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Flashcards in Vascular: Pathoma, BRS, First Aid Deck (164):
1

What is vasculitis?

Inflammation of blood vessel wall

2

BV wall has what 3 components?

1. endothelial intima
2. smooth muscle media
3. CT adventitia

3

Etiology of vasculitis is usually what?

Unknown or immune mediated.

4

Clinical features of vasculitis? 2

1. Nonspecific symptoms of inflammation
2. Symptoms of organ ischemia

5

Nonspecific symptoms of inflammation include? (4)

1. Fever
2. Fatigue
3. Weight loss
4. Myalgias

6

Symptoms of organ ischemia are due to what?

Luminal narrowing or thrombosis of inflamed vessels

7

Large-vessel vasculitis involves what?

Aorta and its branches

8

Medium vessel vasculitis involves what?

Muscular arteries that supply organs

9

Small vessel vasculitis involves what? (3)

1. Arterioles
2. Capillaries
3. venules

10

Temporal Giant Cell arteritis is what?

Granulomatous vasculitis that classically involves branches of the carotid artery

11

Temporal giant cell arteritis is the most common vasculitis in what patients?

Older adults (especially females)

12

How does temporal giant cell arteritis present? 6

1. Unilateral Headache: Due to temporal artery
2. Visual distrubance: Ophthalmic artery (can go blind)
3. Jaw claudication
4. Polymyalgia rheumatica
5. Elevated ESR
6. Nodules along course of artery involved

13

Biopsy of temporal giant cell arteritis reveals what? 4

Inflamed vessel wall (fibrosis)
Giant cells
Lesions are segmental
Many granulocytes

14

Treatment of temporal giant cell arteritis is?

Corticosteroids

15

Takayasu arteritis is what?

Granulomatous vasculitis that involves aortic arch at branch points

16

What demographic has takayasu arteritis the most?

Young asian females

17

How does takayasu arteritis present?

1. Visual symptoms
2. Neurologic smptoms
3. Weak or absent pulse in upper extremity
4. ESR elevated

18

Treatment of takayasu arteritis?

Corticosteroids

19

What syndrome does takayasu arteritis produce?

Aortic arch syndrome

20

What are the two medium vessel vasculitises?

Polyarteritis Nodosa
Kawasaki Disease
Buerger Disease

21

Polyarteritis nodosa is what?

Necrotizing vasculitis involving muscular arteries that supply organs.

22

What organ is spared in polyarteritis nodosa?

Lungs

23

How does polyarteritis nodosa classically present?

Young adult
Hypertension: Renal artery involvement
Abdominal pain with melena: Mesenteric artery
IHD: Coronary arteries
Neurologic dysfunction
Skin lesions

24

What serum antigen is associated with Polyarteritis nodosa?

Hepatitis B surface antigen

25

Early lesion of polyarteritis nodosa consists of what?

Transmural inflammation with fibrinoid necrosis

26

How do early lesions in polyarteritis nodosa heal?
What does this produce?

Fibrosis

String of pearls appearance

27

Treatment for polyarteritis nodosa? 2
What happens if not treated?

1. Corticosteroids
2. Cyclophosphamide

Fatal

28

Fibrinoid necrosis is clasically seen in what two scenarios?

1. Malignant HTN
2. Vasculitis

29

Early lesions have what effect in polyarteritis nodosa?
What can result?

Weaken vessel wall

Aneurysm

30

What mediates polyarteritis nodosa?

Immune complexes

31

What organ causes most deaths in polyarteritis nodosa?

Kidneys: Vasculitis in arterioles and glomeruli and renal artery lesions

32

Kawasaki disease typically affects what demographic?

Asian children under 4 years old.

33

How does kawasaki disease present? 5

1. Fever
2. Conjunctivitis
3. Red rash of palms and soles
4. Enlarged cervical lymph nodes
5. Strawberry tongue

34

What artery is dangerous for kawasaki disease?
Why?

