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Flashcards in X - The Blood Vessels Deck (110):
1

In these arteries, elastic fibers alternate in layers with smooth muscle cells. Examples are the common carotid artery, iliac arteries and pulmonary arteries.

Large or elastic arteries
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

2

In these arteries, tunica media is composed primarily of smooth muscle cells, with elastin limited to the internal and external elastic lamina. Examples are the coronaries and renal arteries.

Medium-sized or muscular arteries
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

3

These are the principal control points for regulation of physiologic resistance to blood flow.

Arterioles
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 340

4

These vessels are approximately the diameter of an RBC, have an endothelial cell lining but no media.

Capillaries
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

5

Diameter of an RBC.

7-8 um
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

6

These are thin-walled, endothelium lined channels that drain excess interstitial tissue fluid, returning it to blood via the thoracic duct.

Lymphatics
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

7

These are small spherical dilatations, typically in the circle of Willis.

Developmental/berry aneurysms
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

8

These are abnormal, typically small, direct connections between arteries and veins that bypass the intervening capillaries.

Arteriovenous fistulas
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

9

Focal, irregular thickening of the walls of medium and large muscular arteries. Segments of the vessel wall are focally thickened by combination of irregular medial and intimal hyperplasia and fibrosis, causing luminal stenosis.

Fibromuscular dysplasia
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 341

10

Literally means hardening of the arteries, term reflecting arterial wall thickening and loss of elasticity, affecting small arteries and arterioles.

Arteriolosclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

11

Characterized by calcific deposits in muscular arteries, typical in persons older than 50 yrs old. The radiographically visible, palpable calcifications do not encroach on the vessel lumen, and are not clinically significant.

Mönckenberg medial calcific sclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

12

Characterized by intimal lesions called atheromas that protrude into vascular lumina.

Atherosclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 343

13

Three principal components of an atheromatous plaque.

1. Cells (SM cells, macrophages, T cells)
2. Extracellular matrix (collagen, elastic fibers, proteoglycan)
3. Intracellular and extracellular lipid )Fibrous cap, central lipid core, neovascularization)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 344

14

Non-modifiable risk factors for atherosclerosis. (4)

Increasing age
Male gender
Family history
Genetic abnormalities
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 344

15

Composed of lipid-filled foam cells but are not significantly raised and thus do not cause any disturbance in blood flow. Can appear as early as 1 year, and present in virtually all children older than 10 years old.

Fatty streaks
(TOPNOTCH)

16

Composed of lipid-filled foam cells but are not significantly raised and thus do not cause any disturbance in blood flow. Can appear as early as 1 year, and present in virtually all children older than 10 years old.

Fatty streaks
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 349

17

Arrange in descending order, based on which blood vessel is most extensively involved in development of atherosclerosis.
Popliteal arteries
Internal carotid arteries
Circle of Willis
Coronaries
Abdominal aorta

Abdominal aorta > coronaries > popliteal arteries > internal carotid arteries > circle of Willis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 350

18

Fate of an atheromatous plaque wherein the luminal surface exposes the bloodstream to highly thrombogenic substances and induces thrombus formation.

Rupture, ulceration or erosion
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

19

Fate of an atheromatous plaque due to rupture of the overlying fibrous cap or the thin-walled vessels in the areas of neovascularization.

Hemorrhage
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

20

Fate of an atheromatous plaque causing discharge of debris into the bloodstream, producing microemboli composed of plaque contents.

Atheroembolism
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

21

Fate of an atherosclerotic plaque due to increased pressure or ischemic atrophy of the underlying media, with loss of elastic tissue, leading to weakness of the vessel wall.

Aneurysm formation
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 351

22

Most common cause of hypertension.

Idiopathic (essential hypertension)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 355

23

This vascular lesion consists of a homogenous pink hyaline thickening of the walls of arterioles with loss of underlying structural detail and with narrowing of the lumen. A major morphologic characteristic in benign nephrosclerosis.

Hyaline arteriolosclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 356

24

Characteristic of malignant hypertension, associated with "onion-skin" concentric, laminated, thickening of the walls of arterioles with luminal narrowing. These laminations consist of smooth muscle cells and thickened duplicated basement membrane.

