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136 Cards in this Set

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Simple tubular structures made up of a layer of _____ cells surrounded by one or more layers of ________ cells
Endothelial

Smooth Muscle
Layers of blood vessels
Tunica Intima
Tunica Media
Tunica Adventitia
The Aorta and Large Arteries are _____
Elastic
The smaller arteries are ____ arteries
muscular
Tiniest blood vessels
Capillaries
Blood vessels important in maintaining blood pressure
Arterioles
The majority of the clotting factors are produced in the _______ with the exception of _______, which has a component of which that is produced in the endothelial cells.
Liver

Factor VIII
Vascular smooth muscle is involved in _____ and _____
Vasoconstriction and Dilation
VAscular Smooth Muscle is involved in __1___synthesis.
After injury to the blood vessel it can ___2___.
It has receptors for __3__
It can also perform __4__
1. Matrix (collagen, elastin)
2. migration and proliferation
3. lipoproteins
4. Phagocytosis
Atherosclerosis is a disease of ____ and ____ arteries.
It is accumulation within the ______ of smooth muscle cells and lipids.
Medium and Large sized

Intima
Leading cause of death in the US
Ischemic Heart Disease
Macrophage with ingested lipid =
Foam cells
Stages of atherosclerotic plaque development
1. Fatty Streak
2. Fibrous plaque
3. Thrombus on top of Atheroma
1st step in Atherosclerosis and possible causes (5)
Chronic Endothelial injury
-increased lipids
-cigarette smoking
-homocysteine
-infections
-Hypertension
2nd step in Atherosclerosis
endothelial dysfunction such as increased permeability allowing lipids and cells to trickle thru endothelium
3rd step in Atherosclerosis
Smooth Muscle emigration from Media to Intima.

Macrophage activation and secretion of cytokines
4th step in Athersclerosis
Macrophage and smooth muscle cells engulf lipid

Fatty Streak development
5th step in Atherosclerosis
Smooth muscle proliferation
Collagen and ECM deposition
Extracellular Lipid

Fibrofatty Atheroma
Type of Atheromas that are more dangerous
Soft ones with more lipids because they can rupture more easliy
Initial lesion of Atherosclerosis
Fatty streak
Two components of Atheroma
1. Fibrous cap
2. Soft center (atheroma)
What is the risk factor for Atherosclerosis?
any factor associated with a doubling in the incidence of ishemic heart disease
4 Nonmodifiable Major risk factors for Atherosclerosis
1. Increasing Age
2. Male
3. Family History
4. Genetic Abnormalities
4 "Potentially controllable" risk factors for Atherosclerosis
1. Hyperlipidemia
2. Hypertension
3. Cigarette Smoking
4. Diabetes
Type of cholesterol that is more atherogenic
Oxidized LDL
Cholesterol Metabolism and Atherosclerosis:
-__1__ defect.
-Polymorphism of __2__
-Lipoprotein__3__
1. LDL receptor defect = Familial Hypercholesterolemia
2. Apolipoprotein E
3. Lipoprotein (a)
Apolipoprotein that causes reduced or absent HDL
ApoA1
Enzyme Defects that cause Atherosclerosis (3)
1. Lipoprotein Lipase --> Type 1 Hyperlipidemia
2. Hepatic Lipase --> elevated IDL and LDL --> Severe Atherosclerosis
3. LCAT --> mild hypertriglyceridemia, reduced HDL
Receptor defect that causes severely elevated LDL
Familial Hypercholesterolemia
4 complications of Atherosclerosis
1. Acute occlusion --> ischemic necrosis
2. Chronic occlusion --> atrophy
3. Aneurysm formation
4. Embolism
Most common sites of Severe Atherosclerosis (5)
1. Abdominal Aorta and Iliac Arteries
2. Proximal Coronary Arteries
3. Thoracic Aorta, Femoral, and Popliteal Arteries
4. Internal Carotid Arteries
5. Vertebral, basilar, and middle cerebral arteries
4 Non-invasive measures for Atherosclerosis Intervention
1. Dietary control and exercise
2. Lipid lowering drugs
3. Anti-oxidant supplements
4. Aspirin
6 Invasive measures for Atherosclerosis intervention
1. Balloon angioplasty
2. Fibrinolytic therapy
3. Endarterectomy
4. Endovascular atherectomy
5. Arterial by-pass
6. Stenting
Drugs:
High LDL --> 1
HIgh Lp(a) --> 2
high plasma Triglyceride -> 3
Low HDL -> 4
Hypertension -> 5
Hyperglycemia -> 6
Hyperhomocysteine -> 7
High Fibrinogen -> 8
1. Statins
2. Nicotinic acid
3. Fibric acid
4. Nicotinic acid
5. Thiazide diuretics
6. Insulin
7. Folic Acid
8. Fibric Acid
Complication with Balloon Angioplasty and Vascular replacement
Destruction of endothelial wall causing re-stenosis
Aneurysms: localized __1__ of blood vessles caused by a congenital or acquired weakness in the __2__
1. dilation
2. media
4 types of Aneurysms
Dissecting
Arteriovenous
*Fusiform
*Saccular

