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150 Cards in this Set

  • Front
  • Back
Name the types of vessels that lack medial layer. (3)
- capillaries
- post-capillary venules
- lymphatics
Which type of vessel is this?

- thick medial layer
- rich in elastic fibers separated by alternating smooth muscle cells
large elastic arteries
Which type of vessel is this?

- elastin in internal and external elastic lamina
- circulatory or spirally arranged smooth muscle cells
medium sized muscular arteries
Which type of vessel is this?

- no medial layer
- one cell layer endothelium
- no valves
capillaries
Which type of vessel is this?

- no medial layer
- one cell layer endothelium
- one way valves
lymphatic vessel
Which type of vessel is this?

- 1-2 layers of smooth muscle cells
- resistance vessels
- internal elastic lamina
arterioles
Which type of vessel is this?

- thin medial layer
- no internal elastic lamina
- one way valves
- large capacitance
veins
Which type of vessel is this?

- no medial layer
- site of vascular leakage and leukocyte emigration
post-capillary venules
Atherosclerosis usually takes place in which type of vessels?

What about HTN?
Atheroclerosis
- large elastic arteries
- medium sized muscular arteries

HTN
- small size muscular arteries
- arterioles
Which type of capillaries are in these organs?

- endocrine glands, renal glomeruli, some digestive tract capillaries
fenestrated
Which type of capillaries are in these organs?

- heart, lung, skin, muscle, CNS
continuous
Which type of capillaries are in these organs?

- liver, spleen, marrow
sinusoids
What are some antigens expressed on endothelial cells under normal condition?
- CD31(PECAM1) at inter-endothelial junction: leukocyte transmigration
- CD34 on endothelial cells in lymph nodes: bind to naive T cell
- vWF
Ultrastructure near endothelial cell membrane.
pinocytic vesicles
Ultrastructure of endothelial cells with neighbouring cells.
junctional complexes: eg tight junctions, etc.
Intracellular ultrastructure of endothelial cells. (hint: storage site for vWF)
Weibel-Palade bodies
Endothelial cell functions. (6)
- transfer of molecules
- produce ECM
- regulate blood flow
- regulate stasis
- regulate cell growth
- regulate inflammation, immuniry.
How does endothelial cells regulate blood flow?
- synthesis of vasoconstrictors: endothelin, ACE
- synthesis of vasodilators: NO, prostacyclin
How does endothelial cells regulate stasis?
- synthesis of pro-thrombotic factors: vWF, TF, plasminogen activator inhobitor
- synthesis of anti-thrombotic factors: prostacyclin, thrombomodulin, plasminogen activator, heparin like molecules
How does endothelial cells regulate cell growth?
- synthesis of growth stimulators: PDGF, FGF, CSF
- synthesis of growth inhibitors: TGF-beta, heparin
How does endothelial cells regulate inflammation and immunity?
- make cytokines: IL1,6,8
- make surface molecules: VCAM1, ICAM, E-selectin, P-selectin, CD31, HLA antigens.
Which of the following is faster?

- endothelial stimulation
- endothelial activation
- endothelial stimulation: seconds to minutes
Endothelial stimulation or activation?

- rapid, reversible
- induced by histamine to increase permeability, inhibit NO synthesis
- redistribute P-selectin from Weibel-Palade bodies to cell surface
endothelial stimulation:
histamine, thrombin, PAF, cytokines by activated macrophages
Endothelial stimulation or activation?

- slow, hours to days
- express newly acquired properties: altered gene expression and synthesis of new proteins
endothelial activation:
- activators: cytokines, lipid products, hemodynamic forces, viruses, complement products, hypoxia, advanced glycosylation end products.
- induced genes: adhesion molecules, cytokines, GF, vasoactive mediators, coagulation proteins, MHC molecules.
What are some normal functions of smooth muscle cells in blood vessels? (3)
- vasoconstriction, vasodilation
- synthesize collagen, elastin, proteoglycans
- synthesize GF, cytokines
Minor or major vascular injury?

- proliferation of endothelial cells to repair the injury
- smooth muscle minimally stinulated and stay in the medial layer
minor vascular injury
Minor or major vascular injury?