Hyperplastic arteriolosclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 356

25

It is a localized abnormal dilation of a blood vessel or heart.

Aneurysm
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

26

Aneurysm which involves all three layers of the arterial wall, or the attenuated wall of the heart.

True aneurysm
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

27

A breach in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space.

False aneurysm
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

28

Arises when blood enters the wall of an artery, as a hematoma dissecting between its layers. Often, but not always aneurysmal in origin.

Arterial dissection
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

29

Aneurysms which are spherical outpouchings, involving only a portion of the vessel wall, varying in size from 5-20cm in diameter and often contain thrombi.

Saccular aneurysms
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

30

Aneurysms which involve diffuse, circumferential dilation of a long vascular segment, varies in diameter and length, and can involve extensive portions of the aortic arch, abdominal aorta,and iliacs.

Fusiform aneurysms
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

31

Two most important causes of aortic aneurysms.

Atherosclerosis
Cystic medial degeneration of the arterial media
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

32

Infection of a major artery that causes weakness to its wall.

Mycotic aneurysm
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 357

33

This disease can more commonly affects men >50 years old. Lesion usually positioned below the renal arteries and above the aortic bifurcation. Can be saccular or fusiform.

Abdominal aortic aneurysm (AAA)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

34

Abdominal aortic aneurysm characterized by dense periaortic fibrosis containing abundant lymphoplasmacytic infiltrate with many macrophages and often giant cells.

Inflammatory AAA
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

35

Atherosclerotic lesions infected by lodging of circulating microorganisms in the wall, particularly in the setting of bacteremia from a Salmonella gastroenteritis. Suppuration further destroys the media, potentiating rapid dilation and rupture.

Mycotic abdominal aortic aneurysm
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

36

Small blood vessels and vasa vasorum show luminal narrowing and obliteration (obliterative endarteritis), scarring of the vessel wall and a dense surrounding rim of lymphocytes and plasma cells that may extend into the media. Characteristic of the tertiary stage of syphilis.

Syphilitic aortitis
(TOPNOTCHRobbins Basic Pathology, 8th Ed p. 359

37

Most common point of origin of an aortic dissection.

Ascending aorta, 10 cms from the aortic valve
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 360

38

Most frequent pre-existing histologically detectable lesion in aortic dissection, characterized by elastic tissue fragmentation and separation of the elastic and smooth muscle cell elements of the media by cystic spaces filled with amorphous proteoglycan-rich extracellular matrix.

Cystic medial degeneration
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 361

39

Classification of aortic dissection involving either the ascending aorta only or both the ascending and descending aorta.

Type A dissections (proximal)
Type I DeBakey - ascending aorta only
Type II DeBakey - ascending and descending aorta
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 361

40

Classification of aortic dissections involving the descending aorta only, usually distal to the subclavian artery.

Type B dissection / type III DeBakey
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 361

41

Granulomatous inflammation frequently involving the temporal artery, occuring in patients >50 years old, associated with polymyalgia rheumatica.

Giant cell (Temporal) arteritis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 363

42

Granulomatous inflammation usually occuring in patients younger than 50 years old. Classically involves the aortic arch, with intimal hyperplasia and irregular thickening of the vessel wall. Origin of great vessels are obliterated causing weakness of peripheral pulses.

" pulseless "

Takayasu arteritis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 364

43

Used to distinguish between giant cell arteritis and takayasu arteritis of the aorta.

Age of patient
Giant cell >50
Takayasu

44

In this disease, affected blood vessels develop nodular intimal thickening, granulomatous inflammation within the inner media centered on the internal elastic membrane, and fragmentation of the internal elastic lamina. Typically involves temporal and ophthalmic arteries.

Giant - cell/Temporal arteritis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 364

45

A systemic vasculitis causing transmural necrotizing inflammation of small to medium sized vessels, with mixed infiltrate of neutrophils, eosinophils, and mononuclear cells, frequently accompanied by fibrinoid necrosis. Typically involves renal arteries but spares pulmonary vessels.