*most common
Classification of Aneurysms by Etiology (5)
1. Atherosclerotic
2. Syphilitic
3. Dissecting
4. Mycotic
5. Congenital
Atherosclerotic aneurysms most commonly occur in the __1___. They are usually of this type: __2__. They may contain a __3__. Microscopically there is destruction of __4__
1. Abdominal Aorta and common Iliac Arteries
2. Fusiform
3. Mural Thrombosis
4. arterial wall elastic fibers
3 clinical features of Atherosclerotic aneurysms
1. Rupture: emergency with severe pai, shock, bleeding into ab/thoracic cavity
2. Local ischemic effects due to compression of surrounding arteries
3. Ab pain due to compression of nerves
Atherosclerotic aneurysms greater than _____ have a great risk of rupture
5 cm
Factors of Aortic Aneurysms that leads to Mural Thrombosis
1. exposure of sub-endothelial tissue to the blood which results in thrombosis
2. Stagnation or alteration in blood flow in the dilated vessl allows for Thrombosis
Abdominal Aortic Aneurysms are usually located ______
below the renal artery orifices
What is an Aortic Dissection?
a form of hematoma within the vessel wall = blood flowing through the layers of the wall
Cause for 90% of Aortic Dissections
Older males who have hypertension
Other causes for Aortic Dissection
Marfan Syndrome and Cystic Medial necrosis
What is Cystic Medial Necrosis
fragmentation of elastic fibers in the Media (associated with pregnant women and Marfan syndrome)
Most common site of Aortic dissection
Ascending Aorta usually within 10 cm of Aortic Ring
Clinical presentation of person with Aortic Dissection
Severe, tearing chest pain that starts in the chest and radiates in the direction of the dissection = along the arch of aorta and down into the abdomen.
Aortic Dissection characteristically results in __1__, most often into the __2__, causing hemopericardium and fatal __3__
1. aortic rupture
2. pericardial sac
3. cardiac tamponade
What is a double-barreled aorta?
Dissecting aneurysm that has ruptured back into the lumen of the Aorta
Define Type A and B Dissection Aneurysms
Type A = ascending aorta
Type B = descending aorta
Syphilitic Aneurysm:
Incidence: __1__
Most common site: __2__
Intima appearance: __3__
Obliterative __4__ of the __5__ with __6__ infiltration
Organism: __7__
1. uncommon
2. Thoracic Aorta
3. Tree Bark appearance (due to necrosis and scarring)
4. Endarteritis
5. Vasa vasorum (supplies blood to intima media)
6. Plasma cell
7. Treponema Pallidum
Syphilitic aneurysm can affect the ascending aorta and the aortic ring leading to ________
Aortic Valve Insufficiency causing Left Ventricular Dilation and Hypertrophy
Berry Aneurysm:
Involves the __1__ arteries.
Congenital defect in __2__ of blood vessels.
The most frequent cause of __3__ hemorrhage
Age range: 4
Morph: 5
1. Cerebral
2. muscularis (media)
3. subarachnoid
4. usually 30-40
5. Saccular
Berry Aneurysms usually occur at this general spot
bifurcations of cerebral arteries
Mycotic Aneurysms result from __1__ and __2__ of the vessel wall
1. microbial infection
2. weakening
Vessels most commonly affected by Mycotic Aneurysms (3)
Aorta
Cerebral vessels
Splanchnic arteries
What is a Pseudoaneurysm?
leakage of blood from an artery into the surrounding tissue with persistent communication between the originating artery and the terminating blood filled cavity
Another word for Vasculitis
Angiitis
Vasculitis due to Immune Complexes (3)
Henoch Schonlein
Lupus Vasculitis
Polyarteritis Nodosa (HBV associated)
Vasculitis due to Direct Antibody Attack (2)
Goodpasture's Syndrome
Kawasaki disease
Vasculitis associated with ANCA (Anti-neutrophil Cytoplasmic Antibodies) (3)
Wegener's
Microscopic Polyangiitis
Churg Strauss
Polyarteritis Nodosa:
Artery types: __1__
__2__ involvement of arteries.
__3__ necrosis with infiltration of __4__.
Associated with __5__.
Can produce small __6__
1. Small and Medium arteries
2. Patchy
3. Fibrinoid
4. Eosinophils
5. Thrombosis
6. Aneurysms (nodosa)
Polyarteritis Nodosa:
-Associated with __1__ in 30% of patients.
-Organs involved __2__ (4)
-spares these arteries: __3__
-DOC's: __4__ (2)
1. Hepatitis B
2. Kidney, Heart, Skeletal muscle, Skin
3. Pulmonary
4. Steroids and Cyclophosphamide
This is common if the kidneys are involved in Polyarteritis Nodosa
Hypertension
Giant Cell Arteritis alternate name
Temporal Arteritis

