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136 Cards in this Set
- Front
- Back
Simple tubular structures made up of a layer of _____ cells surrounded by one or more layers of ________ cells
|
Endothelial
Smooth Muscle |
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Layers of blood vessels
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Tunica Intima
Tunica Media Tunica Adventitia |
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The Aorta and Large Arteries are _____
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Elastic
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The smaller arteries are ____ arteries
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muscular
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Tiniest blood vessels
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Capillaries
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Blood vessels important in maintaining blood pressure
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Arterioles
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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.
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Liver
Factor VIII |
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Vascular smooth muscle is involved in _____ and _____
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Vasoconstriction and Dilation
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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__ |
1. Matrix (collagen, elastin)
2. migration and proliferation 3. lipoproteins 4. Phagocytosis |
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Atherosclerosis is a disease of ____ and ____ arteries.
It is accumulation within the ______ of smooth muscle cells and lipids. |
Medium and Large sized
Intima |
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Leading cause of death in the US
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Ischemic Heart Disease
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Macrophage with ingested lipid =
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Foam cells
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Stages of atherosclerotic plaque development
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1. Fatty Streak
2. Fibrous plaque 3. Thrombus on top of Atheroma |
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1st step in Atherosclerosis and possible causes (5)
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Chronic Endothelial injury
-increased lipids -cigarette smoking -homocysteine -infections -Hypertension |
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2nd step in Atherosclerosis
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endothelial dysfunction such as increased permeability allowing lipids and cells to trickle thru endothelium
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3rd step in Atherosclerosis
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Smooth Muscle emigration from Media to Intima.
Macrophage activation and secretion of cytokines |
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4th step in Athersclerosis
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Macrophage and smooth muscle cells engulf lipid
Fatty Streak development |
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5th step in Atherosclerosis
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Smooth muscle proliferation
Collagen and ECM deposition Extracellular Lipid Fibrofatty Atheroma |
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Type of Atheromas that are more dangerous
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Soft ones with more lipids because they can rupture more easliy
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Initial lesion of Atherosclerosis
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Fatty streak
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Two components of Atheroma
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1. Fibrous cap
2. Soft center (atheroma) |
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What is the risk factor for Atherosclerosis?
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any factor associated with a doubling in the incidence of ishemic heart disease
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4 Nonmodifiable Major risk factors for Atherosclerosis
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1. Increasing Age
2. Male 3. Family History 4. Genetic Abnormalities |
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4 "Potentially controllable" risk factors for Atherosclerosis
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1. Hyperlipidemia
2. Hypertension 3. Cigarette Smoking 4. Diabetes |
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Type of cholesterol that is more atherogenic
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Oxidized LDL
|
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Cholesterol Metabolism and Atherosclerosis:
-__1__ defect. -Polymorphism of __2__ -Lipoprotein__3__ |
1. LDL receptor defect = Familial Hypercholesterolemia
2. Apolipoprotein E 3. Lipoprotein (a) |
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Apolipoprotein that causes reduced or absent HDL
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ApoA1
|
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Enzyme Defects that cause Atherosclerosis (3)
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1. Lipoprotein Lipase --> Type 1 Hyperlipidemia
2. Hepatic Lipase --> elevated IDL and LDL --> Severe Atherosclerosis 3. LCAT --> mild hypertriglyceridemia, reduced HDL |
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Receptor defect that causes severely elevated LDL
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Familial Hypercholesterolemia
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4 complications of Atherosclerosis
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1. Acute occlusion --> ischemic necrosis
2. Chronic occlusion --> atrophy 3. Aneurysm formation 4. Embolism |
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Most common sites of Severe Atherosclerosis (5)
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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 |
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4 Non-invasive measures for Atherosclerosis Intervention
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1. Dietary control and exercise
2. Lipid lowering drugs 3. Anti-oxidant supplements 4. Aspirin |
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6 Invasive measures for Atherosclerosis intervention
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1. Balloon angioplasty
2. Fibrinolytic therapy 3. Endarterectomy 4. Endovascular atherectomy 5. Arterial by-pass 6. Stenting |
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Drugs:
High LDL --> 1 HIgh Lp(a) --> 2 high plasma Triglyceride -> 3 Low HDL -> 4 Hypertension -> 5 Hyperglycemia -> 6 Hyperhomocysteine -> 7 High Fibrinogen -> 8 |
1. Statins
2. Nicotinic acid 3. Fibric acid 4. Nicotinic acid 5. Thiazide diuretics 6. Insulin 7. Folic Acid 8. Fibric Acid |
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Complication with Balloon Angioplasty and Vascular replacement
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Destruction of endothelial wall causing re-stenosis
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Aneurysms: localized __1__ of blood vessles caused by a congenital or acquired weakness in the __2__
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1. dilation
2. media |
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4 types of Aneurysms
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Dissecting
Arteriovenous *Fusiform *Saccular *most common |
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Classification of Aneurysms by Etiology (5)
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1. Atherosclerotic
2. Syphilitic 3. Dissecting 4. Mycotic 5. Congenital |
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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__
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1. Abdominal Aorta and common Iliac Arteries
2. Fusiform 3. Mural Thrombosis 4. arterial wall elastic fibers |
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3 clinical features of Atherosclerotic aneurysms
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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 |
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Atherosclerotic aneurysms greater than _____ have a great risk of rupture
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5 cm
|
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Factors of Aortic Aneurysms that leads to Mural Thrombosis
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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 |
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Abdominal Aortic Aneurysms are usually located ______
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below the renal artery orifices
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What is an Aortic Dissection?