Polyarteritis Nodosa (PAN)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 365

46

Arteritis associated with mucocutaneous lymph node syndrome, which usually occurs in children. Coronary arteries can be involved with aneurysm formation or thrombosis. Fibrinoid necrosis usually less prominent.

Kawasaki disease
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 366

47

Granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels, including cresencteric glomerulonephritis. Associated with c-ANCA.

Wegener granulomatosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 367

48

A necrotizing vasculitis that generally affects capillaries, arterioles and venules, with few or no immune deposits. Necrotizing glomerulonephritis and pulmonary capillaritis are common. Associated with p-ANCA.

Microscopic polyangiitis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 368

49

Eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small vessels. Associated with asthma and blood eosinophilia. Associated with p-ANCA.

Churg-Strauss syndrome
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 368

50

Characterized by sharply segmental avute and chronic vasculitis of medium sized and small arteries, predominantly of the extremities. There is acute and chronic inflammation accompanied by luminal thrombosis, containing microabscess composed of neutrophils surrounded by granulomatous inflammation. Strong relationship with cigarette smoking.

Thromboangiitis obliterans (Buerger disease)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 368

51

Results from an exaggerated vasoconstriction of digital arteries and arterioles, inducing paroxysmal pallor or cyanosis of the digits of the hands and feet.

Raynaud phenomenon
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 369

52

Reflects an exaggeration of central and local vasomotor responses to cold or emotion. Structural changes in the arterial walls are absent except late in course when intimal thickening can appear.

Primary Raynaud phenomenon (Raynaud disease)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 369

53

Reflects vascular insufficiency of the extremities in the context of arterial disease caused by other entities including SLE, Buerger disease, or atherosclerosis.

Secondary Raynaud phenomenon
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 370

54

Abnormally dilated, tortous veins produced by prolonged increase in intraluminal pressure and loss of vessel wall support. Veins show wall thinning at the points of maximal dilation with smooth muscle hypertrophy and intimal fibrosis. Focal thrombosis and venous valve deformities are common.

Varicose veins
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 370

55

Most common blood vessels involved in development of varicose veins.

Superficial veins of the upper and lower leg
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 370

56

Three sites of varices produced in the presence of portal hypertension.

GEJ (Esophageal varices)
Rectum (Hemorrhoids)
Periumbillical veins (Caput medusae)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 370

57

Common and serious complication of of deep vein thrombosis (DVT).

Pulmonary embolism
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 371

58

The acute inflammation elicited when bacterial infections spread into and through the lymphatics.

Lymphangitis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 371

59

These are bright red to blue lesions, that vary from a few millimeters to several centimeters in diameter. Unencapsulated aggregates of closely packed, thin-walled capillaries, usually blood-filled and lined by flattened endothelium. Vessels are separated by scant connective tissue stroma.

Capillary hemangiomas
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 372

60

Appears as red-blue, soft, spongy masses 1-2 cm in diameter, which can affect large subcutaneous areas of the face, extremities, and othe body regions. Mass is sharply defined but not encapsulated, composed of large, cavernous, blood-filled spaces.

Cavernous hemangioma
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 372

61

This form of capillar hemangioma is a rapidly growing peduncular red nodule on the skin, gingival, or oral mucosa, bleeds easily and is often ulcerated.

Pyogenic granuloma(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 373

62

These are round, slightly elevated, red-blue firm nodules,

Glomus tumor (Glomangioma)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 373

63

A specialized arteriovenous structure involved in thermoregulation.

Glomus body(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 373

64

This lesion is the ordinary "birthmark" and is the most common form of ectasia. Characteristically a flat lesion on the head or neck, ranging in color from light pink to deep purple.

Nevus flammeus
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 374

65

This non-neoplastic vascular lesion grossly resembles a spider. There is radial, often pulsatile array of dilated subcutaneous arteries or arterioles about a central core, that blanches when pressure is applied to its center.