- stimulation of smooth muscle cells: migrate to intimal layer and increase in proliferation and synthesis of ECM, lost ability to contract.
Major/chronic vascular injury
- results in intimal thickening -> stenosis, thrombotic occlusion
Causes of intimal thickening. (3)
- progressive atherosclerosis (most common)
- post-angioplasty: restenosis
- post-organ transplant: stenosis
What is the cause of the largest morbidity of all US diseases?
atherosclerosis
What is the age onset of atheroscleosis?
teens, usually becomes symptomatic in middle age.
Describe the progression of atherosclerosis from normal artery to clinical evident diseases.
- normal artery
- fatty streak
- fibrofatty plaque
- vulnerable plaque
- aneurysm, rupture, thrombosis, stenosis.
What is this disease?

- hardening of large arteries
atherosclerosis
What is this disease?

- hardening of small arteries and arterioles
ateriolosclerosis
What is this disease?

- thickened arterial walls
- calcium deposits in medial layer of medium muscular arteries
- do not cause stenosis alone
Monckeberg medial calcific sclerosis
What is the "foot print" of atherosclerosis?
atheromatous plaque: yellowish-gray,slightly elevated.
What are these called? Compare these 2 pictures.
left: atheromatous plaque, class IV or V lesion
right: ulcerated athreroatous plaque, class VI lesion.
What are the components of atheromatous plaque?
What is this disease?
coronary artery plaque
- fibrosis in intima: fibrous cap
- weak,thin media
- lipid core of cholesterol clefts
- 65% stenosis of lumen
Which class of atherosclerosis is this?

- isolated macrophage foam cells with lipid
class I
Which class of atherosclerosis is this?

- fatty streak
class II
Which class of atherosclerosis is this?

- fatty streak
- small extracellular lipid pool
class III
Which class of atherosclerosis is this?

- atheroma: core of extracellular lipid
class IV
Which class of atherosclerosis is this?

- fibroatheroma: lipid core and fibrotic layer
class V
Which class of atherosclerosis is this?

- lesion with surface defect (ulceration)
- hematoma or thrombosis
- accompanied by dystrophic calcification
class VI
Which classes of atherosclerosis are clinically significant?
class V and VI
Class VI atherosclerotic lesion:

What is the cause of hemorrhage?
- rupture of neovascular vessels or fibrous cap
Class VI atherosclerotic lesion:

What is the cause of thrombosis (most serious complicaiton)?
- exposure of thrombogenic substance -> secondary acute occlusion of lumen -> acute ischemic infarction
What are the top 5 manifestations of atherosclerosis in the US?
- coronary arteries: angina, MI
- cerebral arteries: TIA, infarction, multi-infarct dementia
- aorta: aneurysm, embolism
- lower extremity arteries: ischemia (claudication), stasis ulcers, gangrenous necrosis
- mesenteric arteries: ischemic enteritis, acute infarction.
What happens to the medial layer of medium/large arteries in atherosclerosis?
aneurysm
- variable atrophy
- loss of elastic fibers
- dystrophic calcification
What are the components of fatty streak?
- lipid filled foam cells (macrophages)
- small amounts of T cells
- extracellular lipids
- not raised
Phases of atherosclerosis:

- chronic endothelial injury
Phase I
- hyperlipidemia
- HTN
- smoking
- homocysteine
- hemodynamic factors
- toxins
- viruses
- immune reactions
How does hyperlipidemia cause chronic endothelial injury?
- LDL-cholesterol oxidized at sites of fatty streak -> chemotactic for monocytes, toxic to endothelial cells
- ingested by macrophages
Phases of atherosclerosis:

- increased endothelial permeability
- leukocyte adhesion via VCAM1
- monocyte adhesion via VCAM1 and emigration
Phase II: endothelial dysfunction
Phases of atherosclerosis:

- smooth muscle emigrate into intimal layer: change from contractile phenotype to sythetic phenotype
- macrophage activation: secrete IL1,TNF, monocyte chemoattractant protein-1, smooth muscle cell growth factor (PDGF, FGF, TGF-alpha)
Phase III: smooth muscle cell emograion
Phases of atherosclerosis:

- macrophages and smooth muscle cells engulf lipid: oxidzed LDL-cholesterol
- T cells augment inflammation and secrete cytokines
Phase IV: lipid phagocytosis
Phases of atherosclerosis:

- smooth muscle cell proliferation
- collagen, ECM deposition
- extracellular lipid
Phase V: collagen and extracellular lipid deposition and smooth muscle cell proliferation
T/F: Risk factors for atherosclerosis are more than additive.
T.
Non-modefiable risks for atherosclerosis.
- aging
- male
- family history
- genetic abnormality
Modefiable risks for atherosclerosis.
- hyperlipidemia
- HTN
- smoking
- diabetes
- lack of exercise
Which genetic lipoprotein disorder is this?

