Vascular Path Flashcards
1
Q
Is SBP/DBP more important in determining CV risk?
A
SBP
2
Q
Postcapillary Venules
A
Sites of leukocyte exudation and vascular leakage
3
Q
The primary regulators of arterial blood pressure are…
A
arterioles and small muscular arteries
4
Q
Weibel-Palade Bodies
A
Membrane bound storage vesicles within endothelial cells that contain vWF
5
Q
Discontinuous Capillaries are located
A
Liver
Bone marrow
Spleen
6
Q
Continuous Capillaries are located
A
Fat
Muscle
CNS/PNS
7
Q
Fenestrated Capillaries are located
A
Intestinal villi
Endocrine glands
Kidney glomeruli
8
Q
Benign/Essential HTN
A
Controlled HTN with no short term problems
9
Q
Hypertensive Urgency
A
> 220/120 with no organ damage
10
Q
Hypertensive Emergency
Accelerated HTN
A
Significant increase in BP with organ damage
11
Q
Hypertensive Emergency
Malignant HTN
A
Significant increase in BP with organ damage and papilledema
12
Q
Licorice is bad because
A
It is structurally similar to aldosterone and then allows for Na retention
13
Q
Renal a. Stenosis –>
A
Increased renin secretion due to perceived hypovolemia
Increased Ang2 –> Increased Aldosterone
Vasoconstriction
Increased BP
Treat with surgery to correct stenosis
14
Q
ENaC control reabsorption of only
A
2% of Na
15
Q
Liddle Syndrome
A
Recessive mutation in PHA1 which causes an increased ENaC resorb and K secrete
16
Q
Primary Prevention
A
Prevent onset of disease in at risk pt –> susceptible
17
Q
Secondary Prevention
A
Early diagnosis and risk factor assessment –> asymptomatic
18
Q
Tertiary Prevention
A
Prevent recurrences with disease –> symptomatic
19
Q
Areas prone to atherosclerosis
A
Turbulent flow and low shear stress
20
Q
Occlusion must be >__ before Sx occur
A
70%
21
Q
Multiple atherosclerotic risk factors…
A
Are compounding –> 2 lead to 4x risk while 3 lead to 7x the risk
22
Q
Metabolic Syndrome
A
Hyperlipiemia Insulin resistance Obesity HTN (hypercoagulable and inflame state)
23
Q
Young obese woman presents with RUQ pain
A
Cholelithiasis
24
Q
Statins 2 functions in cholesterol metabolism
A
Inhibits HMG-CoA reductase and thus synthesis of cholesterol
Promote synthesis of LDL receptors
25
Estrogen replacement therapy does/does not decrease risk for MI in post menopausal women
DOES NOT
26
Best predictor of risk for CVD?
C-Reactive Protein
27
Infections that may contribute to atherosclerosis
Chylamydia pneumonia
cytomegalovirus
herpesvirus
28
True aneurysm
Bounded by arterial wall component or myocardium
29
Saccular aneurysm (True)
appears rounded (berry aneurysm)
30
Fusiform aneurysm
| True
involves long segment of artery, not rounded, common in aorta
31
```
False aneurysm
(Pseudoaneurysm)
```
Hematoma secondary to transmural rupture (vessel popped and hematoma outside vessel)
32
Using NSAIDs does what for CVD risk factors?
Inhibiting COX2 prostacyclin release by endothelium due to NSAIDs use leads to a high proportion of COX1 thromboxane A2 leading to a pro-thrombotic state
33
When does a AAA require surgery?
When the size become 5cm or greater
34
What is the mutation in Marfan's and how does it cause the clinical features?
Loss of function mutation of fibrillin in the FBN1 gene
| With decreased fibrillin 1 there is an increased TGF-B activity and serum levels which leads to overgrowth of bones
35
What was the mutation of Marfan's once thought to be?
Once thought to be a dominant negative mutation but it's not!! Autosomal dominant and sporadic pattern
36
Mutations in TGF-B receptors is called
Loeys-Dietz syndrome
37
Giant Cell Arteritis
```
Temporal arteritis
Granulomatous inflamm
Large aa. vasculitis
>50 y/o
Assc. polymyalgia rheumatica
Permanent blindness/diplopia
2/3 have anti-end or anti-SM Ab
```
38
Takaysu Arteritis
```
"Pulseless disease"
Granulomatous inflamm of aorta and major branches
<40
Weakening of pulses
Reduced BP in UE
```
39
Polyarteritis Nodosa
```
Medium sized vessel vasculitis
Necrotizing inflamm
Young adults
Renal aa. involvement w/o glomerulonephritis
30% with HepB Ag/Ab complex
palpable purpura
Malaise, HTN, melena, infarcts, weight loss, Abd pain, fever
Tx: steroids and cyclophosphamide
```
40
Kawasaki Disease
```
80%<4y/o
Anti-endo and anti-SM Ab
Involves coronary aa.
