Cv2 Manivel Carlos 4

Front 1

__________ is a clinical term for arterial thickening/hardening that may have 4 different pathologic causes:
_____ Arteriosclerosis.
Monckeberg (medial) sclerosis/calcification.
Hypertensive arteriolosclerosis.
___________ (is the most important).

Back 1

arteriosclerosis

senile

atherosclerosis

Front 2

Which form of arteriosclerosis does this represent?
Intimal thickening (due to fibrosis)
Loss of media medial muscle, increase in collagen (fibrosis)
Gradual diffuse distention and elongation of large elastic arteries

Back 2

Senile arteriosclerosis

Front 3

Which form of arteriosclerosis does this represent?
Medial lesion only - no intimal thickening/no luminal narrowing
Affects medium sized muscular arteries
No clinical significance - any ischemia is solely attributable to co-existing atherosclerosis

Back 3

Monckeberg's (medial calcific) Sclerosis

Front 4

Which form of arteriosclerosis does this represent (which form specifically)?
Mild/moderate systemic hypertension or diabetes causes it
Arterioles and small arteries show thickening from leakage of plasma components and extracellular matrix produced by smooth muscle cells

Back 4

Hypertensive Arteriolosclerosis - Hyaline Arteriosclerosis

Front 5

Which form of arteriosclerosis does this represent (which form specifically)?
Malignant hypertension produces malignant nephrosclerosis
Small arteries show onion skin appearance, or fibrinoid necrosis
Focal hemorrhages and mico-infarcts seen

Back 5

Hypertensive arteriolosclerosis - Hyperplastic form

Front 6

Which form of arteriosclerosis does this represent?
Disease of the intima
Affects large (elastic) and medium sized (muscular) arteries
Formation of fibrofatty plaque with a lipid core and fibrous cap

Back 6

Atherosclerosis - most important! Major cause of death and morbidity in developed countries (50% of US)

Front 7

An aneurysm is a localized abnormal _______ of a blood vessel, usually an artery.
2 possible mechanisms:
Wall _______ (e.g. due to medionecrosis)
Excessive ______ force (e.g. due to hypertension)

Back 7

dilation
weakening
dilating

Front 8

What distinguishes a True Aneurysm from a False Aneurysm?
Which is nicknamed "pulsating hematoma"?

Back 8

True contains remnants of the original artery in its wall
False is an evacuated hematoma that communicates with the artery's lumen

Front 9

Which shape of aneurysm is this?
Weakening of the entire circumference of the arterial wall - dilates. Results in mural thrombus often.
Most common cause is atherosclerosis
Most common site is abdominal aorta
Most common aneurysm in elderly

Back 9

Fusiform (cylindrical) Aneurysm

Front 10

Which shape of aneurysm is this?
Carotid artery stenosis
Sx: TIA, stroke
Cause: atherosclerosis, usually with thrombus at or near bifurcation

Back 10

Fusiform (cylindrical aneurysm)

Front 11

What is the main predictor for aneurysm perforation?

Back 11

Size - rises significantly with diameter
bad prognosis - 7.5cm or higher

Front 12

Which shape of aneurysm is this?
Leriche syndrome (atherosclerosis of iliac arteries)
Sx: intermittent claudication in legs

Back 12

Fusiform (cylindrical) aneurysm

Front 13

Which shape of aneurysm is this?
Abdominal angina drom atherosclerosis of mesenteric arteries
Postprandial pain (abdominal after eating)
May precede thrombosis with infarction

Back 13

Fusiform (cylindrical) aneurysm

Front 14

Inflammatory aortic aneurysm can be distinguished from atheromatous aortic aneurysm bc patients are...
age?
symptomatic
thick aneurysm wall
_____ marker elevated in blood
Mechanism:

Back 14

younger
CRP (inflammatory)
autoimmune

Front 15

Which shape of aneurysm is this?
Only a portion of the circumference of an artery is weakened, connected to rest of artery by ostium
Most common is cystic medionecrosis of the aorta... also berry, arteritis, syphilitic

Back 15

Saccular aneurysms

Front 16

Which shape of aneurysm is this? what type specifically?
Most common cause of large arterial saccular aneurysms at present
associated with aging and/or hypertension
associated with Marfan syndrome