- defeciency of LDL receptor
heterozygous familial hypercholesterolemia
Which genetic lipoprotein disorder is this?

- apo B-100 problem
- familial defective apoprotein B
- hypobetalipoproteinemia
Give four common lipoprotein disorders that put people at risk for atherosclerosis
- familial combined hyperlipidemia: 1:200
- heterozygous familial hypercholesterolemia and familial hypertriglyceridemia: 1:500
- familial defective apoprotein B: 1:700
- hypobetalipoproteinemia: 1:1000
Name the three biochemical risk factors for atherosclerosis.
- CRP: reflect chronic component of atherosclerosis
- homocycteine: risk for ischemic heart disease
- Lp(a): apoB-100 of LDL linked to apoA, particularly for men.
Two congenital vascular anomalies.
- berry (saccular) aneurysms of cerebral arteries
- arteriovenous fistula
Where is a common location of berry aneurysms?
ACA and MCA near branch points
What increases the risk for berry aneurysm to rupture?
- inherited disease: marfan, Ehlers-Danlos, NF-1
- smoking
- HTN
What is consequence when berry aneurysms rupture?
subarachnoid hemorrhage
What are some causes of AV fistula?
- trauma
- inflammation
- surgery created fistula for vascular access during hemodialysis
What are AVM or AV fistula at risks for?
- high output heart failure: more blood on venous side
- inadequate exchange of O2, CO2, and nutrients: bypass capillaries
- rupture with hemorrhage
What is this disease?
cerebral AVM
- gross: soft, spongy, red-brown mass
- histo: haphazard arrangement of variably-sized vessels, most larger than capillaries.
What are the two most likely cause of essential HTN?
- retention of excess Na
- vasoconstriction and vascular hypertrophy
What are hypertensive people most likely at risk for? (6)
- heart failure: cardiac hypertrophy
- atherosclerosis
- renal failure: renal vascular arteriolosclerosis
- cerebral hemorrhage and infarction
- aortic dissection
- ruptured berry and atherosclerotic aneurysms
Which of the following seconday cause of HTN is most common?

- renal
- cardiovascular
- endocrine
- neurologic
- renal
What are hypertensive people most likely at risk for? (6)
- heart failure: cardiac hypertrophy
- atherosclerosis
- renal failure: renal vascular arteriolosclerosis
- cerebral hemorrhage and infarction
- aortic dissection (CMD)
- ruptured berry and atherosclerotic aneurysms
Which of the following seconday cause of HTN is most common?

- renal
- cardiovascular
- endocrine
- neurologic
- renal
What is the most common lesion associated with HTN?
Hyaline arterioloscleosis
- thickening of media by pink hyaline material
What is the pathogenesis of hyaline arteriolosclerosis?
HTN -> endothelial damage -> leakage of plasma to media -> stimulation of smooth muscle to synthesize ECM
Sequelae of hyaline arteriolosclerosis (HTN)
Progressive arteriolar stenosis:
- diffuse renal ischemia -> atrophy of glomeruli -> nephrosclerosis -> renal insufficiency -> worsen HTN (increased TPR)
What lesion is associated with malignant HTN?
Hyperplastic arteriolosclerosis
- "onion-skin" thickening of arteriolar media and intima
What type of HTN is this?

- diastolic pressure > 110-120
malignant HTN
True or False aneurysm?

- vascular wall contains all components of arterial wall
- blood ramains within normal circulation
- true
True or False aneurysm?