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a form of hematoma within the vessel wall = blood flowing through the layers of the wall
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Cause for 90% of Aortic Dissections
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Older males who have hypertension
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Other causes for Aortic Dissection
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Marfan Syndrome and Cystic Medial necrosis
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What is Cystic Medial Necrosis
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fragmentation of elastic fibers in the Media (associated with pregnant women and Marfan syndrome)
|
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Most common site of Aortic dissection
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Ascending Aorta usually within 10 cm of Aortic Ring
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Clinical presentation of person with Aortic Dissection
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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.
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Aortic Dissection characteristically results in __1__, most often into the __2__, causing hemopericardium and fatal __3__
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1. aortic rupture
2. pericardial sac 3. cardiac tamponade |
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What is a double-barreled aorta?
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Dissecting aneurysm that has ruptured back into the lumen of the Aorta
|
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Define Type A and B Dissection Aneurysms
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Type A = ascending aorta
Type B = descending aorta |
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Syphilitic Aneurysm:
Incidence: __1__ Most common site: __2__ Intima appearance: __3__ Obliterative __4__ of the __5__ with __6__ infiltration Organism: __7__ |
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 |
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Syphilitic aneurysm can affect the ascending aorta and the aortic ring leading to ________
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Aortic Valve Insufficiency causing Left Ventricular Dilation and Hypertrophy
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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 |
1. Cerebral
2. muscularis (media) 3. subarachnoid 4. usually 30-40 5. Saccular |
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Berry Aneurysms usually occur at this general spot
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bifurcations of cerebral arteries
|
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Mycotic Aneurysms result from __1__ and __2__ of the vessel wall
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1. microbial infection
2. weakening |
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Vessels most commonly affected by Mycotic Aneurysms (3)
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Aorta
Cerebral vessels Splanchnic arteries |
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What is a Pseudoaneurysm?
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leakage of blood from an artery into the surrounding tissue with persistent communication between the originating artery and the terminating blood filled cavity
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Another word for Vasculitis
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Angiitis
|
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Vasculitis due to Immune Complexes (3)
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Henoch Schonlein
Lupus Vasculitis Polyarteritis Nodosa (HBV associated) |
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Vasculitis due to Direct Antibody Attack (2)
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Goodpasture's Syndrome
Kawasaki disease |
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Vasculitis associated with ANCA (Anti-neutrophil Cytoplasmic Antibodies) (3)
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Wegener's
Microscopic Polyangiitis Churg Strauss |
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Polyarteritis Nodosa:
Artery types: __1__ __2__ involvement of arteries. __3__ necrosis with infiltration of __4__. Associated with __5__. Can produce small __6__ |
1. Small and Medium arteries
2. Patchy 3. Fibrinoid 4. Eosinophils 5. Thrombosis 6. Aneurysms (nodosa) |
|
Polyarteritis Nodosa:
-Associated with __1__ in 30% of patients. -Organs involved __2__ (4) -spares these arteries: __3__ -DOC's: __4__ (2) |
1. Hepatitis B
2. Kidney, Heart, Skeletal muscle, Skin 3. Pulmonary 4. Steroids and Cyclophosphamide |
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This is common if the kidneys are involved in Polyarteritis Nodosa
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Hypertension
|
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Giant Cell Arteritis alternate name
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Temporal Arteritis
Granulomatous Arteritis |
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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__ |
1. granulomatous
2. temporal 3. >50 4. cord-like and nodular 5. thrombus 6. temporal headhache 7. Visual (ophthalmic artery) 8. ESR 9. Males |
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Wegener's Granulomatous:
-Vessels involved: __1__ - Sites affected: __2__ (3) -serum antibody present: __3_ -__4__ and __5__ inflammation |
1. Small arteries and veins
2. Nasal sinuses, Lungs, Kidneys 3. c-ANCA 4. Necrosis 5. Granulomatous |
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Hypersensitivity Angiitis alternative name
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Microscopic Polyarteritis
|
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What is Hypersensitivity Angiitis due to?
