Pathoma - 7 (Vascular)

eliot2014's version from 2016-01-17 02:46

Section 1

Question Answer
What joint and muscle pain condition is associated with temporal giant cell arteritis?polymyalgia rheumatica
name 2 branches of the carotid artery that are involved in temporal giant cell arteritiscarotid artery --> temporal artery and ophthalamic artery
Biopsy reveals inflammed vessel with giant cells and intimal fibrosistemporal giant cell arteritis
whats the tx of temporal giant cell arteritis?corticosteroids = risk of blindness if not
name 2 granulomatous vasculiditistemporal giant cell arteritis and takayasu arteritis
pulseless diseasetakayasu arteritis
weak pulse in upper extremitistakayasu arteritis
pt is <50 years old and involves aortic archtakayasu arteritis
name the 3 medium vessel vasculiditis = involving muscular arteries that supply organs1) polyarteritis nodosa 2) kawasaki disease 3) buerger disease
what organ is spared in polyarteritis nodosaLUNGS
what type of necrosis is seen in polyarteritis nodosa?transmural inflammation with FIBRINOID necrosis --> produces string of pearls appearance
necrotizing vasculitis involving MULTIPLE organs but spares the lungsPAN
whats the treatment of PAN?corticosteroids and cyclophosphamide
blood vessel shows "string of pearl" appearancepolyarteritis nodosa
young azn boy presents with BL conjunctivitis, fever and rash of palms and soleskawasaki disease
vasculitis a/w rash on palms and soleskawasaki disease
whats the tx for kawasaki disease?aspirin and IVIG
what artery is involved in kawasaki disease?coronary artery --> increased risk for thrombosis and MI, aneurysms
necrotizing vasculitis involving DIGITSbeurgers disease
pt presents with vasculitis cauing ulceration, gangrene and amputation of fingersbeurgers disease
raynauds is a/w with which vasculitis?beurgers disease
whats the tx of wegeners granulomatosis and PAN?corticosteroids and cyclophosphamide
small vessel necrotizing vasculitis involving lung and kidney, p-ANCA+microscopic polyangitis
necrotizing granulomatous inflammation with eosinophilschurg strauss syndrome
IgA nephropathy + rashhenoch-schonlein purpura
vasculitis due to IgA immune complex depositionhenoch-schonlein purpura
Can temporal giant cell arteritis be ruled out with a negative biopsyno because lesions are segmental and diagnosis requires biopsy of a long segment of vessel
Name 2 "granulomatous vasculiditis"Temporal giant cell and takayasu
Name 3 "necrotizing vasculiditis"Polyarteritis nodosa, Buerger disease, and Microscopic polyangiitis
Nme two "necrotizing granulomatous vasculiditis"Wegener and Churg-Strauss
How do you treat henoch-schonlein purpuranothing--disease is self-limited (may give steroids if really bad)
Which vasculitis is associated with smoking?Buerger
What organs are usually associated with Wegenernasopharynx, lungs, and kidneys
What organs are usually associated with microscopic polyangiitis?lungs and kidneys
What organs are usually associated with churg strauss?lungs and heart

