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Pathology > Vascular: Pathoma, BRS, First Aid > Flashcards

Vascular: Pathoma, BRS, First Aid Flashcards

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1
Q

What is vasculitis?

A

Inflammation of blood vessel wall

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2
Q

BV wall has what 3 components?

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

Etiology of vasculitis is usually what?

A

Unknown or immune mediated.

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4
Q

Clinical features of vasculitis? 2

A
  1. Nonspecific symptoms of inflammation

2. Symptoms of organ ischemia

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5
Q

Nonspecific symptoms of inflammation include? (4)

A
  1. Fever
  2. Fatigue
  3. Weight loss
  4. Myalgias
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6
Q

Symptoms of organ ischemia are due to what?

A

Luminal narrowing or thrombosis of inflamed vessels

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7
Q

Large-vessel vasculitis involves what?

A

Aorta and its branches

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8
Q

Medium vessel vasculitis involves what?

A

Muscular arteries that supply organs

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9
Q

Small vessel vasculitis involves what? (3)

A
  1. Arterioles
  2. Capillaries
  3. venules
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10
Q

Temporal Giant Cell arteritis is what?

A

Granulomatous vasculitis that classically involves branches of the carotid artery

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11
Q

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

A

Older adults (especially females)

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12
Q

How does temporal giant cell arteritis present? 6

A
  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
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13
Q

Biopsy of temporal giant cell arteritis reveals what? 4

A

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

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14
Q

Treatment of temporal giant cell arteritis is?

A

Corticosteroids

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15
Q

Takayasu arteritis is what?

A

Granulomatous vasculitis that involves aortic arch at branch points

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16
Q

What demographic has takayasu arteritis the most?

A

Young asian females

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17
Q

How does takayasu arteritis present?

A
  1. Visual symptoms
  2. Neurologic smptoms
  3. Weak or absent pulse in upper extremity
  4. ESR elevated
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18
Q

Treatment of takayasu arteritis?

A

Corticosteroids

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19
Q

What syndrome does takayasu arteritis produce?

A

Aortic arch syndrome

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20
Q

What are the two medium vessel vasculitises?

A

Polyarteritis Nodosa
Kawasaki Disease
Buerger Disease

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21
Q

Polyarteritis nodosa is what?

A

Necrotizing vasculitis involving muscular arteries that supply organs.

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22
Q

What organ is spared in polyarteritis nodosa?

A

Lungs

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23
Q

How does polyarteritis nodosa classically present?

A 
Young adult
Hypertension: Renal artery involvement
Abdominal pain with melena: Mesenteric artery
IHD: Coronary arteries
Neurologic dysfunction
Skin lesions
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24
Q

What serum antigen is associated with Polyarteritis nodosa?

A

Hepatitis B surface antigen

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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

Pathology (36 decks)

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