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response to exogenous substances
|
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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__ |
1. Leukocytoclastic vasculitis = PMN's release tissue degrading substances
2. Small -> arterioles, capillaries, venuoles 3. Lupus Erythematosus 4. p-ANCA 5. Palpable Purpura |
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Difference between Hypersensitivity Angiitis and Polyarteritis Nodosa
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HSA vessels are all at the same stage of inflammation.
PAN vessels may be at all stages of acute and chronic inflammation |
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Churg-Strauss Syndrome alternate name
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Allergic Granulomatosis and Angiitis
|
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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 |
1. Eosinophilia
2. Asthma 3. necrotizing 4. small and medium arteries and veins 5. p-ANCA |
|
Takayasu Arteritis:
-known as __1__ disease - Vessels affected: __2__ -persons affected: __3__ -__4__ thickening and obliteration of __5__ - absent __6__ pulse |
1. Pulseless
2. Aortic arch, large arteries 3. Young women 4. INTIMA 5. lumen 6. upper extremities |
|
Kawasaki Disease:
-Alternate name:__1__ - Age group: __2__ - Clinical manifestations: __3__ (4) -may cause aneurysms in __4__ |
1. Mucocutaneous lymph node syndrome
2. < 4 yoa 3. Fever, rash, conjuctival and oral lesions, Lymphadenitis 4. Coronary Artery |
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Thrombo-angiitis Obliterans alternate name
|
Buerger Disease
|
|
Buerger Disease:
-Vessels involved: __1__ - painful __2__ disease, often leading to __3__ -associated with __4__ -Intermittent __5__ |
1. small and medium arteries
2. ischemic (occlusive) 3. gangrene 4. SMoking 5. claudication |
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Large Vessel Vasculitis' (2)
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Giant Cell Arteritis
Takayasu Arteritis |
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Medium-sized Vessel Vasculitis (2)
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Polyarteritis Nodosa
Kawasaki disease |
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Small Vessel Vasculitis (5)
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Wegener's Granulomatosis
Churg-Strauss Syndrome Leukocytoclastic Vasculitis Henoch Schonlein Purpura (IgA immunocomplexes) Microscopic Polyarteritis |
|
Antineutrophil Cytoplasmic Antibodies:
Heterogenous group of __1__ against enzymes mainly in __2__ |
1. Autoantibodies
2. Neutrophil Granules |
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c-ANCA is seen in _____
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Wegener's
|
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p-ANCA is seen in these 2
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Microscopic Polyarteritis
Churg-Strauss |
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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__ |
1. bilateral
2. ischemia 3. pallor, pain, parasthesia 4. Cold 5. Arterial spasm 6. young females 7. Scleroderma |
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4 Benign Tumors of Blood Vessels
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1. Hemangioma
2. Granuloma Pyogenicum 3. Vascular Ectasia 4. Glomus Tumor |
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Borderline (intermediate) Tumor of Blood Vessels
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Hemangioendothelioma
|
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Malignant Tumors of Blood Vessels (3)
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1. Angiosarcoma
2. Hemangiopericytoma 3. Kaposi Sarcoma |
|
Only great concern with Hemangiomas
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Is if they start to bleed
|
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2 type of Hemangiomas
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Capillary Hemangioma
Cavernous Hemangioma |
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Histology of Cavernous Hemaniogmas
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Large vascular spaces lined by FLATTENED endothelial cells
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A malignant neoplasm of vascular origin characterized by MASSES of Endothelial cells
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Angiosarcoma
|
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Development of HEPATIC Angiosarcomas is associated with... (3)
|
Polyvinyl Chloride
Arsenic Thorotrast (Thorium Dioxide) |
|
Sites where Angiosarcomas occur (4)
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Skin
Soft Tissue Breast Liver |
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Histology of Angiosarcomas
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irregular vascular spaces lined by Malignant-apearing endothelial cells with HYPERCHROMATIC NUCLEI
|
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Explain "Lymphedema Associated Angiosarcoma"
|
Development of an Angiosarcoma in the Lymphedematous arm of a patient who has has AXILLARY LYMPH NODE DISSECTION for breast cancer (due to Statis)
|
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Alternate name for "Lymphedema Associated Angiosarcoma"
|
Stewart-Treves Syndrome
|
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Classic Kaposi's Sarcoma affects these people
|
Older European men
|
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African Kaposi's Sarcoma presents with this
|
Lymphadenopathy in African men and children
|
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Transplants associated KS is due to this
|
Immunosuppression
|
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AIDS associated KS occurs in these people and with what co-infection?