Spider telangiectasia
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 374

66

An opportunistic infection in immunocompromised persons that manifest as vascular proliferations involving skin, bone, brain and other organs. Characterized grossly by red papules and nodules, or rounded subcutaneous masses. Histologically, there is capillary proliferation with prominent epitheloid EC's showing nuclear atypia and mitoses. Lesions contain stromal neutrophils, nuclear dust nd purplish granular material.

Bacillary angiomatosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 374

67

Common in patients with AIDS, caused by HHV 8, causing skin lesions ranging from patches, plaques to nodules.

Kaposi sarcoma
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 375

68

These are malignant endothelial neoplasms, with varying histology from plump, anaplastic but recognizable endothelial cells producing vascular channels to widely undifferentiated tumors having solid, spindle cell appearance and producing nondefinite blood vessels.

Angiosarcoma
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 376

69

Form of hypertension characterized by
-systolic pressure more than 200 mmHg or diastolic pressure more than 120 mmHg
-renal failure, and
-retinal hemorrhages and exudates

Malignant Hypertension
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 488

70

The most important independent risk factor for atherosclerosis.

Family history
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 492.

71

The initial event in the pathogenesis of atherosclerosis

Endothelial injury and dysfunction
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

72

The major lipoprotein involved in the pathogenesis of atherosclerosis.

LDL
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

73

2 most important causes of endothelial dysfunction

Hemodynamic disturbances
Hypercholesterolemia
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 494

74

The key processes in atherosclerosis

Intimal thickening and lipid accumulation (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 496

75

The major structural component of fibrous cap in an atheromatous plaque

Collagen
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 500

76

Medial ischemia leading to degenerative changes of aorta, leading to scarring, loss of elastic fibers, inadequate extracellular matrix synthesis, and production of amorphous ground substance. This can be seen in Marfan syndrome and scurvy.

Cystic medial degeneration
(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 502

77

Most common etiology associated with ascending aortic aneurysm

Hypertension
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 502

78

A 70 y/o male, hypertensive, present with sudden severe abdominal pain. On physical examination, there is a presence of pulsatile abdominal mass. The most likely diagnosis is:

Abdominal aortic aneurysm
(TOPNOTCH)

79

The most frequent preexisting histologically detectable lesion in aortic dissection

Cystic medial degeneration
(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 504

80

Presents with sudden onset of excruciating pain, usually beginning in the anterior chest, radiating to the back between the scapulae, and moving downward.

Aortic dissection
(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 505

81

Most common cause of death in aortic dissection.

Rupture of the dissection into the pericardial, pleural or peritoneal cavities
(TOPNOTCH) Robbins Basica Pathology, 9th ed., p. 505

82

A 38 y/o male presents with severe headache and diplopia associated with fever and fatigue. Area along the course of the superficial temporal artery was painful to palpation. Biopsy done revealed intimal thickening of the artery, granulomatous inflmmation of the internal elastic lamina with infiltrate of T cells and macrophages. What is the most likely diagnosis?

Giant cell arteritis
(TOPNOTCH)

83

Patient initially present with fatigue, weight loss and fever and then reduced blood pressure and weak pulses in the carotids and upper extremities, ocular disturbances and neurologic deficits. The most likely diagnosis is:

Takayasu arteritis
(TOPNOTCH)

84

Most common involved blood vessel in Takayasu arteritis.

Aortic arch
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 509

85

This disease presents with rapidly accelerating hypertension, abdominal pain, bloody stool, myalgia and peripheral neuritis. The most likely diagnosis:

Polyarteritis nodosa
(TOPNOTCH)

86

A 4 y/o female presented with fever and maculopapular rash on her trunk and extremities. This is associated with conjunctival erythema, edema of the hands and feet, and cervical lymph node enlargement. The patient is at risk for what type of blood vessel involvement?

Coronary artery aneurysm which may lead to acute MI. (Case of Kawasaki Disease)
(TOPNOTCH)

87

Patient presents with asthma, allergic rhinitis, palpable purpura, GI bleeding, renal disease, and cardiomyopathy. Histologic findings showed vascular granulomata and hypereosinophilia. The most likely diagnosis is:

Churg-Strauss syndrome
(TOPNOTCH)

88

It presents as a clinical triad of recurrent oral apthous ulcers, genital ulcers, and uveitis.