Back 16

Saccular aneurysm due to cystic medionecrosis

Front 17

Which shape of aneurysm is this? what type specifically?
Common when teritary syphilis was frequent. Proximal aorta is prime site of aneurysm.
Micro-infarcts of media, tree bark intimal wrinkling with fibrosis
NEVER LEADS TO DISSECTING aneurysm due to medial scarring

Back 17

Saccular - Syphilitic aneurysm

Front 18

Which shape of aneurysm is this? What type specifically?
Pre-existing defect in media of arteries at branch points
Protrusion of intima and adventitia
Systemic hypertension facilitates
Associated with type III polycystic renal disease and von Hippel-Lindau syndrome
Rupture leads to SA hemorrhage

Back 18

Saccular - berry aneurysm of the circle of willis

Front 19

What is misconceiving about the name cystic medionecrosis? What is it really?

Back 19

No cysts or necrosis
Really loss of smooth muscle which doesn't regenerate, but fill with mucopolysaccharides

Front 20

Which syndrome has mutations in fibrillin-1 which normally causes microfibrils in extracellular matrix that form scaffolding on which tropoelastin is deposited → Elastic fibers.
What type of aneurysm does this cause?

Back 20

Marfan Syndrome

Cystic medionecrosis

Front 21

CLASSIFICATION OF ARTERITIS
Sx: > 50, Headache, jaw claudication, blind, stroke
Pathology: Intramural granulomatous (Epithelial histiocytes) inflammation, many giant cells
Immune process targets elastic membrane

Back 21

Giant Cell Arteritis (temporal, cranial)

Front 22

CLASSIFICATION OF ARTERITIS
Females under 40
Effects aortic arch and branches (esp carotid and sublavian - no pulse)
Same Sx as temporal arteritis
Autoimmune problem, genetic predisposition (inc HLA)

Back 22

Takayasu's Disease

Front 23

CLASSIFICATION OF ARTERITIS
Immune-related necrotizing arteritis
Nasopharynx, lungs, kidney usually
Foci necrosis, giant cells, peripheral granulomas, necrotizing vasculitis, acute inflammation (which leukocyte?)

Back 23

Wegener Granulomatosis

PMN

Front 24

Which arteritis can you tet for using indirect immunofluorescence test for anti-neutrophil cytoplasmic antibody (ANCA)? - tests positive for c-ANCA

Back 24

Wegener granulamatosis

Front 25

What is c-ANCA? What does it test for?
What is p-ANCA? What does it test for?

Back 25

(diffuse) cytoplasmic anti-neutrophil cytoplasmic antibody (serine)
Wegener
perinuclear anti-neutrophil cytoplasmic antibody (myeloPeroxidase)
Churg-Strauss syndrome

Front 26

CLASSIFICATION OF ARTERITIS
Segmental, vasculitis in middle-aged smoker (male)
Rare in US
Sx: acute, painful, occlusion of large arteries and veins of legs and arms
Increased immune response to collagen types II and III
acute and granulomatous inflammation of all layers of arteries, veins, nerves

Back 26

Throboangiitis Obliterans
BUERGER DISEASE

Front 27

CLASSIFICATION OF ARTERITIS
Acute or subacute, multifocal, multi-organ necrotizing arteritis
Immune modulated
Fibrinoid necrosis, arterial wall, many hepatitis B positive
Increased BP, renal failure, stroke
Macroscopic and microscopic (polyangiitis) forms

Back 27

Polyarteritis nodosa (fibrinoid necrosis)

Front 28

CLASSIFICATION OF ARTERITIS
Similar to polyarteritis nodosa or microscopic polyangiitis but with granulomas and eosinophils
Association with allergic rhinitus, aosinophilia
Heart, lung, spleen, nerves, skin

Back 28

Churg-Strauss
p-ANCA 50%

Front 29

CLASSIFICATION OF ARTERITIS
40% <4 years old
autoantibodies to cells
fever, rash, lymphadenopathy
Necrotizing coronary arteritis, coronary aneurysms, thrombosis with MI (most common MI cause in kids)

Back 29

Kawasaki Disease

Front 30

Mycotic Aneurysm: aneurysm due to _____

Back 30

infection

Front 31

MICROANEURYSMS
DIABETES MELLITUS in which body parts?

