Vascular Potpurri

Front 1

what is fibromuscular dysplasia?

Back 1

focal, irregular thickening of the wall of medium and large muscular arteries

Front 2

who is fibromuscular dysplasia most common in? what artery does it most commonly hit? what are the clinical results?

Back 2

- young women
- the renal artery
- causes renal hypertension and aneurysmal dilations between areas of thickening

Front 3

what is an aneurysm?

Back 3

a localized abnormal dilation of a blood vessel (it must be at least a 50% increase in caliber)

Front 4

what is the difference between a true aneurysm and a false or pseudoaneurysm?

Back 4

true aneurysm involves all layers of the vascular wall while a false aneurysm is a breach through the wall that results in an extravascular hematoma

Front 5

what is a vessel dissection?

Back 5

a split within the vessel wall where blood enters and leads to a hematoma between the layers of the wall

Front 6

what are the 2 types of aneurysms?

Back 6

- saccular
- fusiform

Front 7

describe a saccular aneurysm? what causes them?

Back 7

- these look like a bud from the vessel
- these are congenital defects

Front 8

describe a fusiform aneurysm? what causes them?

Back 8

- these are dilations of the entire vessel
- most often caused by atherosclerosis

Front 9

what is the most common cause of aneurysms?

Back 9

atherosclerosis (cause intimal thickening which leads to ischemia of the inner walls which leads to smooth muscle loss/dysfunction which leads to Erdheim medial degeneration

Front 10

what is Erdheim medial degeneration?

Back 10

elastic tissue fragmentation and/or loss with separation of the elastic and fibromuscular elements by cyst-like spaces resulting in weakening of the tunica media

Front 11

who most commonly gets abdominal aortic aneurysms? where exactly are they most commonly located?

Back 11

- smokers > 65 years old
- distal to the renal arteries

Front 12

what is the most common place for an atherosclerotic aneurysm to occur?

Back 12

the abdominal aorta

Front 13

what is the most common cause of abdominal aortic aneurysms?

Back 13

atherosclerosis

Front 14

what is the critical diameter for an abdominal aortic aneurysm?

Back 14

5 cm. once it reaches this point it has a greatly increased chance of rupture

Front 15

T or F:a ruptured abdominal aortic aneurysm has a high rate of mortality.

Back 15

true about 50%

Front 16

what is the most common structure for an abdominal aortic aneurysm to compress or invade?

Back 16

the duodenum. if it invades it will cause massive GI bleeds

Front 17

what is the classic cause of a thoracic aorta aneurysm?

Back 17

tertiary syphilis

Front 18

what are thoracic aortic aneurysms most commonly caused by these days?

Back 18

atherosclerosis

Front 19

where do syphilic (luetic) aneurysms occur?

Back 19

thoracic aorta specifically the ascending aorta

Front 20

what morphologic changes do you see in syphilic aneurysms?

Back 20

- obliterative endarteritis
- necrosis of the media
- fibrosis & loss of elastic recoil which leads to dilation

Front 21

a man is brought to the ED after he clutched his chest and then dropped to the ground. he was pronounced dead upon arrival to the ED. during the autopsy you find that he has a ruptured aorta. you cut open the aorta and your attending tells you that it has a tree-barking appearance. what is the cause of death?

Back 21

ruptured syphilic aortic aneurysm

Front 22

what is the number one risk factor for an Abdominal Aortic Aneurysm?

Back 22

atherosclerosis

Front 23

what is the number one risk factor for a Thoracic Aortic Aneurysm?

Back 23

hypertension

Front 24

what are 3 complications of a thoracic aortic aneurysm?

Back 24

- rupture
- encroachment or invasion of adjacent structures
- CHF due to aortic insufficiency

Front 25

what is the age group most commonly affected by dissecting aorta?

Back 25

40 - 60 year olds

Front 26

what is the most common cause of a dissecting aorta?

Back 26

hypertension (~90%)

Front 27

what layers of the aorta are most commonly separated in a dissecting aorta?

Back 27

the middle and outer thirds of the media

Front 28

where are most aortic dissections located?

Back 28

in the ascending aorta usually within 10 cm of the aortic valve

Front 29

T or F: a person can live with a dissected aorta.

Back 29

true. the false lumen can re-epithelialize and the person can live with this. it is called a double-barrel aorta

Front 30

what is a Type A aortic dissection?

Back 30

a dissection that involves the trunk of the aorta prior to the first branches and may or may not involve more of the aorta

Front 31

what is a Type B aortic dissection?

Back 31

these only involve the descending aorta

Front 32

what is the most common cause of death associated with aortic dissections?

Back 32

adventitial rupture into the pericardial sac causing cardiac tamponade

Front 33

will a patient feel an aortic dissection? if so what will they describe?

Back 33

- yes
- a tearing sensation in the chest

Front 34

what are varicose veins? what causes them?

Back 34

- abnormally dilated, tortuous veins
- prolonged increases in lumenal pressure leading to loss of vascular support

Front 35

what is the most common venous lesion in adults?

Back 35

varicose veins

Front 36

which veins are most commonly affected by varicosities?

Back 36

the superficial veins of the lower extremity esp. the saphenous veins

Front 37

name the four major risk factors for developing varicose veins

Back 37

- age
- female
- family history
- obesity

Front 38

what is stasis dermatitis?

Back 38

a complication of varicose veins. pooling of the blood due to the varicosities causes ischemia to the skin. this leads to ulcers that are called stasis or skin ulcers. these can thrombose but embolisms are rare

Front 39

what is a bacillary angiomatosis?

Back 39

a non-neoplastic vascular tumor seen in immunosuppressed people

Front 40

what causes bacillary angiomatosis?

Back 40

infection with Bartonella which leads to vascular proliferation

Front 41

what is the gross appearance of bacillary angiomatosis? what is the morphologic appearance?

Back 41

- red papules or nodules under the skin
- granulation tissue with lots of capillaries and neutrophils

Front 42

a patient comes in with a port wine stain, early onset glaucoma, a history of seizures, and are mental retardation. what is the most likely diagnosis?

Back 42

Sturge-Weber syndrome

Front 43

an increase in which hormone is associated with spider telangiectasia?

Back 43

estrogen

Front 44

what is Osler-Weber-Rendu disease?

Back 44

an autosomal dominant disease that causes dilated capillaries and veins of the skin and mucous membranes

Front 45

what is the most common vascular tumor?

Back 45

hemangioma

Front 46

what is the most common pediatric neoplasm?

Back 46

hemangioma

Front 47

a patient presents to your ED complaining of a very painful red-blue "thing" under the fingernail. they denied any recent trauma to the fingernail. what is the most likely diagnosis?

Back 47

glomus tumor

Front 48

a female patient presents with a cavernous lymphangioma in her neck. you also notice that she has wide shoulders, a wide neck, and has a history of never menstruating. what is the most likely diagnosis?

Back 48

cystic hygroma

Front 49

what is an angiosarcoma?

Back 49

a highly malignant tumor that arises from hepatic origin due to chemical exposure esp. to vinyl chloride