Coronary artery

Can lead to:
1. Thrombosis with MI
2. Aneurysm with rupture

35

Treatment for kawasaki disease is what?

1. Aspirin
2. IV immunoglobulin

36

Buerger disease is what?

Necrotizing vasculitis involving digits

37

How does Buerger disease present?

Ulceration
Gangrene
Autoamputation of fingers and toes
Raynaud phenomenon

38

What is Buerger's disease heavily associated with?
Which leads into what is the best treatment for Buerger disease?

Smoking

Cessation of smoking

39

What demographic typically presents with Buerger's disease?

Young Jewish men

40

What are the four small vessel vasculitis?

Wegener Granulomatosis
Microscopic Polyangiitis
Churg-Strauss syndrome
Henoch-Schonlein purpura

41

Wegener Granulomatosis is what?

Fibrinoid-Necrotizing granulomatous vasculitis involving nasopharynx, lungs, and kidneys

42

Classic presentation of Wegener granulomatosis?

1. Middle-aged male
2. Sinusitis/nasopharyngeal ulceration
3. Hemoptysis with bilateral nodular lung infiltrates
4. Hematuria: Glomerulonephritis

43

Treatment of Wegener granulomatosis 2
What happens despite treatment

Cyclophosphamide
Steroids

Relapse

44

Wegener granulomatosis correlates with what serum level?

Circulating-Antineutrophil cytoplasmic antibodies (C-ANCA)

45

Biopsy of Wegener granulomatosis reveals what?

Large necrotizing granulomas (with giant cells) with adjacent necrotizing vasculitis

46

The TRIAD of Wegener granulomatosis?

1. Focal necrotizing vasculitis
2. Necrotizing granulomas in lung and URT
3. Necrotizing glomerulonephritis

47

Microscopic polyangiitis is what?

Necrotizing vasculitis of multiple organs especially lung and kidney?

48

How do microscopic polyangiitis symptoms differ from wegener's? 2

No nasopharyngeal symptoms
No granulomas

49

Treatment of microscopic polyangiitis? 2

Corticosteroids and cyclophosphamide

50

What serum level correlates with microscopic polyangiitis AND Churg-Strauss syndrome?

Serum p-ANCA

51

Churg-strauss syndrome is what?

Necrotizing granulomatous inflammation with eosinophils involving multiple organs especially lungs and heart

52

How does Churg-strauss syndrome present? 4

1. Asthma
2. Peripheral eosinophilia
3. Palpable purpura
4. Glomerulonephritis

53

What is elevated in Churg-Strauss syndrome? 2

1. p-ANCA
2. IgE

54

Henoch-Schoenlein Purpura is what?

Vasculitis due to IgA immune complex deposition

55

Henoch-Schoenlein Purpura is the most common vasculitis in what demographic?

Children

56

How does Henoch-Schoenlein Purpura present? 5

1. Palpable purpura on buttocks and legs
2. GI pain and bleeding
3. Hematuria (IgA nephropathy)
4. Follows URT infection (Causes excess IgA)
5. Anthralgia

57

How to treat Henoch-Schonlein Purpura?

Usually goes away on own but steroids if needed

58

What is Raynaud's disease?

Recurrent vasospasm of small arteries and arterioles

59

Symptom of Raynaud's disease?
What precedes it

Pallor/Cyanosis especially fingers and toes

Chilling

60

Raynaud disease is most common in who?

Young, healthy women

61

What is Raynaud phenomenon?

Similar to Raynaud disease but is secondary to an underlying disorder

62

What is the underlying disorder in Raynaud's phenomenon? 2

SLE = Lupus
CREST syndrome = Systemic sclerosis

63

Hypertension is what?

Increased blood pressure

64

Does hypertension involve pulmonary or systemic circulation?

