Zaman 8-28-07 Pathology Of Blood Vessesls-1

Front 1

3 forms of arteriosclerosis

Back 1

1. atherosclerosis
2. Monckeberg medial calcific sclerosis
3. arteriololsclerosis

Front 2

The principal points of physiologic resistance to blood flow.

Back 2

arterioles

Front 3

2 principal mechanisms of vasucular disease

Back 3

1- narrowing or obstructing vessel
2- weakening of vessel walls

Front 4

what are the 3 layer of blood vessels?

Back 4

intima, media, adventitia

Front 5

pathology affecting elastic and muscular arteries

Back 5

Atherosclerosis

(b/c of size range)

Front 6

pathology affecting small muscular arteries and arterioles

Back 6

HTN


(b/c of size range)

Front 7

different types of vasculitis affect different _______

Back 7

calibers of vessels

Front 8

classification of coronary and renal arteries

Back 8

muscular

(smooth muscle)

Front 9

vasoconstriction and dilation occur in the _______ arteries

Back 9

small arteries

Front 10

blood flow in the small arteries is steady and ________

Back 10

non-pulsatile

Front 11

small arteries are < ____mm in diameter

Back 11

2

Front 12

Capillaries, which are approximately the diameter of a red blood cell (7 to 8 µm), have an endothelial cell lining but no ________.

Back 12

media

Front 13

In many types of inflammation, vascular leakage and leukocytic exudation occur preferentially in ______________.

Back 13

postcapillary venules

(site of WBC migration)

Front 14

____________ constitute an important pathway for disease dissemination through transport of bacteria and tumor cells to distant sites.

Back 14

Lymphatics

Front 15

Among the diverse congenital vascular anomalies, two have importance: ____________ and ______.

Back 15

1- developmental or berry aneurysms and
2- arteriovenous fistulas.

Front 16

AV fistulas may cause ______-output heart failure.

Back 16

high

Front 17

a generic term for thickening and loss of elasticity of arterial walls:
a) atherosclerosis
b) arteriosclerosis
c) arteriolosclerosis
d) Monkeyberg medial calcific slerosis

Back 17

arteriosclerosis

Front 18

3 types of arteriosclerosis

Back 18

1 atherosclerosis
2 Monckeberg medial calcific sclerosis
3 arteriolosclerosis

Front 19

The least clinically important arteriosclerosis type

Back 19

Monckeberg medial calcific sclerosis

Front 20

Arteriosclerosis found in muscular arteries of people over 50.

Back 20

Moncheberg medial calcific sclerosis

Front 21

2 types of arteriolosclerosis

Back 21

hyaline and
hyperplastic arteriolosclerosis

Front 22

type of arteriosclerosis assoc. with DM and HTN

Back 22

hyaline arteriolosclerosis

Front 23

cause of 50% of all death in US, Europe and Japan:
a) arteriosclerosis
b) atherosclerosis
c) arteriolosclerosis
d) Monkeyberg

Back 23

Arteriolsclerosis - Zamam ("US, Europe, Japan")

Atherosclerosis - Robbins ("Western World")

Front 24

Atherosclerosis is characterized by intimal lesions called _______

Back 24

atheromas

Front 25

Arteriosclerosis results from an excessive ________ and proliferative response to various forms of injury to the endothelium and
smooth muscle of the arterial wall.

Back 25

inflammatory

Front 26

Factors thought important in Arteriosclerosis' pathogenesis include:

Back 26

- changes in lipid metabolism,
• increased endothelial permeability to serum lipoprotein complexes,
• susceptibility of the intima to mechanical injury from flow turbulence at
major bifurcations,
• presence of hypertension, elastic tissue fragmentation and thrombosis or
disruption of vasa vasorum.

Front 27

Surgical therapy is now commonplace for occlusive disease of the ________(3) arteries

Back 27

coronary, carotid, and
mesenteric

Front 28

Arteriosclerosis may present as an occlusive process
when the disease attacks the intima more rapidly than
the media and adventitia, but may present as an __________
when the reverse is true.

Back 28

aneurysm

Front 29

Arteriosclerosis may present as an ___________________
when the disease attacks the intima more rapidly than
the media and adventitia

Back 29

occlusive process

Front 30

Arteriosclerosis may present as an ______________
when the disease attacks the media and adventitia more rapidly than intima.
the ,

Back 30

aneurysm

Front 31

early human lesions begin at sites of ___________ endothelium.

Back 31

morphologically intact


Thus, nondenuding endothelial dysfunction causing increased endothelial permeability, enhanced leukocyte adhesion, and alterations in expression of EC gene products is critical to the human disease.

Front 32

Chronic or repetitive endothelial injury is the cornerstone of the "response to injury" hypothesis of arteriosclerosis.

Back 32

Duh.

Front 33

Intimal plaques are composed of lipid deposits and
proliferated spindle cells made up of ______ and ________.

Back 33

fibroblasts and smooth muscle cells

Front 34

What is the stereotypic response to vascular injury?

Back 34

1,2,3

Front 35

Atherosclerosis:
The earliest changes, which are considered to be reversible, are
____________of the intima.

Back 35

fatty dots and fatty streaks

Front 36

Atheromatous plaques, the typical lesions of atherosclerosis, consist of an irreversibly altered softened central area filled with _____________and__________ surrounded by collagenous fibrous tissue

Back 36

cholesterol crystals and cell debris

Front 37

Atheromatous plaques aka

Back 37

atheroma

Front 38

composed of lipid-filled foam cells, are not significantly raised and thus do not cause any disturbance in blood flow.