Behcet Disease
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 511

89

This disease presents with persistent pneumonitis with bilateral nodular infiltrates, chronic sinusitis, mucosal ulceration of the nasopharynx, and renal disease. Histologic findings of upper respiratory tract lesion showed mucosal granuloma with geographic patterns of central necrosis and vasculitis. The most likely diagnosis:

Granulomatosis with polyangitis/Wegener granulomatosis
(TOPNOTCH)

90

A 30 y/o male, smoker, presents with severe leg pain aggravated by exercise and relieved on rest. It further progressed to extremity ulcerations. What is the most likely diagnosis?

Thromboangiitis obliterans (Buerger disease)(TOPNOTCH)

91

Most imprortant risk factor for DVT

Prolonged immobiliztion resulting in venous stasis
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 514

92

A 50 y/o male, diagnosed with lung cancer, presented with edema and cyanosis of the head, neck, and arms with cyanosis. This is a case of:

Superior vena cava syndrome
(TOPNOTCH)

93

The most common etiologic agent in lymphangitis.

Group A beta hemolyitc streptococcus
(TOPNOTCH) Robbins Basic Pathology, 9th ed. p. 515

94

An autosomal dominant disorder caused by mutations in genes that encode components of TGF-B signaling pathway. Presents with telengiectasia that are widely distributed over the skin and mucus membranes.

Hereditary hemorrhagic telengiectasia/Osler-Weber-Rendu disease
(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 516

95

Most common type of hemangioma

Capillary hemangioma
(TOPNOTCH) Robbins Basic Pathology, 9th ed. p. 516

96

Painful tumors arising from modified smooth muscle cells of arteriovenous structure, most commonly found in the distal portion of the digits.

Glomus tumor (Glomangioma)
(TOPNOTCH)Robbins Basic Pathology, 9th Ed p. 517

97

A 13 year old male dies of a stray bullet to the head on New Year's Eve. At autopsy, there is a flat yellowish streak seen on the intimal surface of his abdominal aorta, near the bifurcation of the renal arteries.
This streak
(A) causes minor disturbance in blood flow
(B)is expected in his age group
(C) is composed of hemosiderin-filled foam cells
(D) would have certainly evolved into an atheromatous plaque if he lived to old age

expected in his age group ("fatty streak"
(TOPNOTCH)Robbins Basic Pathology, 8th Ed pp 348-349)

98

Early atherosclerotic lesions are usually focal, patchy, and eccentric because
(A) there are differences in the vascular hemodynamics at various points
(B) the expression of LDL receptors along the blood vessels is varied
(C) concentrations of macrophage-activating cytokines are different along blood vessels
(D) certain endothelial cells are more sensitive to toxins and hyperglycemia than others

there are differences in vascular hemodynamics at various points
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 349

99

A 65 year old diabetic female with poor glycemic control and a 5 year history of intermittent chest pain develops pallor, shortness of breath and diaphoresis. She dies 16 hours later. At autopsy, the left ventricular wall is thickened, with dark mottling of the anterior portion, along with the septum and apex. Which of the following describes the likely histology of her left anterior descending artery? (A) an eccentric atheromatous plaque with a fibrous cap (B) a ruptured fibrous cap with calcifications in the lumen of the vessel (C) a ruptured fibrous cap with thrombus formation (D) complete occlusion of the original lumen by fibrous tissue, with neovascularization in the periphery

a ruptured fibrous cap with thrombus formation (TOPNOTCH)Robbins Basic Pathology, 8th Ed p.351

100

What is the most common cause of aneurysms?

atherosclerosis
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

101

What is the most common site of atherosclerotic aneurysms?

abdominal aorta
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 358

102

A 75 year old male with heart failure symptoms of 10 years dies. At autopsy, his aortic trunk is dilated, with fibrous scars and wrinkling of the intima. The aortic valve is also dilated, and the left ventricle is markedly enlarged. Microscopic examination of the aorta shows narrowed or obliterated vasa vasorum to be narrowed, with a dense rim of lymphocytes and plasma cells, some extending into the media. Which of the following can suggest the etiology of the patient's findings?
(A) family history of diabetes
(B) chronic alcohol intake
(C) history of sexually transmitted infection
(D) occupational exposure to benzene