Strawberry tongue
Erythema/desquam rash on soles and palms
Mucocutaneous lymph node syndrome
conjunctival and oral erythema
```
41
Microscopic polyangitis
```
Leukocytoclastic vasculitis
Necrotizing vaculitis (Pauci-Immune)
p-ANCA (MPO-ANCA)
Palpable purpura
Necrotizing glomerulonephritis
Pulmonary capillaries
Hemoptysis
```
42
Churg-Strauss
Eosinophil-rich granulomatous necrotizing vasculitis
Involves RT, strong assc. w/allergic rhinitis, bronchial asthma, lung infiltrates
Blood esosinophilia
p-ANCA (MPO-ANCA)
Coronary artertitis
Eosinophilic myocarditis both cause morbidity and mortality
43
Behcet Disease
```
Neutrophilic vasculitis
1) Recurrent oral aphthous ulcers
2) Genital ulcers
3) Uveitis
HLA-B51
+ pathergy test (minor trauma results in exaggerated rxn)
```
44
Granulomatosis with polyangiitis
Wegener's granulomatosis
1) Acute necrotizing granulomas of URT LRT
2) Granulomas of vessels in lungs, upper airways and eyes/skin
3) Renal disease with focal necrotizing, crescentic, glomerulonephritis with hematuria/proteinuria/renal failure
c-ANCA(PR3-ANCA)
Proteinase 3 in azurophilic granules
45
Granulomatosis with Polyangitis Clinical Featuers
```
M>F ~40 yrs
Persistent pneumonitis, bilateral nodular and cavitary infiltrates
Chronic sinusitis
Mucosal ulcerations of nasopharynx
Renal disease
Tx: immunosuppresion
```
46
Lymphatoid Granulomatosis
```
Not a vasculitis
Often presents similar to Wegner's
Pulmonary infiltrates with lymphoid and plasmacytoid cells and cellular atypia
Infiltrates invade vessel walls
Evolving lymphoproliferative disorder
50% develop lymphoidmalignancy
```
47
Thomboangitis Obliterans
Segmental, thrombosing, acute and chronic inflammation which can involve veins and nerves
Often occurs in heavy smokers s
Severe pain even at rest due to nerves
48
Rheumatoid vasculitis
Clincially significant aortitis
| Visceral Infarction
49
Infective Vasculitis
Direct invasion of pseudomonas or Aspergillus and mucromycosis
Can result in mycotic aneurysm
50
Hypothermia
Vasoconstriction and increased permeability leads to edema
| Alcohol inducing vasodilation
51
Frostnip
Vasoconstriction involving nose, ears, hands and feet
52
Chillblain (Perniones/Perniosis)
Nonfreezing temperatures and damp conditions
| Chronic recurrent vasculitis with red raised lesions
53
Immersion
| Trench Foot
Feet wet but not freezing
May not heal, chronic pain, edema, blotchy discoloration
Superficial moist, liquefactive gangrene
54
Frostbite
Sudden sharp drops in temperature that are persistent
Vasoconstriction and increased viscosity
Hyperemia, edema, large clear blisters, vesicles filled with hemorrhagic fluid to complete gangrene
55
Raynaud Phenomenon
Primary due to emotion or cold induced vasoconstriction
Secondary due to arterial insufficiency caused by other conditions (SLE, systemic sclerosis, atherosclerosis, Buergers)
Red --> White --> Blue (fingertips)
56
Chronic Venous Insufficiency
Bilateral dusky brown coloring
Chronic edema
Ulcerations due to increased pressure
Chronic congestion
57
Phlebosclerosis
Elastic tissue degeneration and spotty calcifications in the media
58
Varicose veins
```
Dilated tortuous veins (elevated intraluminal pressure and loss of vessel wall support)
Vavlvular incompetence
Pedal edema
>50 yrs old, obese, women
Can develop stasis dermatitis
Variation in thickness of vein wall
```
59
Lymphangitis
Infections w/i lymphatics
Group A Beta hemolytic streptoccoci
Cause cellulitis/focal abscesses
Red streaks with painful enlarged regional lymph nodes
60
Lymphedema
```
Primary
1) Isolated congenital defects
2) Familial Milroy disease presenting with lymphatic agenesis or hypoplasia
3) lymphedema praecox
Secondary Obstructive
```
61
