06 - Pathology Blood Vessels

Front 1

Simple tubular structures made up of a layer of _____ cells surrounded by one or more layers of ________ cells

Back 1

Endothelial

Smooth Muscle

Front 2

Layers of blood vessels

Back 2

Tunica Intima
Tunica Media
Tunica Adventitia

Front 3

The Aorta and Large Arteries are _____

Back 3

Elastic

Front 4

The smaller arteries are ____ arteries

Back 4

muscular

Front 5

Tiniest blood vessels

Back 5

Capillaries

Front 6

Blood vessels important in maintaining blood pressure

Back 6

Arterioles

Front 7

The majority of the clotting factors are produced in the _______ with the exception of _______, which has a component of which that is produced in the endothelial cells.

Back 7

Liver

Factor VIII

Front 8

Vascular smooth muscle is involved in _____ and _____

Back 8

Vasoconstriction and Dilation

Front 9

VAscular Smooth Muscle is involved in __1___synthesis.
After injury to the blood vessel it can ___2___.
It has receptors for __3__
It can also perform __4__

Back 9

1. Matrix (collagen, elastin)
2. migration and proliferation
3. lipoproteins
4. Phagocytosis

Front 10

Atherosclerosis is a disease of ____ and ____ arteries.
It is accumulation within the ______ of smooth muscle cells and lipids.

Back 10

Medium and Large sized

Intima

Front 11

Leading cause of death in the US

Back 11

Ischemic Heart Disease

Front 12

Macrophage with ingested lipid =

Back 12

Foam cells

Front 13

Stages of atherosclerotic plaque development

Back 13

1. Fatty Streak
2. Fibrous plaque
3. Thrombus on top of Atheroma

Front 14

1st step in Atherosclerosis and possible causes (5)

Back 14

Chronic Endothelial injury
-increased lipids
-cigarette smoking
-homocysteine
-infections
-Hypertension

Front 15

2nd step in Atherosclerosis

Back 15

endothelial dysfunction such as increased permeability allowing lipids and cells to trickle thru endothelium

Front 16

3rd step in Atherosclerosis

Back 16

Smooth Muscle emigration from Media to Intima.

Macrophage activation and secretion of cytokines

Front 17

4th step in Athersclerosis

Back 17

Macrophage and smooth muscle cells engulf lipid

Fatty Streak development

Front 18

5th step in Atherosclerosis

Back 18

Smooth muscle proliferation
Collagen and ECM deposition
Extracellular Lipid

Fibrofatty Atheroma

Front 19

Type of Atheromas that are more dangerous

Back 19

Soft ones with more lipids because they can rupture more easliy

Front 20

Initial lesion of Atherosclerosis

Back 20

Fatty streak

Front 21

Two components of Atheroma

Back 21

1. Fibrous cap
2. Soft center (atheroma)

Front 22

What is the risk factor for Atherosclerosis?

Back 22

any factor associated with a doubling in the incidence of ishemic heart disease

Front 23

4 Nonmodifiable Major risk factors for Atherosclerosis

Back 23

1. Increasing Age
2. Male
3. Family History
4. Genetic Abnormalities

Front 24

4 "Potentially controllable" risk factors for Atherosclerosis

Back 24

1. Hyperlipidemia
2. Hypertension
3. Cigarette Smoking
4. Diabetes

Front 25

Type of cholesterol that is more atherogenic

Back 25

Oxidized LDL

Front 26

Cholesterol Metabolism and Atherosclerosis:
-__1__ defect.
-Polymorphism of __2__
-Lipoprotein__3__

Back 26

1. LDL receptor defect = Familial Hypercholesterolemia
2. Apolipoprotein E
3. Lipoprotein (a)

Front 27

Apolipoprotein that causes reduced or absent HDL

Back 27

ApoA1

Front 28

Enzyme Defects that cause Atherosclerosis (3)

Back 28

1. Lipoprotein Lipase --> Type 1 Hyperlipidemia
2. Hepatic Lipase --> elevated IDL and LDL --> Severe Atherosclerosis
3. LCAT --> mild hypertriglyceridemia, reduced HDL

