissection—> debarked type III (beginning beyond the subclavian artery.

Question 24

Is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilatation or ballooning of the blood vessel

Answer 24

Intracranial aneurysm

Question 25

Intracranial aneurysm 1. Lifestyle risk factors 2. Genetic conditions 3. Classifications (3) 4. Aneurysm in the ____ have a higher risk of rupture 5. Symptoms 6. Treatment 7. Prognosis

Answer 25

1. Lifestyle risk factors: HTN, smoking alcoholism and obesity 2. Genetic conditions: Marian, MEN, AD-PKD, neurofibromatosis 3. I. Saccular- berry aneurysm II. Fusiform- widening of entire artery III. Microaneurysm- Charcot-Bouchard ( small blood vessel) 4. Posterior circulation have a higher risk of rupture 5. Barely any symptoms— there may be some nausea, vomiting, headache, confusion, loss of consciousness or visual abn. 6. Surgical slipping/endovascular coiling or cerebral bypass surgery 7. Depends

Question 26

Diseases of venous system and thrombosis

Answer 26

1. Varicose veins | 2. DVT

Question 27

Varicose veins and phlebothrombosis/ thrombophlebitis account for at least ______ of cases of clinically relevant venous disease

Answer 27

90%

Question 28

Varicose veins 1. What is it 2. Which veins involved 3. Men/ women 4. Associates with 5. Clinical features

Answer 28

1. Abn. Dilated tortuous veins produced by chronically increased intraluminal pressures and weakened wall support 2. Superficial veins of the upper and lower leg 3. 1/5 men and 1/3 women 4. Associates with obesity, compression of the vena cava during pregnancy and there is a familial tendency 5. Clinical features— valves become incompetent and leads to thrombosis

Question 29

DVT: 1. Local manifestations 2. Common and serious clinical complication of DVT

Answer 29

1. Local manifestations— distal edema, swelling and pain (from pressure) Hoffman sign positive 2. Pulmonary embolism is the most common and serious complication

Question 30

Pathogenesis of thrombosis: virchow triad

Answer 30

1. Endothelial injury 2. Turbulence (abn. Blood flow) 3. Hypercoagulability

Question 31

Risk factors for hypercoagulable states

Answer 31

1. Primary (genetic)— factor V mut. | 2. Secondary (acquired)— prolonged bed rest, MI, Afib, prosthetic cardiac valve

Question 32

vasa vasorum associated with

Answer 32

syphilitic aneurysm

Question 33

most common site of intracranial saccular aneurysm

Answer 33

anterior communicating artery

Question 34

most common aneurysm in the posterior circulation

Answer 34

basilar artery