(C) history of sexually transmitted infection (tertiary/cardiovascular syphilis)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.359, 703

103

A 30 year old female with 3 year history of fever, weight loss and fatigue presents with right eye blindness. PE showed weak pulses in the upper extremities. Which of the following suggests that she has Takayasu arteritis, rather than temporal arteritis?
(A) age
(B) constitutional symptoms
(C) giant cells in the large blood vessels
(D) giant cells in the medium blood vessels

age
(50 giant cell)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 364-365

104

Classic polyarteritis nodosa affects small to medium sized vessels most commonly in which organ?
(A) kidneys
(B) heart
(C) liver
(D) GI tract

kidneys
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 365

105

A 2 year old boy presents with erythema of the conjunctiva, oral mucosa, palms and soles, with focal erosions. Palpation shows enlarged cervical lymph nodes. He suddenly dies a few hours after ER admission. Autopsy showed marked mononuclear infiltration of his left anterior descending artery, with fibrinoid necrosis and lumen occlusion. What could have prevented this fatal sequela?
(A) low dose corticosteroids
(B) Hepatitis B vaccine
(C) Beta-lactam and aminoglycoside combination
(D) intravenous immunoglobulin

(D) intravenous immunoglobulin (Kawasaki disease)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.366

106

A 42 year old man with 2 weeks of epistaxis undergoes an intranasal biopsy, which showed chronic granulomatous inflammation with giant cells. Xray showed cavitary lung lesions. He is treated with anti-Koch's for 6 months, but the epistaxis recurred. He also developed hematuria. Which of the following can help support a diagnosis of Wegener's granulomatosis, rather than TB?
(A) positive P-ANCA
(B) positive C-ANCA
(C) urinalysis with RBC morphology
(D) biopsy of the lung lesion

positive C-ANCA
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 367-368

107

A 27 year old Israeli expat presents with intermittent pain and pallor of the right index and middle fingers, precipitated by smoking and cold temperature. He reports symptomatic relief whenever he stops smoking. What is expected in the arteries of the involved fingers?
(A) thrombus with neutrophil aggregates and necrosis
(B) histiocytes and giant cells
(C) ruptured fibrous cap and underlying foamy cells
(D) eosinophils and lymphocytes in the media and intima

(A) thrombus with neutrophil aggregates and necrosis (Buerger disease)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.368

108

A 21 year old G1P0, 24 weeks AOG, has a reddish 1.0 cm diameter nodule on her left lower gum. She reports that the nodule appeared at 1 month of pregnancy. A biopsy showed shows capillaries with an acute and chronic inflammatory infiltrate and stromal edema. There is no pleomorphism, necrosis, or atypical mitosis. This nodule:
(A) can be found in 20% of pregnant women
(B) is malignant
(C) may spontaneously regress or fibrose after pregnancy
(D) is metastatic from an ovarian primary

(C) may spontaneously regress or fibrose after pregnancy (granuloma gravidarum/pregnancy tumor/pyogenic granuloma)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.373

109

A 3 year old female with a large "port wine stain" on the right side of her face has occasional seizures. Further examination showed mental developmental delay. She may also have
(A) more extensive vascular malformations
(B) multiple colonic polyps
(C) color blindness
(D) alpha thalassemia

(A) more extensive vascular malformations (Sturge-Weber syndrome)
(TOPNOTCH)Robbins Basic Pathology, 8th Ed p.374

110

A 38 year old HIV-positive man has multiple reddish-purple plaques and nodules on his arms and legs. He has never been on antiretroviral therapy. Biopsy of one of the nodules showed sheets of plump spindle cells encompassing small vessels and slit-like spaces, with focal hemorrhage, hemosiderin deposits, lymphocytes, and macrophages. Mitotic figures are common. This neoplasm has been shown to be infected with (A) HPV 16 (B) HHV 8 (C) Hepatitic C (D) HPV 18

HHV8 (Kaposi Sarcoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed p. 375