Chronic edema leads to
Thickended skin, brawny induration or peau d'orange
62
Chylous acites
Chylotrhrax
Chylopericardium
Caused by rupture of obstructed dilated lymphatic into the peritoneum, pleural cavity or pericardium
63
Angiomatosis
Involves large segments of the body
| such as entire extremity
64
Vascular Ectasis
Localized dilation of preexisting vessels
65
Glomus Tumor
Benign often painful tumor
From modified cells of glomus body
Often presents on distal digit
Speaialized glomus cells painful to touch
66
Cavernous Lymphangioma
Cystic Hygroma
Presents in children in neck/axillary
Assoicated with Turner syndrome 45X
67
Cavernous Hemangioma
Large, less circumscribed, involving deep structures
No tendency to regress
Locally destructive
68
Hemangioblastomas
Present in VHL Disease
Angiomatous lesions of cerebellum, brainstem and eye
Cystic neoplasms of pancreas and liver
69
Capillary hemangioma
Most common vascular tumor
70
Juvenile hemangioma
Strawberry type
Occurs in 1/200 newborns
May grow rapidly in first few months and then regresses in 75-90% cases by 7 y/o
71
Hemangiomas
Malignant transformation rare
| Common in skin and liver
72
Pyogenic granuloma
Rapidly growing red nodule on finger or lips
Bleed easily and ulcerate
Develop after trauma
Can present in gingiva in pregnancy
73
Telangiectasia
Congenital anomly or acquired permanent exaggeration of preformed vessels
74
Nevus Falmmeus
Most common form of ectasia
75
Leptomenignes
Inner two menignes
| Pia and Arachnoid mater
76
Port Wine Stain
May grow proportionately with child with no tendency to fade
77
Sturge-Weber Syndrome
Ipsilateral port wine stain in trigeminal nerve distribution
Assc. Sx: MR, seizures, hemiplegia, radiopacities in skill
Venous angiomatous masses in leptomeninges
78
Spider Telangiectasia
Dilated subQ aa.s around a central core that blanches with pressure
Occurs in states of hyperesterinism (pregnancy & cirrhosis)
Presents on face neck and upper chest
79
Hereditary Hemorrhagic Telangiectasia
Congenital dilation of capillaries
Presents widespread at birth on skin and mucosa
Pt have tendency to bleed due to dilated capillaries
Autosomal dominant mutation in TGF-B signaling pathway
80
Bacillary Angiomatosis
Opportunistic infection caused by gram negative Bartonella species (B.hensale and B.quintana)
HIF-1a induction by bacteria causes increased VEGF
Treat with erythromycin
81
Kaposi Sarcoma
```
Caused by HHV-8 which infects endo cells
G protein induced by virus induces VEGF
Hyaline globules may be found in cells
Most infxns are asymptomatic
Raised red-purple discoloration that progresses form flat lesion to plaque(w/RBC extravasation) to nodule that ulcerates
```
82
Epithelioid Hemangioendothelioma
Vascular tumor presents around medium-large vv. in soft tissue
Tumor cells plump and cuboidal
Tx with excision but 40% recur, 20-30% metastasis and 15% of metastasis lead to death
83
Angiosarcoma
Malignant well differentiated- anaplastic
Local invasion and metastasis common with 30% 5 year survival after metastasis
Induced by radiation, foreign material
Immunohisto: CD31, vWF, CD34 Factor 8
Present in skin, soft tissue, breast, liver
84
Hepatic angiosarcomas
Caused by carcinogens, arsenic, vinylyl chloride, thorotrast
85
Lymphangiosarcoma
Arise in chronic lymphedema
86
Hemangiopericytoma
Derived from pericytes
Staghorn branching pattern
Found pelvic retroperitonel or LE of middle aged women
half malignant half benign
87
Ballon Angioplasty Complications
Complications
1) Abrupt reclosure
2) Proliferative in-stent restenosis
88
Vascular Stent Complications
```
Early thrombosis (use platelet antagonists)
Late intimal thickening (use anti proliferative drugs)
```
89
Neointima
nothing