Either

65

Systemic hypertension is defined how?

greater than 140/90

66

What is normal blood pressure?

less than 120/80

67

Primary hypertension is of what etiology?
What percentage of hypertensions?

Unknown

95%

68

Risk factors for primary hypertension? 6

Age
Race (african americans higher, asians lower)
Obesity
Stress
Lack of physical activity
High-salt diet
Family history
Smoking

69

What can primary hypertension lead to? 4

1. Retinal changes
2. Left ventircular hypertrophy --> Cardiac failure
3. Benign nephrosclerosis
4. IHD

70

Secondary hypertension is due to what?

Secondary to a known cause (5% of HTN cases)

71

What is most common cause of secondary HTN?

Renal disease

72

2 causes of renal hypertension?

1. Renal artery stenosis
2. Disorders of renal parenchyma

73

Renal artery stenosis has what effect?

Decrease blood to glomerulus --> JGA secretes renin -->--> Ang II -->
1. Vasoconstriction --> Increase peripheral resistance
2. Renal release of aldosterone --> Increase Na+ resorption --> Increase plasma volume

74

The effects of ATII leads to what?

HTN with increased plasma renin and unilateral atrophy (due to low blood flow)

75

Important cause of renal artery stenosis in elderly males?

Atherosclerosis

76

Important cause of renal artery stenosis in young females?

Fibromuscular dysplasia: Developmental defect of BV wall leading to thickening of large and medium arteries

77

Endocrine disorders leading to hypertension? 6

1. Primary aldosterone/Conn Syndrome
2. Acromegaly
3. Cushing syndrome
4. Pheochromocytoma
5. Hyperthroidism
6. Diabetes

78

Other causes of HTN? 4

1. Coarctation of aorta (Upper body HTN)
2. Toxemia of pregnancy
3. CNS disorders: (brain tumors)
4. Amphetamines and steroids

79

What is benign HTN?

Mild or moderate elevation in blood pressure

80

Clinical effects of benign HTN?

Silent, damage over looooong period

81

What is most common HTN, benign or malignant?

benign (>95%)

82

Malignant HTN is defined how?

Blood pressure of >200/120

83

What demographic has malignant HTN the most?

Young black males

84

How does malignant HTN present? 4

1. Acute renal failure
2. Headache
3. Papilledema
4. Retinal hemorrhages

85

What does malignant HTN most likely result in? 3

CHF
Stroke
Renal failure

86

What important renal change does malignant HTN produce?

Malignant nephrosclerosis in which glomeruli rupture forming a flea-bitten kidney

87

What is arteriosclerosis?

Thickened blood vessel walls in arteries making them hard

88

3 patterns of arteriosclerosis

1. Atherosclerosis
2. Arteriolosclerosis
3. Monckeberg medical calcific sclerosis

89

Atherosclerosis is what?

Intimal plaque that obstructs blood flow

90

What does the plaque in atherosclerosis consist of? (3)

1. Necrotic lipid core of choelsterol
2. Fibromuscular cap
3. Calcium

91

What arteries are involved in atherosclerosis?

Large and medium size: abdominal, coronary, popliteal, carotid

92

What are the modifiable risk factors for atherosclerosis? 4

1. HTN
2. Hypercholesterolemia
3. Smoking
4. Diabetes

93

What are the nonmodifiable risk factors for atherosclerosis? 3

1. Age (increase with age)
2. Gender (Males and postmenopausal females)
3. Genetics

94

What is the pathogenesis of atherosclerosis?

Damage to endothelium --> Lipids leak into intima --> Lipids oxidized --> Consumed by macrophages --> Form foam cells --> Inflammation/healing leads to deposition of ECM and proliferation of smooth muscle.

95

How does atherosclerosis begin and appear as?
When do these arise?

Fatty streaks: Yellow lesions of intima with lipid-laden macrophages

Early in life

96

Complications of atherosclerosis are how important?

Greater than 50% of all disease in Western countries

97

4 main complications of atherosclersosis?

