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CPR II Exam 1 > Vascular Pathology I > Flashcards

Vascular Pathology I Flashcards

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1
Q

Both arteries and veins are composed how?

A

from inside to out, both arteries and veins are composed of an intima, a media, and an anventitia

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2
Q

what level is blood pressure controlled?

A

at the level of the arteriole

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3
Q

how does a vein’s media differ from an artery’s?

A

since veins are low pressure, they only have a thin walled media without significant elastic fibers

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4
Q

how do capillaries differ from veins/arteries?

A

capillaries only have a simple endothelial lining surrounded by pericytes but no media

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5
Q

what is an arteriovenous malformation?

A

a direct connection of arteries to veins, bypassing capillaries

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6
Q

What do large or multiple AVMs lead to?

A

they shunt blood from arterial to venous circulation, forcing the heart to pump additional volume leading to high-output cardiac failure

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7
Q

why would an AVM be surgically created?

A

it provides vascular access for hemodialysis or chemotherapy agents

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8
Q

how might a patient with a superficial AVM of the brain present?

A

seizure and intracerebral hemorrhage

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9
Q

What is a berry (saccular) aneurysm?

A

a focal abnormal dilation of an artery due to underlying defect in media

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10
Q

what are the risk factors for berry (saccular) aneurysm?

A

HTN and smoking

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11
Q

Berry (saccular) aneurysms are associated with what other diseases?

A

AD polycystic kidney disease, Marfan syndrome, and Ehlers-Danlos syndrome

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12
Q

berry aneurysms can lead to what?

A

subarrachnoid hemorrhage if they rupture

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13
Q

rupture of a berry aneurysm is associated with that?

A

acute increases in intracranial pressure like straining with stool or sexual orgasm

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14
Q

what is a mycotic aneurysm?

A

a dilation of an artery due to damage of the vessel wall by an infectious process

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15
Q

what is fibromuscular dysplasia?

A

an irregular thickening in muscular arteries caused by medial and intimal hyperplasia

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16
Q

how does fibromuscular dysplasia arise?

A

thought to be a developmental abnormality, as it has increased incidence in first degree relatives

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17
Q

how does fibromuscular dysplasia appear on angiography?

A

string of beads appearance

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18
Q

which arteries are most commonly affected by fibromuscular dysplasia and what does this lead to?

A

the renal arteries–> leads to renal artery stenosis; the renal artery stenosis causes low volume of blood flow to the kidney which activates the renin, angiotensis, aldosterone system

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19
Q

what kidney diseases could lead to secondary HTN?

A

renovascular disease, renal artery stenosis (caused by fibromuscular dysplasia or atherosclerosis) or polycystic kidney disease

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20
Q

what endocrine disease could lead to secondary HTN?

A

primary aldosteronism, cushing syndrome, or pheochromocytoma

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21
Q

what cardiovascular diseases could lead to secondary HTN?

A

coarctation of the aorta

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22
Q

how does primary aldosteronism present?

A

HTN and hypokalemia

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23
Q

if a patient is hypokalemic, how might they present?

A

weakness, muscle cramps, paresthesias, and visual disturbances

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24
Q

what is usually the cause of primary hyperaldosteronism?

