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65 Cards in this Set
- Front
- Back
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a 66 year old male has hard, dilated, palpable arteries in the extremities and genitalia that are radiologically visible. He has a history for diabetes. what is the most likely diagnosis?
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Monckeberg Medial Calcific Sclerosis
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which types of arteriosclerosis cause luminal stenosis? which types of atherosclerosis do not cause luminal stenosis?
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- atherosclerosis and arteriosclerosis
- Monckeberg meidal calcific sclerosis |
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what age group is most often affected by monckeberg medial calcific sclerosis?
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> 50 y/o
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what would you see histologically in a patient with monckeberg?
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dystrophic calcification of media and/or interal elastic lamina of the muscular arteries
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what is an atheroma?
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a necrotic lipid core with a fibrous cap that develops in the wall of arteries
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what is the most feared complication of an atheroma?
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thrombosis of the overlying tissue
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what is the main consequence of an atherosclerosis?
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luminal stenosis or occlusion
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what morphological changes may you see in a patient that under went balloon angioplasty with stenting? why are these of importance?
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- balloon angioplasty may cause plaque rupture, medial dissection, or medial stretching. stenting may cause endothelial damage and medial stretching
- all of these create new sites that are at an increased risk for further thrombosis |
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what must you do for all people who have stents placed?
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put them on anti-thrombotics because the stents themselves are thrombotic surfaces
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what are the 2 causes of arteriosclerosis?
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- hypertension
- diabetes |
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what is hypertension?
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a systemic, multiorgan disorder, a sign of which is high blood pressure (> 140/90)
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what is the most common type of hypertension?
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primary or essential hypertension (account of 95%)
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why is it important to recognize secondary hypertension?
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because if we treat the underlying cause we cure the hypertension
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what is arteriosclerosis (in general)?
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a combination of thickening of the walls of the arterioles and luminal stenosis. this leads to downstream ischemia which causes decreased renal blood flow which in turn causes hypertension which will cause more arteriosclerosis.
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what is the main factor in the development of hypertension?
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endothelial cell function
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what causes hyaline arteriosclerosis?
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benign hypertension; BP <200/<120
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what would be present histologically in a patient with hyaline arteriosclerosis?
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homogenous haline thickening of the arterial walls and loss of the underlying structure
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what is the end result of hyaline arteriosclerosis?
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luminal stenosis
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what causes hyperplastic arteriosclerosis?
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malignant hypertension; BP that rapidly rises to >200/>120
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what will you see histologically with hyperplastic arteriosclerosis?
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hyperplastic smooth muscle cells, thickened basement membrane, and lumenal stenosis
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a patient comes in with a rapidly rising blood pressure of 315/180. after a couple of days he dies. an autopsy is performed and you are asked to look at a slide with a section of one of his arteries. on the slide you see an onion-skin appearance, smooth muscle hyperplasia, and lumenal stenosis. what is your diagnosis?
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hyperplastic arteriosclerosis
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what is nephrosclerosis?
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renal scarring due to ischemia that is associated with sclerosis and eventually stenosis of the renal arterioles and small arteries
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what causes nephrosclerosis?
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chronic hypertension and/or diabetes mellitus
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what will the kidney look like grossly in a patient with nephrosclerosis?
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it will have a granular surface due to the cortical scars
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a patient comes in with high blood pressure. ophthalmoscopic exam shows copper and silver wiring in her arteries. what is the most likely diagnosis?
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hypertensive retinopathy
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what are cotton wool spots? where would i find them?
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- accumulations of swollen axons due to choroidal and retinal infarcts
- in the eyes of a patient with hypertensive retinopathy |
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what is the most common type of vasculitis among adults in the US?
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giant cell (temporal) arteritis
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a 55 year old presents to the ER due to sudden onset of blindness in her left eye. physical exam shows a cord-like artery in the temporal region of her skull that is tender to palpation. she states that she has had that for about 3 months. what is the most likely diagnosis? what will you do to confirm your diagnosis?
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- giant cell (temporal) arteritis
- do a biopsy of the inflammed temporal artery |
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T or F; granulomas are present in giant cell (temporal) arteritis.
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true
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what is the prognosis and treatment for giant cell (temporal) arteritis?
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- will have spontaneous remission in 6-12 months
- can give corticosteroids or anti-TNF |
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what age group is most commonly affected by giant cell arteritis?