Front 29

Receptor defect that causes severely elevated LDL

Back 29

Familial Hypercholesterolemia

Front 30

4 complications of Atherosclerosis

Back 30

1. Acute occlusion --> ischemic necrosis
2. Chronic occlusion --> atrophy
3. Aneurysm formation
4. Embolism

Front 31

Most common sites of Severe Atherosclerosis (5)

Back 31

1. Abdominal Aorta and Iliac Arteries
2. Proximal Coronary Arteries
3. Thoracic Aorta, Femoral, and Popliteal Arteries
4. Internal Carotid Arteries
5. Vertebral, basilar, and middle cerebral arteries

Front 32

4 Non-invasive measures for Atherosclerosis Intervention

Back 32

1. Dietary control and exercise
2. Lipid lowering drugs
3. Anti-oxidant supplements
4. Aspirin

Front 33

6 Invasive measures for Atherosclerosis intervention

Back 33

1. Balloon angioplasty
2. Fibrinolytic therapy
3. Endarterectomy
4. Endovascular atherectomy
5. Arterial by-pass
6. Stenting

Front 34

Drugs:
High LDL --> 1
HIgh Lp(a) --> 2
high plasma Triglyceride -> 3
Low HDL -> 4
Hypertension -> 5
Hyperglycemia -> 6
Hyperhomocysteine -> 7
High Fibrinogen -> 8

Back 34

1. Statins
2. Nicotinic acid
3. Fibric acid
4. Nicotinic acid
5. Thiazide diuretics
6. Insulin
7. Folic Acid
8. Fibric Acid

Front 35

Complication with Balloon Angioplasty and Vascular replacement

Back 35

Destruction of endothelial wall causing re-stenosis

Front 36

Aneurysms: localized __1__ of blood vessles caused by a congenital or acquired weakness in the __2__

Back 36

1. dilation
2. media

Front 37

4 types of Aneurysms

Back 37

Dissecting
Arteriovenous
*Fusiform
*Saccular

*most common

Front 38

Classification of Aneurysms by Etiology (5)

Back 38

1. Atherosclerotic
2. Syphilitic
3. Dissecting
4. Mycotic
5. Congenital

Front 39

Atherosclerotic aneurysms most commonly occur in the __1___. They are usually of this type: __2__. They may contain a __3__. Microscopically there is destruction of __4__

Back 39

1. Abdominal Aorta and common Iliac Arteries
2. Fusiform
3. Mural Thrombosis
4. arterial wall elastic fibers

Front 40

3 clinical features of Atherosclerotic aneurysms

Back 40

1. Rupture: emergency with severe pai, shock, bleeding into ab/thoracic cavity
2. Local ischemic effects due to compression of surrounding arteries
3. Ab pain due to compression of nerves

Front 41

Atherosclerotic aneurysms greater than _____ have a great risk of rupture

Back 41

5 cm

Front 42

Factors of Aortic Aneurysms that leads to Mural Thrombosis

Back 42

1. exposure of sub-endothelial tissue to the blood which results in thrombosis
2. Stagnation or alteration in blood flow in the dilated vessl allows for Thrombosis

Front 43

Abdominal Aortic Aneurysms are usually located ______

Back 43

below the renal artery orifices

Front 44

What is an Aortic Dissection?

Back 44

a form of hematoma within the vessel wall = blood flowing through the layers of the wall

Front 45

Cause for 90% of Aortic Dissections

Back 45

Older males who have hypertension

Front 46

Other causes for Aortic Dissection

Back 46

Marfan Syndrome and Cystic Medial necrosis

Front 47

What is Cystic Medial Necrosis

Back 47

fragmentation of elastic fibers in the Media (associated with pregnant women and Marfan syndrome)

Front 48

Most common site of Aortic dissection

Back 48

Ascending Aorta usually within 10 cm of Aortic Ring

Front 49

Clinical presentation of person with Aortic Dissection

Back 49

Severe, tearing chest pain that starts in the chest and radiates in the direction of the dissection = along the arch of aorta and down into the abdomen.