Section 2

Question Answer
whats the cause of primary HTN?UNKNOWN
what is secondary HTN?HTN due to KNOWN CAUSE
whats the most common cause of secondary HTN?renal artery stenosis
why do you see unilateral atrophy of the AFFECTED kidney in secondary HTN?bc of decreased blood flow/nutrients to that kidney
whats the cause of stenosis in eldery males?atherosclerosis
whats the cause of renal stenosis in YOUNG FEMALESfibromuscular dysplasia = irregular thickening of renal artery in females
whats the cause of stenosis in old men vs. young females?old men: atherosclerosis. young female: fibromuscular dysplasia
what fibromuscular dysplasia that causes stenosis in young females?developmental defect of blood vessel wall, resulting in irregular thickening of large and medium sized arteries
malignant HTN>200/120 mmHg
what is atherosclerosis?intimal plaque that obstructs blood flow
name 4 arteries thatt are most common affected with atherosclerosis1) abdominal aorta 2) coronary artery 3) popliteal artery 4) internal carotid artery
whats is the pathogenesis of atherosclerosis?damage to endothelium allows lipids to leak into intima-->lipids are oxidized and then consumed by macrophages via scavenger receptors, resulting in foam cells-->eventually you get inflammation, healing, and increased deposition of lipid in the intima-->deposition of extracellular matrix and proliferation of smooth muscle
atherosclerosis can lead to stenosis of medium sized vessels taht results in impaired blood flow and ischemia leading to:peripheral vascular disease, angina, ISCHEMIC BOWEL DISEASE (mesenteric arteries)
what percentage of occlusion causes symptoms> 70% stenosis
what are the 2 types of arteriolosclerosis?hyaline and hyperplastic
what are the 2 causes of hyaline arteriosclerosis?benign HTN (high BP pushes proteins thru vessel wall) and DM
what causes hyperplastic arteriolosclerosis?thickening of vessel wall by hyperplasia of smooth muscle due to MALIGNANT HTN
what does hyperplastic artheriosclerosis lead to?fibrinoid necrosis of vessel wall with hemorrhage
flea bitten appearance of kidney (and mention pathophys)hyperplastic arteriolosclerosis a/w malignant HTN due to fibrinoid necrosis of vessel wall with hemorrhage
Onion skin appearancehyperplastic arteriolosclerosis (due to hyperplasia of the smooth muscle caused by malignant HTN)
How does an aneurysm form from atherosclerosiso2 normally feeds vessel wall. a plaque decreases o2 diffusion to the intima, media, and adventita-->vessel cannot be fed with o2-->it weakens-->wall balloons out

Section 3

Question Answer
what tears in aortic dissection?INTIMAL tear with dissection of blood thru MEDIA of aortic wall
whats the most common cause of aortic dissectionHTN --> HTN results in hyaline arteriosclerosis of vasa vasorum (blood vessels that provide blood to outer half of blood vessel wall)--> decreased flow causes atrophy of MEDIA
cystic medial necrosis is a/w what 2 diseases?Marfans and Ehlers Danlos
whats the most common cause of death from aortic dissection?pericardial tamponade
what are vaso vasorum?vessels that provide blood to outer half of blood vessel wall
what disease is associated with thoracic aneurysms?tertiary syphillis
whats a major complication of thoracic aneuryms?dilation of aortic valve root --> aortic valve insufficiency
what causes AAA?atherosclerosis
what causes aortic dissection?HTN
hows does atherosclerosis cause AAA?atherosclerosis increases the diffuse barrier to the media, resulting in atrophy and weakness of vessel wall
pt presents with hypotension, pulsatile abd mass and flank painAAA
Whats a local structure that AAA can compress?ureter
What are complications of thoracic aneurysm?dilation of aortic valve root, compression of airway or esophagus, thrombosis/embolism
What are complications of AAA?Rupture (esp when greater than 5 cm), compression of ureter, thrombosis/embolism
What are complications of aortic dissection?pericardial tamponade, rupture, and obstruction of branching arteries (coronary or renal-->cause end organ ischemia)

Section 4

Question Answer
Benign tumor composed of blood vesselshemangioma
pt presents with tumor of blood vessel that presents at birth but regresses in childhoodhemangioma
name 2 places a/w hemangioma (tumor of blood vessels)skin, liver
Liver angiosarcoma is associated with exposure to what three things?arsenic, polyvinyl chloride, and Thorotrast
Most common sites of angisarcoma (3)skin, liver, and breast
hemangioma vs. purpura (bleed into skin/tissues)hemangioma: press down and it would blanch since blood is within vessels. Purpura - press down and WONT blanch since blood is in tissues
maligant proliferation of endothelial cells that line blood vesselsangiosarcoma
what sarcoma is associated with thorotrast (radioconstrast) exposure?liver angiosarcoma
LOW GRADE malignant proliferation of endothelial cells...associated with HHV-8kaposi sarcoma
AIDS pt presents with purple patches that WONT BLANCH when you press downkaposi sarcoma = blood is within tissue and interspersed btw endothelial cells