Granulomatous Arteritis
Giant Cell Arteritis:
-Focal, chronic __1__ inflammation of __2__ arteries
-Age group: __3__
-Artery morph: __4__
-__5__ in lumen is common
- presents with __6__
-__7__ symptoms in 50% of patients
-Elevated __8__
-Gender: __9__
1. granulomatous
2. temporal
3. >50
4. cord-like and nodular
5. thrombus
6. temporal headhache
7. Visual (ophthalmic artery)
8. ESR
9. Males
Wegener's Granulomatous:
-Vessels involved: __1__
- Sites affected: __2__ (3)
-serum antibody present: __3_
-__4__ and __5__ inflammation
1. Small arteries and veins
2. Nasal sinuses, Lungs, Kidneys
3. c-ANCA
4. Necrosis
5. Granulomatous
Hypersensitivity Angiitis alternative name
Microscopic Polyarteritis
What is Hypersensitivity Angiitis due to?
response to exogenous substances
Hypersensitivity Angiitis:
-Cutaneous lesions due to _1_
-Vessels affected: __2__
-may be a feature of other systemic diseases such as __3__.
-__4__ is present
-Clinical presentation: __5__
1. Leukocytoclastic vasculitis = PMN's release tissue degrading substances
2. Small -> arterioles, capillaries, venuoles
3. Lupus Erythematosus
4. p-ANCA
5. Palpable Purpura
Difference between Hypersensitivity Angiitis and Polyarteritis Nodosa
HSA vessels are all at the same stage of inflammation.