- extravascular hematoma communicating with vascular space
- false
What are the two causes of true aneurysm?
- atherosclerosis
- cystic medial degeneration
What are some causes of false aneurysm?
- trauma
- surgery
What are some causes of mycotic aneurysm?
- infection induced
- any infectious agent
What is the most common site to find atherosclerotic aortic aneurysm?
- abdominal aorta > common iliac > aortic arch > descending thoracic aorta
- most develop between renal arteries ans aortic bifurcation
Pathogenesis of atherosclerotic aortic aneurysm (AAA). (4)
- media layer gradually thinned and weakened by intimal plaques.
- connective tissue defects
- HTN and atherosclerosis
- complicated grade VI atherosclerosis
What is this?
AAA of abdominal aorta
- layered fibrin
- unorganized thrombus in lumen
These are associated with which disease?

- pulsatile mass (palpable in thin people)
- impingement on ureter
- atherosmbolism
- ischemia due to occlusion od ostium of major aortic branch
-
AAA
What is this disease?
syphilic aneurysm
- obliterative endarteritis of vasa vasorum -> ischemic injury to media -> aneurysm -> aortic valvular insufficiency (regurgitation) with left ventricular hypertrophy
What do you think of when a patient presents with sudden onset or acutely worsening chest or back pain?
aortic dissection (an emergency)
What people are at risk for aortic dissection?
- HTN patients
- Marfan syndrome
- pregnant women
- patients undergoing invasive vascular procedures
Where in the media does aortic dissection happen?
between middle and outer 1/3 of media
What is the cause of death of this person?
aortic dissection
- proximal spread -> weakened aortic valve annulus -> ruptured aortic root with resulting massive hemopericardium
Name some complications of aortic dissection.
- compression/occlusion of aotic branches -> ischemia of areas supplied by these branches
What disease is this?
aortic dissection
- double shadow sign: column of blood on medial layer creates the sedcond line peripheral to the aortic lumen
What is this?
Type A aortic dissection
- hemopericardium
What is this?
Type A aortic disseciton
- extending around coronary arteries into peridcardial sac
What is this? and what can this cause?
Cystic medial degeneration (always present in Marfan syndrome)
- aneurysm
- aortic dissection
Raynaud disease or phenomenon?

- younger women
- proxysmal and reversibe
- due to exaggerated vasomotor response to cold or emotion
- no underlying disease
Raynaud disease
Raynaud disease or phenomenon?

- older adults
- intermittent and chronic cyanosis and coldness of same area
- due to persistent arterial ischemia
- cause arterial stenosis
- due to exaggerated vasomotor response to cold or emotion
- associated with atherosclerosis, SLE, Buerger disease.
Raynaud phenomenon
What are the two pathogenic mechanisms of vasculitis?
- immune-mediated
- direct invasion by infectious agent
What is the most common vasculitis in the US?
giant cell arteritis (temporal arteritis)
Two patterns of active giant cell arteritis.
- granulomatous inflammation od inner media with giant cells
- nonspecific panarteritis without giant cells
What is this disease?
giant cell arteritis
- intimal fibrosis
- scattered giant cells
- patchy, transmural infiltrate of lymphocytes, plasma cells and macrophages
Where are the major arteries affected by giant cell arteritis?
- temporal
- vertebral
- ophthalmic
What is this disease?

- younger women, under age 40
- weaker pulses and lower pressure in arms than legs
- see giant cell miscroscopically
Takayasu arteritis (pulseless disease)
- intimal thickening -> narrowed arotic orifice of major arteries to upper body
What is this disease?
Takayasu arteritis (puseless disease)
- multiple stenosis of aortic arch vessels
- severe fibrosis with stenosis
- lymphocytic infiltrate with multinucleated giant cells
What is this disease?
PAN
- destruction of medial smooth muscle cell
- fibrinoid necrosis of intima and media
- obliteration/stenosis of lumen
- transmural neutrophils (necrotizing inflammation)
Name a segmental disease.
PAN
What is this disease?

- systemic vasculitis with transmural necrotizing inflammation if medium/small arteries in any organ except lungs.
PAN
What is the most frequently affect artery in PAN?
Kiney

- heart
- liver
- GI tract
- pancreas
- testes
- skeletal muscle
- nervous system
- skin
The following are sequelae of what disease?

- microaneurysms
- obstruction
- ischemia with ulceration
- hemorrhage
- necrosis
- infarction
PAN
What is this disease?

- vasculitis in medium sized vessels in young children
- cardiac sequelae
Kawasaki syndrome
What is this disease?