Front 50

Aortic Dissection characteristically results in __1__, most often into the __2__, causing hemopericardium and fatal __3__

Back 50

1. aortic rupture
2. pericardial sac
3. cardiac tamponade

Front 51

What is a double-barreled aorta?

Back 51

Dissecting aneurysm that has ruptured back into the lumen of the Aorta

Front 52

Define Type A and B Dissection Aneurysms

Back 52

Type A = ascending aorta
Type B = descending aorta

Front 53

Syphilitic Aneurysm:
Incidence: __1__
Most common site: __2__
Intima appearance: __3__
Obliterative __4__ of the __5__ with __6__ infiltration
Organism: __7__

Back 53

1. uncommon
2. Thoracic Aorta
3. Tree Bark appearance (due to necrosis and scarring)
4. Endarteritis
5. Vasa vasorum (supplies blood to intima media)
6. Plasma cell
7. Treponema Pallidum

Front 54

Syphilitic aneurysm can affect the ascending aorta and the aortic ring leading to ________

Back 54

Aortic Valve Insufficiency causing Left Ventricular Dilation and Hypertrophy

Front 55

Berry Aneurysm:
Involves the __1__ arteries.
Congenital defect in __2__ of blood vessels.
The most frequent cause of __3__ hemorrhage
Age range: 4
Morph: 5

Back 55

1. Cerebral
2. muscularis (media)
3. subarachnoid
4. usually 30-40
5. Saccular

Front 56

Berry Aneurysms usually occur at this general spot

Back 56

bifurcations of cerebral arteries

Front 57

Mycotic Aneurysms result from __1__ and __2__ of the vessel wall

Back 57

1. microbial infection
2. weakening

Front 58

Vessels most commonly affected by Mycotic Aneurysms (3)

Back 58

Aorta
Cerebral vessels
Splanchnic arteries

Front 59

What is a Pseudoaneurysm?

Back 59

leakage of blood from an artery into the surrounding tissue with persistent communication between the originating artery and the terminating blood filled cavity

Front 60

Another word for Vasculitis

Back 60

Angiitis

Front 61

Vasculitis due to Immune Complexes (3)

Back 61

Henoch Schonlein
Lupus Vasculitis
Polyarteritis Nodosa (HBV associated)

Front 62

Vasculitis due to Direct Antibody Attack (2)

Back 62

Goodpasture's Syndrome
Kawasaki disease

Front 63

Vasculitis associated with ANCA (Anti-neutrophil Cytoplasmic Antibodies) (3)

Back 63

Wegener's
Microscopic Polyangiitis
Churg Strauss

Front 64

Polyarteritis Nodosa:
Artery types: __1__
__2__ involvement of arteries.
__3__ necrosis with infiltration of __4__.
Associated with __5__.
Can produce small __6__

Back 64

1. Small and Medium arteries
2. Patchy
3. Fibrinoid
4. Eosinophils
5. Thrombosis
6. Aneurysms (nodosa)

Front 65

Polyarteritis Nodosa:
-Associated with __1__ in 30% of patients.
-Organs involved __2__ (4)
-spares these arteries: __3__
-DOC's: __4__ (2)

Back 65

1. Hepatitis B
2. Kidney, Heart, Skeletal muscle, Skin
3. Pulmonary
4. Steroids and Cyclophosphamide

Front 66

This is common if the kidneys are involved in Polyarteritis Nodosa

Back 66

Hypertension

Front 67

Giant Cell Arteritis alternate name

Back 67

Temporal Arteritis

Granulomatous Arteritis

Front 68

Giant Cell Arteritis:
-Focal, chronic __1__ inflammation of __2__ arteries
-Age group: __3__
-Artery morph: __4__
-__5__ in lumen is common
- presents with __6__
-__7__ symptoms in 50% of patients
-Elevated __8__
-Gender: __9__

Back 68

1. granulomatous
2. temporal
3. >50
4. cord-like and nodular
5. thrombus
6. temporal headhache
7. Visual (ophthalmic artery)
8. ESR
9. Males

Front 69

Wegener's Granulomatous:
-Vessels involved: __1__
- Sites affected: __2__ (3)
-serum antibody present: __3_
-__4__ and __5__ inflammation

Back 69

1. Small arteries and veins
2. Nasal sinuses, Lungs, Kidneys
3. c-ANCA
4. Necrosis
5. Granulomatous

Front 70

Hypersensitivity Angiitis alternative name

Back 70

Microscopic Polyarteritis

Front 71

What is Hypersensitivity Angiitis due to?