PAN vessels may be at all stages of acute and chronic inflammation
Churg-Strauss Syndrome alternate name
Allergic Granulomatosis and Angiitis
Churg-Strauss Syndrome:
-Systemic vasculitis with prominent __1__.
-affects young persons with history of __2__
-widespread __3__ vascular lesion.
-Vessels affected: __4__
-__5__ is present in serum
1. Eosinophilia
2. Asthma
3. necrotizing
4. small and medium arteries and veins
5. p-ANCA
Takayasu Arteritis:
-known as __1__ disease
- Vessels affected: __2__
-persons affected: __3__
-__4__ thickening and obliteration of __5__
- absent __6__ pulse
1. Pulseless
2. Aortic arch, large arteries
3. Young women
4. INTIMA
5. lumen
6. upper extremities
Kawasaki Disease:
-Alternate name:__1__
- Age group: __2__
- Clinical manifestations: __3__ (4)
-may cause aneurysms in __4__
1. Mucocutaneous lymph node syndrome
2. < 4 yoa
3. Fever, rash, conjuctival and oral lesions, Lymphadenitis
4. Coronary Artery
Thrombo-angiitis Obliterans alternate name
Buerger Disease
Buerger Disease:
-Vessels involved: __1__
- painful __2__ disease, often leading to __3__
-associated with __4__
-Intermittent __5__
1. small and medium arteries
2. ischemic (occlusive)
3. gangrene
4. SMoking
5. claudication
Large Vessel Vasculitis' (2)
Giant Cell Arteritis
Takayasu Arteritis
Medium-sized Vessel Vasculitis (2)
Polyarteritis Nodosa
Kawasaki disease
Small Vessel Vasculitis (5)
Wegener's Granulomatosis
Churg-Strauss Syndrome
Leukocytoclastic Vasculitis
Henoch Schonlein Purpura (IgA immunocomplexes)
Microscopic Polyarteritis
Antineutrophil Cytoplasmic Antibodies:
Heterogenous group of __1__ against enzymes mainly in __2__
1. Autoantibodies
2. Neutrophil Granules
c-ANCA is seen in _____
Wegener's
p-ANCA is seen in these 2
Microscopic Polyarteritis
Churg-Strauss
Raynaud Phenomenon:
-Intermittent, __1__ attacks of __2__ of fingers or toes leading to __3__
-Related to exposure to __4__
-Due to __5__
-Primary type occurs in __6__
-Associated with __7__
1. bilateral
2. ischemia
3. pallor, pain, parasthesia
4. Cold
5. Arterial spasm
6. young females
7. Scleroderma
4 Benign Tumors of Blood Vessels
1. Hemangioma
2. Granuloma Pyogenicum
3. Vascular Ectasia
4. Glomus Tumor
Borderline (intermediate) Tumor of Blood Vessels
Hemangioendothelioma
Malignant Tumors of Blood Vessels (3)
1. Angiosarcoma
2. Hemangiopericytoma
3. Kaposi Sarcoma
Only great concern with Hemangiomas
Is if they start to bleed
2 type of Hemangiomas
Capillary Hemangioma

Cavernous Hemangioma
Histology of Cavernous Hemaniogmas
Large vascular spaces lined by FLATTENED endothelial cells
A malignant neoplasm of vascular origin characterized by MASSES of Endothelial cells
Angiosarcoma
Development of HEPATIC Angiosarcomas is associated with... (3)
Polyvinyl Chloride
Arsenic
Thorotrast (Thorium Dioxide)
Sites where Angiosarcomas occur (4)
Skin
Soft Tissue
Breast
Liver
Histology of Angiosarcomas
irregular vascular spaces lined by Malignant-apearing endothelial cells with HYPERCHROMATIC NUCLEI
Explain "Lymphedema Associated Angiosarcoma"
Development of an Angiosarcoma in the Lymphedematous arm of a patient who has has AXILLARY LYMPH NODE DISSECTION for breast cancer (due to Statis)
Alternate name for "Lymphedema Associated Angiosarcoma"
Stewart-Treves Syndrome
Classic Kaposi's Sarcoma affects these people
Older European men
African Kaposi's Sarcoma presents with this
Lymphadenopathy in African men and children
Transplants associated KS is due to this
Immunosuppression
AIDS associated KS occurs in these people and with what co-infection?
Homo Males
HHV-8
3 Stages of Lesion development in KS
1. Patch stage
2. Plaque Stage
3. Nodular stage
Benign capillary proliferation involving the skin/visceral organs in AIDS patients caused by Bartonella Henselae (Cat Scratch Fever)
Bacillary Angiomatosis

*responds to Antibiotics*
What are varicose veins?
enlarged tortuous veins
Risk Factors for Varicose Veins of the LEGS (6)
1. Increasing Age
2. FEMALES
3. Hereditary predisposition
4. Obesity
5. Posture (standing job)
6. Increased Venous Pressure
2 Clinical features of Varicose Veins
Swelling
Dull Pain
2 Complications of Varicose Veins
Stasis Dermatitis
Stasis Ulcers
List 3 other sites where Varicose Veins occur (other than leg)
1. Esophageal Varices = portal hypertensio due to Cirrhosis