- sinusitis by necrotizing granulomatous inflammation
- necrotizing capillaritis in lungs
- acute focal glomerulitis
Wegener granulomatosis
- upper respiratory
tract lesion
- lung
- kidney
What is this?
necrotizing capullaritis of lung
- neutrophils infiltrating alveolar septae
- wegener granulomatosis
What is this?
transmural necrosis and obliteratio of lumen in medium sized artery
- wegener granuloamtosis
What type of arteritis is this?

- pneumonitis -> secondary pulmonary vasculitis
infectious arteritis
What type of arteritis is this?

- meningitis -> vasculitis in adjacent superficial cerebral arteries
infectious arteritis
What type of arteritis is this?

- endicarditis -> embolization to arteries
infectious arteritis
Pathogenesis of varicose veins in the leg.
venous stasis -> incompetent venous valves -> congestion, thrombosis -> edema/dermatitis/ulcers
T/F: Pulmonary emboli are often from superficial venous varices.
F.
Pathogenesis of esophageal varices.
cirrhosis -> portal hypertension -> progressively enlarging varices
Pathogenesis of hemorrhoids.
prolonged pelvic venous congestion caused by pregnancy, chronic constipation, straining at stool, pants too tight.
Thrombosis in veins is called ___.
thrombophlebitis / phlebothrombosis
Where does phlebothrombosis most likely originate from?
deep leg veins
What are some risk factors for phlebothrombosis?
- prolonged bed rest
- cardiac failure
- neoplasia
- pregnancy
- post operative state
- obesity
- genetic hypercoagulable state
What is this disease?

- leg edema, redness, swelling
- + homan sign
phlebothrombosis
What is usually the first manefestation of phlebothrombosis?
embolic event
What is the #1 cause of sudden death in post-op patients?
pulmonary thrmobiembolism (saddle)
Which patients are at risk for pulmonary thromboembolism?
- cancer
- post-operative
- cardiac failure
What are some sequelae of pulmonary thromboembolism?
- acute ischemia of lung
- impaired filling of left atrium and ventricle, may lead to cardiovascular collapse
What is this disease?

- dusky cyanosis
- dilated veins of head, neck, arms
- respiratory disress
Superior vena cacal syndrome
- obstruction of SVC by neoplasm (lung cancer mostly)
What ist his disease?

- leg edema
- distension of superficial abdominal collateral veins
- massive proteinuria
inferior vena caval syndrome
- neoplasm compress or envade vein
- mostly hepatocellular carcinoma, renal cell carcinoma
What is this disease?

- dilated lymphatics up to the point of obstruction
- big body parts
- secondary induration and ulaceration of skin
primary lymphedemas (rare)
Name a hereditary familial lymphedema syndrome
Milroy disease
What is this disease?

- female, 10-25 age
- edema in feet, progress upward
lymphedema praecox
What is this disease?

- painful red subcutaneous streaks
- regional llymphadenopathy
lymphangitis
- bacterial infection: group A strep most common
What is this disease?
hemangioma (begnine)
- red-purple spongy mass
- +/- thrombosis
What is this disease?
hemangioma (benign)
- proliferating blood vessels
- irregular vessels lined by uniform endothelial cells
What is this disease?
vascular ectasia (benign)
- dilation of preformed vessels
- telangiectasia
- nevus flammeus
- spider telangiectasia of skin: cirrhosis, pregnancy
What is this disease?
osler-weber-rendu disease
- spontaneous epistaxis
- diffuse telangiectasia
- death from intestinal bleeding
What is the cause of this?
bacillary angiomatosis
- bartonella henselae (cat-scratch)
- bartonella quintana

tumor like growth capillary growth with cellular atypia and mitoses
Name 2 malignant vascular tumors.
- angiosarcoma
- hemagiopericytoma
Which type of kaposi sarcoma do europeans have?
chronic
Which type of kaposi sarcoma do Africans have?
lymphadenopathic
Which type of kaposi sarcoma do transplant patients have?
immunosuppression associated
Which virus is associated with kaposi sarcoma?
HHV8
Describe the stages of skin lesions in kaposi sarcoma.
- patch
- plaque
- nodule
What is this disease?
kaposi sarcoma
- patches and plaque