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> 50 years old
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what is the profile of a person who is most likely to be affected by takayasu arteritis?
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- < 40 years old
- female - Asian |
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what is the treatment of takayasu arteritis?
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- anti-inflammatory agents if found early
- reconstructive vascular surgery if found late |
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what arteries are most commonly involved in takayasu arteritis?
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- aortic arches and its branches
- pulmonary arteries - renal arteries |
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a 33 year old female from Japan presents to your office. she states that her fingers are cold and get numb. physical exam reveals now radial pulses and low blood pressure. what is the most likely diagnosis?
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takayasu arteritis with involvement of the aortic arch
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who is affected by Thromboangitis obliterans (Buerger disease)?
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young males (< 36 years old) who are heavy smokers
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a 28 year old male presents to you office complaining of discoloration of his finger tips and toes. he also says that if he walks for more than about 100 yards at a time it hurts in his legs to take another step. he has a history of smoking about 3 packs of cigarettes per day since he was 16. what is the most likely diagnosis? what will you do to treat it?
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- Thromboangitis obliterans (Buerger disease)
- tell him to quit smoking or he will lose his fingers and toes and it will eventually occur in his penis |
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giant cell arteritis affects what size blood vessels?
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medium to large
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takayasu arteritis affects what size blood vessels?
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medium to large
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thromboangitis obliterans affects what size blood vessels?
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small to medium
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what size blood vessels does polyarteritis nodosa affect?
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small to medium
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which specific organs are affected by PAN?
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- kidneys
- heart - liver - GI - it spares the pulmonary arteries |
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what is the cause of PAN?
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circulating immune complexes
30% are HBs antigen positive and these are usually HBV or HCV |
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T or F: the lesions in PAN all occur at the same time so they are in the same stage.
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false; the lesions can occur at different times and be at different stages. this helps differentiate it from microscopic polyangiitis
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what is the treatment for PAN?
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corticosteroids or cyclophosphamide
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what is the most common cause of death due to PAN?
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renal failure
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you suspect a patient has PAN so you do a biopsy. what do you expect to see to confirm your suspicion?
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- inflammation and fibrinoid necrosis in an active lesion
- fibrous mural thickening in a chronic lesion |
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what size arteries does kawasaki's disease affect? which arteries are especially vulnerable?
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- medium sized arteries
- coronary arteries |
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what is the kawasaki's triad?
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- mucus membrane
- skin - lymph nodes |
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what is the most common acquired heart disease in children in the US? what causes this disease?
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- coronary artery aneurysm
- kawasaki's disease |
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what age group is most commonly affected by microscopic polyangiitis?
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> 16 years old
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what blood vessels are affected by microscopic polyangiitis?
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small arteries, capillaries, and sometimes venules
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what histological changes will you see in a biopsy from a patient with microscopic polyangiitis?
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- fibrinoid necrosis
- erythrocytes extravasation - leukocytoclasis |
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what are the clinical signs of microscopic polyangiitis?
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- palpable purpura
- hemoptysis - hematuria |
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how would you diagnose microscopic polyangiitis?
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biopsy and test for pANCA
> 70% of cases are positive for pANCA |
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what is the treatment for microscopic polyangiitis?
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- remove the offending agent
- corticosteroids or cyclophosphamide |
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T or F: you will never see a patient have Churg-Strauss Syndrome and asthma.
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false; pretty much 100% of patients with Churg-Strauss have asthma as well
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how do you diagnose Churg-Strauss syndrome?
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- look for eosinophila and pANCA (< 50% will be pANCA positive)
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what age group is most often affected by Wegener's granulomatosis?
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peaks in the 40s
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what is the triad for wegeners?
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ELK
- ENT - Lungs - Kidneys |
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what size vessels are affected by wegeners?
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this is a necrotizing vasculitis of small to medium vessels
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how do you diagnose wegener's?
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biopsy and test for cANCA; 95% will be cANCA positive
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what is the treatment for wegener's?
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corticosteroids, cyclophosphamide, or anti-TNF agents
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what will you see grossly with wegener's granulomatosis?
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large, non-caseating, necrotizing granulomas in the parenchyma
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what infectious agent (in general) most often causes mycotic aneurysms?
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bacteria
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