Back 38

fatty streaks

Front 39

Fatty streaks appear in the aortas of some children younger than 1 year of age and all children older than ______ years, regardless of geography, race, sex, or environment

Back 39

10

Front 40

large lipid-laden cells that derive predominantly from blood monocytes (tissue macrophages), but SMCs can also imbibe lipid to become them

Back 40

Foam cells

Front 41

The four major risk factors of atherosclerosis that can be modified

Back 41

hyperlipidemia, hypertension, cigarette smoking, and diabetes.

Front 42

Describe monocytes role in atheromas

Back 42

-

Front 43

Macrophages produce interleukin 1 and tumor necrosis factor, which increase adhesion of ________

Back 43

leukocytes

Front 44

Macrophages produce toxic oxygen species that also cause oxidation of the _____ in the lesions

Back 44

LDL

Front 45

Macrophages eat the oxidized LDL to become _____

Back 45

foam cells

Front 46

an age-related degenerative
process in which the media of large and medium-sized muscular arteries undergoes calcification.

Back 46

Monckeberg medial
calcific sclerosis

Front 47

Hypertension is associated with two forms of small
blood vessel disease:

Back 47

1- Hyaline arteriolosclerosis
2- Hyperplastic arteriolosclerosis

Front 48

Left: hyaline arteriolosclerosis

Right: hyperplastic arteriolosclerosis

Back 48

What's this? What's the difference?

Front 49

Describe hyaline arteriolosclerosis

Back 49

The arteriolar wall is hyalinized and the lumen is markedly narrowed.

Front 50

Describe hyperplastic arteriolosclerosis

Back 50

(onion-skinning) causing luminal obliteration (arrow), with secondary ischemic changes, manifest by wrinkling of the glomerular capillary vessels at the upper left

Front 51

characterized by narrowing of
the lumen of arterioles due to the concentric proliferation of smooth muscle cells in the vessel wall.

Back 51

Hyperplastic arteriolosclerosis

Front 52

Hyperplastic arteriolosclerosis is typically found in what conditions?

Back 52

malignant hypertension,
progressive systemic
sclerosis (scleroderma),
chronic transplant rejection,
and after
radiotherapy.

Front 53

The process of occlusion probably begins in the iliac
arteries near what landmark?

Back 53

the aortic bifurcation

Front 54

Thrombi and emboli can become secondarily infected by
what fungi?

Back 54

particularly Aspergillus and Mucor.

Front 55

Leriche's syndrome

Back 55

The syndrome of distal aortic thrombosis

Front 56

How does Leriche's syndrome manifest itself?

Back 56

an insidious onset and gradual progression of symptoms of pain and easy fatigability in the legs, hips, and back;
intermittent claudication;
and sexual impotence,
absence of pulses below umbilicus

Front 57

3 examples of arteries associated with some degree of fascial fixation.

Back 57

1- ext. iliac artery behind inguinal ligament
2- superficial femoral artery (facial ring beneath adductor longus tendon)
3- anterior tibial artery (interosseous membrane)

Front 58

WTF?

Back 58

Livedo reticularis

Front 59

What are some complications of arterial occlusive disease?

Back 59

Arterial embolism,
livedo reticularis,
gangrene of lower extremities, ocular symptoms, cerebral infarct, GI Bleeding, renal HTN and failure

Front 60

What is livedo reticularis?

Back 60

a vascular condition characterized by a purplish mottled discoloration of the skin, usually on the legs. This discoloration is described as lacy or net-like in appearance.

Front 61

WTF?

Back 61

Livedo reticularis

Front 62

In arterial occlusive disease, simulataneous embolism to various organs may lead to a mistaken clinical diagnosis of _________ (PAN)

Back 62

polyarteritis nodosa

Front 63

What is Polyarteritis nodosa?

Back 63

is a rare autoimmune disease featuring spontaneous inflammation of the arteries (arteritis).

Front 64

How do you diagnose Polyarteritis nodosa? (3 of 10 things)

Back 64

1. Weight loss greater than/equal to 4 kg.
2. Livedo reticularis (a mottled purplish skin discoloration over the extremities or torso).
3. Testicular pain or tenderness. (occasionally, a site biopsied for diagnosis).
4. Muscle pain, weakness, or leg tenderness.
5. Nerve disease (either single or multiple).
6. Diastolic blood pressure greater than 90mmHg (high blood pressure).
7. Elevated kidney blood tests (BUN greater than 40 mg/dl or creatinine greater than 1.5 mg/dl).
8. Hepatitis B virus tests positive (for surface antigen or antibody).
9. Arteriogram (angiogram) showing the arteries that are dilated (aneurysms) or constricted by the blood vessel inflammation.
10. Biopsy of tissue showing the arteritis (typically inflamed arteries).

Front 65

risk factors for atheroma

Back 65

- Arterial hypertension
• Tobacco
• Heredity (familial hypercholesterolemia)
• Endocrine (DM, Postmenopausal, hypothyroidism
• Reduced physical activity
• Obesity
• Male
• Age

Front 66

modifiable risk factors for atheroma

Back 66

Hypertension, hyperlipidemia, DM, smoking, activity.

Front 67

major risk factors for atheroma

Back 67

Htn, hyperlipidemia, DM, smoking

Front 68

minor risk factors for atheroma

Back 68

Obesity, rich diet, physical inactivity, type A, stress.

Front 69

the most important risk factors under age 45 for atheroma

Back 69

Hyperlipidemia and especially hypercholesterolemia

Front 70

Homozygotes for FH can die by what age?

Back 70

20

Front 71

Heterozygotes develop AS by what age?

Back 71

40

Front 72

What are the steps of the injury hypothesis of atherosclerosis

Back 72

-