Back 71

response to exogenous substances

Front 72

Hypersensitivity Angiitis:
-Cutaneous lesions due to _1_
-Vessels affected: __2__
-may be a feature of other systemic diseases such as __3__.
-__4__ is present
-Clinical presentation: __5__

Back 72

1. Leukocytoclastic vasculitis = PMN's release tissue degrading substances
2. Small -> arterioles, capillaries, venuoles
3. Lupus Erythematosus
4. p-ANCA
5. Palpable Purpura

Front 73

Difference between Hypersensitivity Angiitis and Polyarteritis Nodosa

Back 73

HSA vessels are all at the same stage of inflammation.

PAN vessels may be at all stages of acute and chronic inflammation

Front 74

Churg-Strauss Syndrome alternate name

Back 74

Allergic Granulomatosis and Angiitis

Front 75

Churg-Strauss Syndrome:
-Systemic vasculitis with prominent __1__.
-affects young persons with history of __2__
-widespread __3__ vascular lesion.
-Vessels affected: __4__
-__5__ is present in serum

Back 75

1. Eosinophilia
2. Asthma
3. necrotizing
4. small and medium arteries and veins
5. p-ANCA

Front 76

Takayasu Arteritis:
-known as __1__ disease
- Vessels affected: __2__
-persons affected: __3__
-__4__ thickening and obliteration of __5__
- absent __6__ pulse

Back 76

1. Pulseless
2. Aortic arch, large arteries
3. Young women
4. INTIMA
5. lumen
6. upper extremities

Front 77

Kawasaki Disease:
-Alternate name:__1__
- Age group: __2__
- Clinical manifestations: __3__ (4)
-may cause aneurysms in __4__

Back 77

1. Mucocutaneous lymph node syndrome
2. < 4 yoa
3. Fever, rash, conjuctival and oral lesions, Lymphadenitis
4. Coronary Artery

Front 78

Thrombo-angiitis Obliterans alternate name

Back 78

Buerger Disease

Front 79

Buerger Disease:
-Vessels involved: __1__
- painful __2__ disease, often leading to __3__
-associated with __4__
-Intermittent __5__

Back 79

1. small and medium arteries
2. ischemic (occlusive)
3. gangrene
4. SMoking
5. claudication

Front 80

Large Vessel Vasculitis' (2)

Back 80

Giant Cell Arteritis
Takayasu Arteritis

Front 81

Medium-sized Vessel Vasculitis (2)

Back 81

Polyarteritis Nodosa
Kawasaki disease

Front 82

Small Vessel Vasculitis (5)

Back 82

Wegener's Granulomatosis
Churg-Strauss Syndrome
Leukocytoclastic Vasculitis
Henoch Schonlein Purpura (IgA immunocomplexes)
Microscopic Polyarteritis

Front 83

Antineutrophil Cytoplasmic Antibodies:
Heterogenous group of __1__ against enzymes mainly in __2__

Back 83

1. Autoantibodies
2. Neutrophil Granules

Front 84

c-ANCA is seen in _____

Back 84

Wegener's

Front 85

p-ANCA is seen in these 2

Back 85

Microscopic Polyarteritis
Churg-Strauss

Front 86

Raynaud Phenomenon:
-Intermittent, __1__ attacks of __2__ of fingers or toes leading to __3__
-Related to exposure to __4__
-Due to __5__
-Primary type occurs in __6__
-Associated with __7__

Back 86

1. bilateral
2. ischemia
3. pallor, pain, parasthesia
4. Cold
5. Arterial spasm
6. young females
7. Scleroderma