2. Hemorrhoids = internal/external hemorrhoid plexus of rectum

3. Varicocele = pampiniform plexus of Scrotum
Thrombus of Veins without Inflammation
Phlebothrombosis
Thrombus of veins associated with Inflammation
Thrombophlebitis
Which one is more dangerous - Thrombophlebitis or Phlebothrombosis? Why?
Phlebothrombosis b/c it is more likely to break off and produce Pulmonary Emboli
Lymphangitis
An acute inflammation involving Lymphatics, usually BACTERIAL in origin causing painful red streaks in the SUBCUTIS
Occlusion of Lymphatics leading to accumulation of interstitial fluid
Lymphedema
5 causes of Lymphedema
1. invasion of lymphatics by malignant cells
2. radical surgery
3. post-irradiation fibrosis
4. post-inflammatory scarring
5. parasitic infection --> Filariasis
Arteriosclerosis = __1__ and __2__ of the ARTERIES
1. thickening
2. Hardening
Arteriosclerosis due to aging
Senile Arteriosclerosis
Medial Calcification Sclerosis
Monckeberg's Medial Sclerosis
Monckeberg's Medial Sclerosis usually occurs in these arteries and affects this age group
Arteries of Upper/Lower Extremities (radial & Ulnar)

> 50 yoa

*usually asymptomatic
Hypertension: Systolic pressure > __1__ or Diastolic pressure > __2__
1. 140 mm Hg
2. 90 mm Hg
What is Secondary Hypertension?
5-10% of cases in which a DEFINITE CAUSE can be identified
What is Primary Or Essential Hypertension?
90-95% of cases that have UNKNOWN etiology
Secondary Causes of Hypertension
R = REnal
E = Endocrine
N = Neurogenic
A = Aortic
L = Labile
Renal causes of Secondary Hypertension (4)
1. Stenosis of Artery -> Renin release -> Angiotensin -> 1. constricts arterioles 2. Aldosterone release -> Sodium retention

2. Fibromuscular Dysplasia

3. Atherosclerosis

4. Glomeruonephritis/ Pyelonephritis
Endocrine causes of Secondary Hypertension
1. Adrenal Cortical Hyperfunction (Aldosterone) = Cushing's
2. Adrenal Medullary Hyperfunction (Catecholamines) = Pheochromocytoma
Essential Hypertension is a product of __1__ and __2__.
It is influenced by __3__ and __4__
1. Cardiac Output
2. Peripheral Resistance
3. Renal function
4. Sodium Homeostasis
Pathogenesis of Essential Hypertension:
-Genetic defect in __1__
-Genetic defect in __2__ in vascular smooth muscle
-Variation in genes encoding __3__
1. Renal Sodium excretion
2. Sodium/Calcium transport
3. Angiotensinogen
Hypertension Risk Factors (6)
1. Family History
2. High Sodium intake
3. Stressful lifestyle
4. Obesity
5. High Alcohol intake
6. ORAL CONTRACEPTIVES
Clinical Manifestations of Hypertension:
-Early = 1
-Later = 2
1. Headhache, nosebleeds, tinnitus, dizziness

2. Stroke, Heart failure, Renal failure
Changes associated with Benign Hypertension
Hyaline or Sclerotic Arteriolar changes that are slowly progressing
Describe Malignant Hypertension
Rapidly progressive, Arteriolar spasm, Edema, Necrosis
CNS and Renal Complications
Describe the Histology of Malignant Hypertension
- concentric, "onion-skinned" thickening of the smooth muscle (hyperplasia)
- Fibrinoid Necrosis
- No inflammation
Vascular Pathology in Hypertension:
-Accelerates __1__
-Potentiates __2__ and __3__
1. Atherogenesis
2. Aortic Dissection
3. Cerebrovascular Hemorrhage
Hyaline changes in arteriolar walls indicate _______
Hyaline Arteriosclerosis = Benign HTN
"Onion-skin" lesions with Fibrinoid Necrosis indicate ________
Hyperplastic Arteriosclerosis = Malignant HTN
Factors indicating Adverse Prognosis in HTN:
-Race: __1__
-Age: __2__
-Sex: __3__
-Persistent Diastolic pressure > __4__
1. black
2. younger age
3. males
4. 115