1. Stenosis of medium sized vessels --> Impaired blood flow and ischemia
2. Plaque rupture with thrombosis --> MI/Stroke
3. Plaque rupture with embolization
4. Weakening of vessel wall results in aneurysm

98

Impaired blood flow and ischemia in turn can lead to what? (3)

1. Peripheral vascular disease
2. Angina
3. Ischemic bowel disease

99

What are fibrous plaques also known as?

Atheromas

100

What is difference in LDL and HDL in atherosclerosis?

LDL: Makes it worse
HDL: Makes it better

101

What is arteriolosclerosis?

Narrowing of small arterioles

102

Two divisions of arteriolosclerosis?

Hyaline
Hyperplastic

103

Hyaline arteriolosclerosis is caused by what?

Proteins leaking into vessel wall --> Vascular thickening

104

How does hyaline arteriolosclerosis appear on microscopy?

Pink hyaline

105

Hyaline arteriolosclerosis is the result of what?

1. Long standing benign HTN
2. Diabetes

106

Why does diabetes cause hyaline arteriolosclersosis?

Non-enzymatic glycosylation of BM --> Leaky BV wall

107

Hyaline arteriolosclerosis results in what? 2

1. Organ ischemia
2. Glomerular scarring --> Chronic renal failure

108

Hyperplastic arteriolosclerosis is what?

Thickening of vessel wall by hyperplasia of smooth muscle (concentric, onion-like)

109

Hyperplastic arteriolosclerosis is the consequence of what?

Malignant HTN

110

What does hyperplastic arteriolosclerosis result in?

1. End organ ischemia
2. Fibrinoid necrosis of vessel wall
3. Acute renail failure --> Flea-bitten appearance

111

What is Monckeberg medial calcific sclerosis?

Calcification of the media of muscular arteries; nonobstructure

112

Is Monckeberg medial calcific sclerosis clinically significant?

No.

113

What arteries are most often affected in Monckeberg?

Radial and ulnar

114

What is aortic dissection?

Intimal tear with dissection of blood through mdia of the aortic wall

115

Where does aortic dissection occur?

Proximal 10 cm of the aorta (high stress)
Place where weakness of media is

116

Most common cause of aortic dissection?
What 3 things will also cause this?

Hypertension
Bicuspid aortic valve, Marfan and Ehlers-Danlos weaken CT in media

117

Hypertension causes aortic dissection how?

Hyaline arteriolosclerosis of vasa vasorum --> Decrease flow --> Atrophy of media

118

How does aortic dissection present?

Sharp tearing chest pain radiating to the back

119

Complications of aortic dissection?
Which is most common cause of death

1. Pericardial tamponade (most common)
2. Rupture with fatal hemorrhage
3. Obstruction of branching arteries --> Organ ischemia

120

Thoracic aneurysm is what?

Balloon-like dilation of thoracic aorta

121

What is thoracic aneurysm due to?

Weakness in aortic wall

122

How does thoracic aneurysm typically present? 3

1. Tertiary syphilis
2. HTN
3. Marfan's

123

What happens in thoracic aneurysm?

Endarteritis of vasa vasorum --> Luminal narrowing --> Decreased flow --> Atrophy of vessel wall

124

Hwo does aorta appear in thoracic aneurysm?

Tree-bark

125

Major complication of thoracic aneurysm?

Dilation of aortic valve root --> Aortic valve insufficiency

126

Other complications of thoracic aneurysm?

1. Compression of trachea or esophagus
2. Thrombosis/embolism

127

What is abdominal aortic aneurysm?
Where is it usually?

Balloon-like dilation of abdominal aorta?
Below renal arteries but above aortic bifurcation

128

What is abdominal aortic aneurysm due to mainly? 4

Atherosclerosis
Males
Old
HTN

129

How does abdominal aortic aneurysm present?