A

bilateral nodular hyperplasia of the adrenal gland

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25
what effect does aldosterone have on the body?
it reabsorbs sodium and excretes potassium leading to HTN and hypokalemia
26
what causes cushing syndrome?
increased cortisol production by the adrenal gland
27
what is a pheochromacytoma?
a tumor of chromaffin cells of the adrenal medulla
28
what does a pheochromocytoma secrete?
catecholamines including epinephrine and norepinephrine
29
besides HTN, what are the other associated features of a pheochromocytoma?
it can induce paroxysms of elevated BP associated with tachycardia, palpitation, HA, diaphoresis, tremor
30
what are pheochromocytomas associated with?
MEN 2 syndromes
31
how would you test for a pheochromocytoma?
test urinary or plasma metanephrines (they'll be elevated)
32
what is the adult form of coarctation of the aorta?
there's a congenital narrowing or infolding of the aorta opposite the ligamentum arteriosum
33
what effect does coarctation of the aorta have on the body?
HTN in the UEs with weak pulses and hypotension in the LEs
34
what is coarctation of the aorta associated with?
bicuspid aortic valve
35
what effect does mild to moderate chronic hypertensive disease have on the small arterioles?
hyaline arteriolosclerosis
36
what is hyaline arteriolosclerosis?
there is arteriolar narrowing- the hyaline material is compromised of precipitated plasma proteins
37
what happens in hyaline nephrosclerosis?
there is narrowing--> impairment of the renal blood supply and ischemic glomerulosclerosis
38
what is the definition of a hypertensive crisis?
a rapid increase in BP: systolic >180-200 and diastolic >120
39
what is a hypertensive emergency?
a hypertensive crisis with end organ damage
40
what is hyperplastic arteriolosclerosis?
occurs in severe HTN, the pressure induces the artery to produce lamellated, thickening of the walls--> smooth muscle forms concentric lamellations showing an "onion skinning" pattern
41
the gross findings of a kidney in long standing HTN correspond with what?
hyaline arteriolosclerosis with characteristic pink amorphous change
42
what are the gross findings in a kidney in a case of rapidly increasing BP?
numerous petechial hemorrhages--> hyperplastic arteriolosclerosis
43
what is myocardial vessel vasospasm?
excessive vasoconstriction of myocardial arteries or arterioles which could cause ischemia or infarct
44
what are 3 causes of myocardial vascular contraction (vasospasm)?
1) high levels of vasoactive mediators 2) elevated thyroid hormones 3) autoantibodies and T cells in scleroderma
45
what are 3 examples of vasoactive mediators that can cause myocardial vascular contraction (vasospasm)?
cocaine, epinephrine, and norepinephrine
46
what is Takotsubo cardiomyopathy?
"broken heart syndrome"- severe emotional distress can cause an overwhelming release of catecholamines stimulating increased contractility and constriction of coronary arteries--> can lead to ischemic cardiomyopathy
47
what are varicose veins?
abnormally dilated, twisted veins which occur from prolonged increased intraluminal pressure leading to incompetence of venous valves and dilation of the veins
48
what can varicose veins lead to?
stasis, congestion, thrombus, edema, pain, and ischemia of overlying skin (stasis dermatitis)
49
what does portal hypertension lead to?
esophageal varices, splenomegaly, hemorrhoids, and caput medusae
50
what is the most common cause of superior vena cava syndrome?
intrathoracic malignancy--> bronchogenic lung carcinoma and lymphoma
51
how does superior vena cava syndrome present?
marked dilation of veins of head, neck, chest wall, arms with cyanosis; facial swelling, neurologic manifestations, respiratory distress
52
what is the most common cause of inferior vena cava syndrome?
neoplasms- especially hepatocellular carcinoma and renal cell carcinoma
53
how does inferior vena cava syndrome present?
lower extremity edema and distention of the superficial collateral veins of the lower abdomen
54
what is thrombophelitis?
a venous thrombosis and inflammation
55
what cases are paradoxical emboli seen?
ventricular septal defect, PDA, and AV malformations
56
lymphangitis is usually caused by what?
beta-hemolytic streptococcus
57
what is a cause of primary lymphedema?
congenital defect- familial milroy disease (lymphatic agenesis)
58
what is peau d'orange?
in breast cancer, when draining lymphatics fill with tumor, one can see distinctive pitting or dimpling texture
59
What is vascular ectasias? and what are 2 examples?
local dilation of a blood vessel; nevus simplex and port-wine stain
60
what is sturge-weber syndrome?
rare disorder characterized by a facial port wine stain with associated additional capillary venous malformations that affect the brain and the eye
61
what is a prototypical clinical presentation of sturge-weber syndrome?
a large facial telangiectasia in a child with mental deficiency
62
what causes sturge-weber syndrome?
somatic mutations in fetal ectodermal tissue causing inappropriate maturation of blood vessel formation- so its not heritable
63
when are spider telangiectasias commonly seen?
in cases of increased circulating estrogen--> pregnancy or liver disease
64
what is osler-weber-rendu syndrome?
an autosomal dominant disorder in which numerous telangiectasias and AV malformations form throughout the body
65
what mutation is associated with osler-weber-rendu disease?
mutation in TGF-beta signaling pathway
66
what occurs when the TGF-beta pathway is mutated?
abnormal blood vessel formation in the skin, mucous membranes, and organs
67
what is a hemangioma?
common, benign vascular tumor of children and adults
68
when internal involvement of hemangiomas is present, where are they likely found?
liver
69
what is a cavernous hemangioma?
an irregular dilated vascular channel making a lesion with an indistinct border; more likely to involve deep tissue and more likely to bleed
70
what is the histologic appearance of a cavernous hemangioma?
it has enlarged vascular spaces filled with blood
71
what is a glomus tumor?
a mesenchymal tumor composed of modified smooth muscle arising from glomus body responsible for thermoregulation
72
what are the characteristics of a glomus tumor?
bluish tumor with a predilection for the subungal location under the fingernail; painful and gets worse with temperature changes
73
what are the 2 principal types of lymphangioma?
1) simple (capillary) lymphangioma and 2) cavernous lymphangioma
74
what is the key difference between hemangiomas and capillary lymphangiomas?
in capillary lymphangiomas, the dilated spaces do not contain RBCs
75
what is a cavernous lymphangioma?
thought to arise from a congenital malformation where the lymphatics fail to communicate with the venous system
76
what are cavernous lymphangiomas associated with?
turner syndrome
77
What is bacillary angiomatosis?
a reactive vascular proliferation to gram negative bartonella bacilli- occurs in immunocompromised
78
what are the microscopic features of bacillary angiomatosis?
lobular proliferation of capillaries and ectatic vessels lined by endothelial cells typically with background inflammatory cells; bacteria on silver stain
79
what is kaposi sarcoma?
an angioproliferative disorder caused by HHV 8
80
what are the 4 types of kaposi sarcoma?
classic, endemic (africa), iatrogenic, and AIDS
81
all 4 subtypes of kaposi sarcoma can show 3 distinct stages on the skin- what are they?
1) patch 2) plaque 3) tumor
82
what are 3 important risk factors for angiosarcoma?
1) liver angiosarcoma: arsenic, thortrast, and PVC production 2) lymphedema- s/p axillary lymph node dissection--> lymphgosarcoma 3) radiation for carcinoma
83
what do angiosarcomas stain for?
CD31 or CD34

CPR II Exam 1 (13 decks)

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