Front 87

4 Benign Tumors of Blood Vessels

Back 87

1. Hemangioma
2. Granuloma Pyogenicum
3. Vascular Ectasia
4. Glomus Tumor

Front 88

Borderline (intermediate) Tumor of Blood Vessels

Back 88

Hemangioendothelioma

Front 89

Malignant Tumors of Blood Vessels (3)

Back 89

1. Angiosarcoma
2. Hemangiopericytoma
3. Kaposi Sarcoma

Front 90

Only great concern with Hemangiomas

Back 90

Is if they start to bleed

Front 91

2 type of Hemangiomas

Back 91

Capillary Hemangioma

Cavernous Hemangioma

Front 92

Histology of Cavernous Hemaniogmas

Back 92

Large vascular spaces lined by FLATTENED endothelial cells

Front 93

A malignant neoplasm of vascular origin characterized by MASSES of Endothelial cells

Back 93

Angiosarcoma

Front 94

Development of HEPATIC Angiosarcomas is associated with... (3)

Back 94

Polyvinyl Chloride
Arsenic
Thorotrast (Thorium Dioxide)

Front 95

Sites where Angiosarcomas occur (4)

Back 95

Skin
Soft Tissue
Breast
Liver

Front 96

Histology of Angiosarcomas

Back 96

irregular vascular spaces lined by Malignant-apearing endothelial cells with HYPERCHROMATIC NUCLEI

Front 97

Explain "Lymphedema Associated Angiosarcoma"

Back 97

Development of an Angiosarcoma in the Lymphedematous arm of a patient who has has AXILLARY LYMPH NODE DISSECTION for breast cancer (due to Statis)

Front 98

Alternate name for "Lymphedema Associated Angiosarcoma"

Back 98

Stewart-Treves Syndrome

Front 99

Classic Kaposi's Sarcoma affects these people

Back 99

Older European men

Front 100

African Kaposi's Sarcoma presents with this

Back 100

Lymphadenopathy in African men and children

Front 101

Transplants associated KS is due to this

Back 101

Immunosuppression

Front 102

AIDS associated KS occurs in these people and with what co-infection?

Back 102

Homo Males
HHV-8

Front 103

3 Stages of Lesion development in KS

Back 103

1. Patch stage
2. Plaque Stage
3. Nodular stage

Front 104

Benign capillary proliferation involving the skin/visceral organs in AIDS patients caused by Bartonella Henselae (Cat Scratch Fever)

Back 104

Bacillary Angiomatosis

*responds to Antibiotics*

Front 105

What are varicose veins?

Back 105

enlarged tortuous veins

Front 106

Risk Factors for Varicose Veins of the LEGS (6)

Back 106

1. Increasing Age
2. FEMALES
3. Hereditary predisposition
4. Obesity
5. Posture (standing job)
6. Increased Venous Pressure

Front 107

2 Clinical features of Varicose Veins

Back 107

Swelling
Dull Pain

Front 108

2 Complications of Varicose Veins

Back 108

Stasis Dermatitis
Stasis Ulcers

Front 109

List 3 other sites where Varicose Veins occur (other than leg)

Back 109

1. Esophageal Varices = portal hypertensio due to Cirrhosis

2. Hemorrhoids = internal/external hemorrhoid plexus of rectum

3. Varicocele = pampiniform plexus of Scrotum

Front 110

Thrombus of Veins without Inflammation

Back 110

Phlebothrombosis

Front 111

Thrombus of veins associated with Inflammation

Back 111

Thrombophlebitis

Front 112

Which one is more dangerous - Thrombophlebitis or Phlebothrombosis? Why?

