Vascular Pathology

Question 1

What is vasculitis?

Answer 1

Inflammation of the blood vessel wall.

Question 2

What are the layers of the arterial wall?

Answer 2

Endothelial intima smooth muscle media

Question 3

What are common clinical features of vasculitis?

Answer 3

Nonspecific inflammatory symptoms (fever fatigue

Question 4

How is vasculitis classified by vessel size?

Answer 4

Large-vessel (aorta and major branches) medium-vessel (muscular arteries to organs)

Question 5

What is temporal (giant cell) arteritis?

Answer 5

Granulomatous vasculitis involving branches of the carotid artery common in older adults

Question 6

What are key symptoms of temporal arteritis?

Answer 6

Headache (temporal artery) visual disturbances (ophthalmic artery)

Question 7

How is temporal arteritis diagnosed and treated?

Answer 7

Diagnosis requires a biopsy with giant cells and intimal fibrosis; treatment is corticosteroids to prevent blindness.

Question 8

What is Takayasu arteritis?

Answer 8

Granulomatous vasculitis involving the aortic arch at branch points often in young Asian females.

Question 9

What are the main clinical features of Takayasu arteritis?

Answer 9

Visual and neurologic symptoms weak or absent pulse in the upper extremity (“pulseless disease”)

Question 10

How is Takayasu arteritis treated? .

Answer 10

Corticosteroids

Question 11

What is polyarteritis nodosa?

Answer 11

Necrotizing vasculitis involving multiple organs except the lungs common in young adults.

Question 12

What are key symptoms of polyarteritis nodosa?

Answer 12

Hypertension (renal artery) abdominal pain with melena (mesenteric artery)

Question 13

What does polyarteritis nodosa look like on imaging?

Answer 13

“String-of-pearls” appearance due to varying stages of lesions with transmural inflammation and fibrinoid necrosis.

Question 14

How is polyarteritis nodosa treated?

Answer 14

Corticosteroids and cyclophosphamide; fatal if untreated.

Question 15

What is Kawasaki disease?

Answer 15

An acute vasculitis affecting children especially Asian children under 4 years old.

Question 16

What are clinical features of Kawasaki disease?

Answer 16

conjunctivitis Fever

Question 17

What are the main complications of Kawasaki disease?

Answer 17

Coronary artery thrombosis (risk of MI) and aneurysm with rupture.

Question 18

How is Kawasaki disease treated?

Answer 18

Aspirin and IVIG; it is self-limited.

Question 19

What is Buerger disease?

Answer 19

A necrotizing vasculitis affecting the digits often associated with smoking.

Question 20

What are symptoms of Buerger disease?

Answer 20

Ulceration gangrene

Question 21

How is Buerger disease treated?

Answer 21

Smoking cessation.

Question 22

What is Wegener granulomatosis?

Answer 22

Necrotizing granulomatous vasculitis affecting the nasopharynx lungs

Question 23

What are symptoms of Wegener granulomatosis?

Answer 23

Sinusitis or nasopharyngeal ulcers hemoptysis with lung nodules

Question 24

What lab marker is associated with Wegener granulomatosis?

Answer 24

Serum c-ANCA which correlates with disease activity.

Question 25

How is Wegener granulomatosis diagnosed and treated?

Answer 25

Biopsy shows necrotizing granulomas; treatment is cyclophosphamide and steroids though relapses are common.

Question 26

What is microscopic polyangiitis?

Answer 26

Necrotizing vasculitis similar to Wegener's but without nasopharyngeal involvement or granulomas.

Question 27

What lab marker is associated with microscopic polyangiitis?

Answer 27

Serum p-ANCA which correlates with disease activity.

Question 28

How is microscopic polyangiitis treated?

Answer 28

Corticosteroids and cyclophosphamide; relapses are common.

Question 29

What is Churg-Strauss syndrome?

Answer 29

Necrotizing granulomatous vasculitis with eosinophils affecting multiple organs

Question 30

What are key features of Churg-Strauss syndrome?

Answer 30

Asthma peripheral eosinophilia

Question 31

What is Henoch-Schönlein purpura?

Answer 31

IgA-mediated vasculitis the most common vasculitis in children.

Question 32

What are symptoms of Henoch-Schönlein purpura?

Answer 32

Palpable purpura on buttocks/legs GI pain/bleeding

Question 33

How is Henoch-Schönlein purpura treated?

Answer 33

Usually self-limited; steroids if severe.

Question 34

What is hypertension?

Answer 34

Increased blood pressure which can affect the systemic or pulmonary circulation.

Question 35

How is systemic hypertension (HTN) defined?

Answer 35

Pressure ≥ 140/90 mm Hg; normal is <120/80 mm Hg.

Question 36

How is HTN classified based on etiology?

Answer 36

Primary (unknown cause 95%) and secondary (identifiable cause

Question 37

What are the risk factors for primary hypertension?