Pulsatile abdominal mass that grows with time

130

What are the complications of abdominal aortic aneurysm? (3)

1. Rupture: Greater than 5cm
2. Compression of local structures (ureter)
3. Thrombosis/Embolism

131

What are Berry aneurysms?

Small saccular lesions seen in small arteries of brain, especially circle of Willis

132

Where do berry aneurysms grow?

Weakness at bifurcations of cerebral arteries?

133

Berry aneurysms are the most common cause of what?

Subarachnoid hemorrhage

134

Venous thrombosis/phlebothrombosis most commonly arises where?

Deep veins of lower extremities

135

What is Venous thrombosis/phlebothrombosis if it becomes inflamed?

Thrombophlebitis

136

Predisposing factors of Venous thrombosis/phlebothrombosis include?

1. Venous circulatory stasis
2. Obstructed venous return

137

Main result of Venous thrombosis/phlebothrombosis?

Embolism --> Pulmonary infarct

138

What are varicose veins?

Abnormally dilated and tortuous veins in superficial veins of lower extremeties.

139

Predisposing factors to varicose veins? (2)

1. Increased venous pressure (Pregnant, obese)
2. People that stand a lot.

140

What are five benign vascular tumors?

1. Spider telangiectasia
2. Hereditary hemorrhagic telangiectasia (OWR)
3. Hemangioma
4. Glomangioma/Glomus tumor
5. Cystic hygroma

141

What is spider telangiectasia?
What is it associated with?

Dilated small vessel surrounding radiating fine channels

Hyperestrinism: Chronic liver or pregnant

142

What is heredtiary hemorrhagic telangiectasia?

Autosomal dominant condition with localized dilation and convolution of venules and capillaries of skin and mucous membranes.

143

When do hemangiomas present?

At birth, but regress through childhood.

144

Hemangioma is the most common tumor of what demographic?

Infants

145

Hemangioma has what characteristic symptom?

Port-wine stain birthmarks

146

Strawberry/Capillary hemangioma is what?
Who is it seen in?

Closely packed capillary-like channels
Infants (1/200 births)

147

Cavernous hemangioma consist of what? Cherry

Large cavernous vascular spaces in skin, mucosal surfaces, and organs

148

What disease usually causes cavernous hemangioma?

von Hippel-Lindau disease

149

What is a cherry hemangioma?

Benign capillary hemangioma of elderly

150

What is Sturge-weber disease?

Congenital vascular disorder that affects capillaries

151

How does sturge-weber disease manifest? 4

1. Port wine stain
2. Leptomeningeal angiomatosis
3. Seizures
4. Glaucoma

152

What is glomangioma/glomus tumor?

Small purple painful subungual nodule in a finger or toe

153

What is a cystic hygroma?
What disease is it associated with?

Cavernous lymphangioma that occurs in neck or axilla.
Turner syndrome

154

What is bacillary aniogmatosis?

Benign capillary skin papules in AIDS patients

155

What are the 4 malignant vascular tumors?

1. Hemangioendothelioma
2. Hemangiopericytoma
3. Angiosarcoma
4. Kaposi sarcoma

156

What is hemangioendothelioma?

Intermediate between benign and malignant

157

What is hemangiopericytoma?

Tumor from pericytes and can be benign or malignant

158

What is a angiosarcoma?

Malignant proliferation of endothelial cells

159

What is angiosarcoma associated with? 2

1. Arsenic
2. Radioactive Thorotrast

160

What is liver angiosarcoma associated with?

Polyvinyl chloride

161

What is Kaposi sarcoma?

Low-grade malignant proliferation of endothelial cells.

162

What disease is kaposi sarcoma associated with?

Herpes HHV-8

163

How does kaposi syndrome present?

Purple patches
Plaques
Nodules on skin

164

What three populations is Kaposi syndrome seen in?

1. Old eastern european males: Tumor in skin
2. AIDS: Spreads fast
3. Transplant recipients