Back 112

Phlebothrombosis b/c it is more likely to break off and produce Pulmonary Emboli

Front 113

Lymphangitis

Back 113

An acute inflammation involving Lymphatics, usually BACTERIAL in origin causing painful red streaks in the SUBCUTIS

Front 114

Occlusion of Lymphatics leading to accumulation of interstitial fluid

Back 114

Lymphedema

Front 115

5 causes of Lymphedema

Back 115

1. invasion of lymphatics by malignant cells
2. radical surgery
3. post-irradiation fibrosis
4. post-inflammatory scarring
5. parasitic infection --> Filariasis

Front 116

Arteriosclerosis = __1__ and __2__ of the ARTERIES

Back 116

1. thickening
2. Hardening

Front 117

Arteriosclerosis due to aging

Back 117

Senile Arteriosclerosis

Front 118

Medial Calcification Sclerosis

Back 118

Monckeberg's Medial Sclerosis

Front 119

Monckeberg's Medial Sclerosis usually occurs in these arteries and affects this age group

Back 119

Arteries of Upper/Lower Extremities (radial & Ulnar)

> 50 yoa

*usually asymptomatic

Front 120

Hypertension: Systolic pressure > __1__ or Diastolic pressure > __2__

Back 120

1. 140 mm Hg
2. 90 mm Hg

Front 121

What is Secondary Hypertension?

Back 121

5-10% of cases in which a DEFINITE CAUSE can be identified

Front 122

What is Primary Or Essential Hypertension?

Back 122

90-95% of cases that have UNKNOWN etiology

Front 123

Secondary Causes of Hypertension

Back 123

R = REnal
E = Endocrine
N = Neurogenic
A = Aortic
L = Labile

Front 124

Renal causes of Secondary Hypertension (4)

Back 124

1. Stenosis of Artery -> Renin release -> Angiotensin -> 1. constricts arterioles 2. Aldosterone release -> Sodium retention

2. Fibromuscular Dysplasia

3. Atherosclerosis

4. Glomeruonephritis/ Pyelonephritis

Front 125

Endocrine causes of Secondary Hypertension

Back 125

1. Adrenal Cortical Hyperfunction (Aldosterone) = Cushing's
2. Adrenal Medullary Hyperfunction (Catecholamines) = Pheochromocytoma

Front 126

Essential Hypertension is a product of __1__ and __2__.
It is influenced by __3__ and __4__

Back 126

1. Cardiac Output
2. Peripheral Resistance
3. Renal function
4. Sodium Homeostasis

Front 127

Pathogenesis of Essential Hypertension:
-Genetic defect in __1__
-Genetic defect in __2__ in vascular smooth muscle
-Variation in genes encoding __3__

Back 127

1. Renal Sodium excretion
2. Sodium/Calcium transport
3. Angiotensinogen

Front 128

Hypertension Risk Factors (6)

Back 128

1. Family History
2. High Sodium intake
3. Stressful lifestyle
4. Obesity
5. High Alcohol intake
6. ORAL CONTRACEPTIVES

Front 129

Clinical Manifestations of Hypertension:
-Early = 1
-Later = 2

Back 129

1. Headhache, nosebleeds, tinnitus, dizziness

2. Stroke, Heart failure, Renal failure

Front 130

Changes associated with Benign Hypertension

Back 130

Hyaline or Sclerotic Arteriolar changes that are slowly progressing

Front 131

Describe Malignant Hypertension

Back 131

Rapidly progressive, Arteriolar spasm, Edema, Necrosis
CNS and Renal Complications

Front 132

Describe the Histology of Malignant Hypertension

Back 132

- concentric, "onion-skinned" thickening of the smooth muscle (hyperplasia)
- Fibrinoid Necrosis
- No inflammation

Front 133

Vascular Pathology in Hypertension:
-Accelerates __1__
-Potentiates __2__ and __3__

Back 133

1. Atherogenesis
2. Aortic Dissection
3. Cerebrovascular Hemorrhage

Front 134

Hyaline changes in arteriolar walls indicate _______

Back 134

Hyaline Arteriosclerosis = Benign HTN

Front 135

"Onion-skin" lesions with Fibrinoid Necrosis indicate ________

Back 135

Hyperplastic Arteriosclerosis = Malignant HTN

Front 136

Factors indicating Adverse Prognosis in HTN:
-Race: __1__
-Age: __2__
-Sex: __3__
-Persistent Diastolic pressure > __4__

Back 136

1. black
2. younger age
3. males
4. 115