THROMBOTIC PURPURA (Moschowitz).

CHARCOT-BOUCHARD aneurysms.

Back 31

retinal vessels, kidneys, heart

Front 32

MICROANEURYSMS
Tend to occur on the lenticulostriate artery in the internal capsule
Site of rupture in systemic hypertension induced cerebral hemorrhage
May just be due to kinked artery

Back 32

Carcot-Bouchard "aneurysms"

Front 33

MICROANEURYSMS
Microaneurysms at artero-capillary junction

Back 33

Thrombotic purpur (Moschowitz disease)

Front 34

What is a traveling intramural hematoma?

Back 34

Dissecting aneurysm

Front 35

Dissecting aneurysm
Hypertension, aging, trauma, or weakening of wall (medionecrosis) causes tearing of artery usually 1-2 cm above the ____ ____. Hematoma separates ____ and inner 2/3 of ____ from media/adventitia.

Back 35

aortic valve
intima
media

Front 36

What is the most common cause of death with dissecting aneurysm?

Back 36

Cardiac tamponade due to external rupture

Front 37

Flow complications of aortic dissecting aneurysm:
1) External rupture leading to what?
2) Occlusion of branches (____ vanishes)
3) Re-entry tears (_____ re-appears)
4) Dissection down ____ branches (including coronary arteries)

Back 37

intrapericardial bleed and cardiac tamponade
pulse
pulse
aortic

Front 38

COMPLICATIONS OF ARTERIAL ANEURYSMS
_______ on adjacent structures
Rupture with massive ________
_______ with occlusion of branches
Thromboembolism

Back 38

Pressure
hemorrhage
thrombosis

Front 39

True or False Aneurysm?
Results from healed, regional, transmural infarct. Virtually never ruptures. Problems due to heart failure or arrhythmia

Back 39

True Cardiac Aneurysm

Front 40

True or False Aneurysm?
Ruptured infarct with adherent pericardium so aneurysm wall consists of pericarium
Very prone to rupture

Back 40

False Cardiac Aneurysm

Front 41

WHICH ANEURYSM TYPE?
Etiology: Atherosclerosis, inflammation
Location: Abdominal
Age: Old
Aortic valve involved? No
Complications: Rupture; stenosis or emboli to leg/renal arteries, sometimes dissection

Back 41

Atherosclerosis

Front 42

WHICH ANEURYSM TYPE?
Etiology: Cystic medial degeneration (Marfan or Ehlers-Danlos syndrome mutations)
Location: Any - rupture usually proximal
Age: Middle
Aortic valve involved? Sometimes in terminal rupture
Complications: Rupture following spolitting of aortic wall by hemorrhage; hypertension common

Back 42

Dissecting

Front 43

WHICH ANEURYSM TYPE?
Etiology: Infectious
Location: Ascending an arch
Age: Middle
Aortic valve involved? Often (regurgitates)
Complications: Rupture; aortic regurgitation w/ HF, erode sternum, second degree atherosclerosis, stretch recurrent laryngeal

Back 43

Syphilitic

Front 44

WHICH ANEURYSM TYPE?
Etiology: Traumatic
Location: Anywhere
Age: Any
Aortic valve involved? No
Complications: Often bullet or stab wound; arterial catheter

Back 44

"False" aneurysm

Front 45

WHICH ANEURYSM TYPE?
Etiology: Congenital? Acquired? Focal absence of smooth muscle in wall
Location: Bifurcation sites
Age: MIddle to Old
Aortic valve involved? n/a
Complications: Rupture; Rx: Clip neck or endo Rx to occlude

Back 45

Berry

Front 46

WHICH ANEURYSM TYPE?
Etiology: Atherosclerotic destruction of wall structure
Location: Anywhere including basilar and vertebrals
Age: Old
Aortic valve involved?
Complications:

Back 46

Atherosclerotic

Front 47

WHICH ANEURYSM TYPE?
Etiology: Infectious (usually SBE), Acute purulent arteritis (bacterial) w/ wall destruction
Location: Anywhere
Age: Middle
Aortic valve involved? n/a

Back 47

Mycotic (rare)