Answer 37

Age race (higher in African Americans)

Question 38

What is a common cause of secondary hypertension?

Answer 38

Renal artery stenosis known as renovascular hypertension.

Question 39

How does renal artery stenosis lead to HTN?

Answer 39

Stenosis reduces glomerular blood flow activating the JGA to secrete renin

Question 40

What causes renal artery stenosis?

Answer 40

Atherosclerosis (in elderly males) and fibromuscular dysplasia (in young females).

Question 41

What is fibromuscular dysplasia?

Answer 41

A developmental defect causing irregular thickening of large- and medium-sized arteries especially the renal artery.

Question 42

How else can HTN be classified?

Answer 42

Benign (most cases slow damage) and malignant (severe HTN > 200/120 mm Hg).

Question 43

What are signs of malignant hypertension?

Answer 43

Acute end-organ damage including acute renal failure

Question 44

What is arteriosclerosis?

Answer 44

Hardening of the arteries due to thickening of the vessel wall.

Question 45

What are the three types of arteriosclerosis?

Answer 45

Atherosclerosis arteriolosclerosis

Question 46

What is atherosclerosis?

Answer 46

Intimal plaque formation in large- and medium-sized arteries often with a necrotic core and fibromuscular cap.

Question 47

What are common sites of atherosclerosis?

Answer 47

Abdominal aorta coronary artery

Question 48

What are modifiable risk factors for atherosclerosis?

Answer 48

Hypertension high LDL cholesterol

Question 49

What are non-modifiable risk factors for atherosclerosis?

Answer 49

Age gender (higher in males and postmenopausal females)

Question 50

What initiates the formation of atherosclerosis?

Answer 50

Endothelial damage allowing lipids to enter the intima.

Question 51

What forms foam cells in atherosclerosis?

Answer 51

Macrophages consume oxidized lipids becoming foam cells.

Question 52

What are the stages of atherosclerosis development?

Answer 52

Starts as fatty streaks (lipid-laden macrophages) progressing to atherosclerotic plaque.

Question 53

What are complications of atherosclerosis?

Answer 53

Stenosis plaque rupture with thrombosis

Question 54

What does stenosis of medium-sized vessels cause?

Answer 54

Impaired blood flow leading to peripheral vascular disease angina

Question 55

What is the consequence of plaque rupture with thrombosis?

Answer 55

Thrombosis can cause myocardial infarction (MI) in coronary arteries or stroke in cerebral arteries.

Question 56

What does plaque rupture with embolization cause?

Answer 56

Atherosclerotic emboli often containing cholesterol crystals.

Question 57

What happens when atherosclerosis weakens the vessel wall?

Answer 57

Can lead to aneurysm formation such as abdominal aortic aneurysm.

Question 58

What is arteriolosclerosis?

Answer 58

Narrowing of small arterioles divided into hyaline and hyperplastic types.

Question 59

What causes hyaline arteriolosclerosis?

Answer 59

Protein leakage into the vessel wall often due to benign HTN or diabetes.

Question 60

What is hyperplastic arteriolosclerosis?

Answer 60

Thickening of vessel walls due to smooth muscle hyperplasia giving an "onion-skin" appearance

Question 61

What is Monckeberg medial calcific sclerosis?

Answer 61

Calcification of the media in muscular arteries which is non-obstructive and clinically insignificant.

Question 62

What is aortic dissection?

Answer 62

Intimal tear with blood dissecting through the aortic media typically in the proximal aorta.

Question 63

What causes aortic dissection?

Answer 63

Most commonly HTN; also connective tissue disorders like Marfan syndrome or Ehlers-Danlos syndrome.

Question 64

What are symptoms and complications of aortic dissection?

Answer 64

Sharp tearing chest pain radiating to the back; complications include pericardial tamponade

Question 65

What is thoracic aneurysm and its classic cause?

Answer 65

Dilation of the thoracic aorta often due to tertiary syphilis

Question 66

What are complications of thoracic aneurysm?

Answer 66

Aortic valve insufficiency compression of nearby structures

Question 67

What is abdominal aortic aneurysm and its classic cause?

Answer 67

Dilation of the abdominal aorta often due to atherosclerosis

Question 68

What is a major complication of abdominal aortic aneurysm?

Answer 68

Rupture particularly when >5 cm

Question 69

What is hemangioma?

Answer 69

A benign tumor of blood vessels commonly seen at birth

Question 70

What is angiosarcoma?

Answer 70

A highly aggressive malignant proliferation of endothelial cells commonly in skin

Question 71

What exposures are associated with liver angiosarcoma?

Answer 71

Polyvinyl chloride arsenic

Question 72

What is Kaposi sarcoma?

Answer 72

A low-grade malignant proliferation of endothelial cells associated with HHV-8 infection.

Question 73

What are the types of Kaposi sarcoma?

Answer 73

Older Eastern European males (localized) AIDS patients (disseminated)