|
Homo Males
HHV-8 |
|
3 Stages of Lesion development in KS
|
1. Patch stage
2. Plaque Stage 3. Nodular stage |
|
Benign capillary proliferation involving the skin/visceral organs in AIDS patients caused by Bartonella Henselae (Cat Scratch Fever)
|
Bacillary Angiomatosis
*responds to Antibiotics* |
|
What are varicose veins?
|
enlarged tortuous veins
|
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Risk Factors for Varicose Veins of the LEGS (6)
|
1. Increasing Age
2. FEMALES 3. Hereditary predisposition 4. Obesity 5. Posture (standing job) 6. Increased Venous Pressure |
|
2 Clinical features of Varicose Veins
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Swelling
Dull Pain |
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2 Complications of Varicose Veins
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Stasis Dermatitis
Stasis Ulcers |
|
List 3 other sites where Varicose Veins occur (other than leg)
|
1. Esophageal Varices = portal hypertensio due to Cirrhosis
2. Hemorrhoids = internal/external hemorrhoid plexus of rectum 3. Varicocele = pampiniform plexus of Scrotum |
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Thrombus of Veins without Inflammation
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Phlebothrombosis
|
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Thrombus of veins associated with Inflammation
|
Thrombophlebitis
|
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Which one is more dangerous - Thrombophlebitis or Phlebothrombosis? Why?
|
Phlebothrombosis b/c it is more likely to break off and produce Pulmonary Emboli
|
|
Lymphangitis
|
An acute inflammation involving Lymphatics, usually BACTERIAL in origin causing painful red streaks in the SUBCUTIS
|
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Occlusion of Lymphatics leading to accumulation of interstitial fluid
|
Lymphedema
|
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5 causes of Lymphedema
|
1. invasion of lymphatics by malignant cells
2. radical surgery 3. post-irradiation fibrosis 4. post-inflammatory scarring 5. parasitic infection --> Filariasis |
|
Arteriosclerosis = __1__ and __2__ of the ARTERIES
|
1. thickening
2. Hardening |
|
Arteriosclerosis due to aging
|
Senile Arteriosclerosis
|
|
Medial Calcification Sclerosis
|
Monckeberg's Medial Sclerosis
|
|
Monckeberg's Medial Sclerosis usually occurs in these arteries and affects this age group
|
Arteries of Upper/Lower Extremities (radial & Ulnar)
> 50 yoa *usually asymptomatic |
|
Hypertension: Systolic pressure > __1__ or Diastolic pressure > __2__
|
1. 140 mm Hg
2. 90 mm Hg |
|
What is Secondary Hypertension?
|
5-10% of cases in which a DEFINITE CAUSE can be identified
|
|
What is Primary Or Essential Hypertension?
|
90-95% of cases that have UNKNOWN etiology
|
|
Secondary Causes of Hypertension
|
R = REnal
E = Endocrine N = Neurogenic A = Aortic L = Labile |
|
Renal causes of Secondary Hypertension (4)
|
1. Stenosis of Artery -> Renin release -> Angiotensin -> 1. constricts arterioles 2. Aldosterone release -> Sodium retention
2. Fibromuscular Dysplasia 3. Atherosclerosis 4. Glomeruonephritis/ Pyelonephritis |
|
Endocrine causes of Secondary Hypertension
|
1. Adrenal Cortical Hyperfunction (Aldosterone) = Cushing's
2. Adrenal Medullary Hyperfunction (Catecholamines) = Pheochromocytoma |
|
Essential Hypertension is a product of __1__ and __2__.
It is influenced by __3__ and __4__ |
1. Cardiac Output
2. Peripheral Resistance 3. Renal function 4. Sodium Homeostasis |
|
Pathogenesis of Essential Hypertension:
-Genetic defect in __1__ -Genetic defect in __2__ in vascular smooth muscle -Variation in genes encoding __3__ |
1. Renal Sodium excretion
2. Sodium/Calcium transport 3. Angiotensinogen |
|
Hypertension Risk Factors (6)
|
1. Family History
2. High Sodium intake 3. Stressful lifestyle 4. Obesity 5. High Alcohol intake 6. ORAL CONTRACEPTIVES |
|
Clinical Manifestations of Hypertension:
-Early = 1 -Later = 2 |
1. Headhache, nosebleeds, tinnitus, dizziness
2. Stroke, Heart failure, Renal failure |
|
Changes associated with Benign Hypertension
|
Hyaline or Sclerotic Arteriolar changes that are slowly progressing
|
|
Describe Malignant Hypertension
|
Rapidly progressive, Arteriolar spasm, Edema, Necrosis
CNS and Renal Complications |
|
Describe the Histology of Malignant Hypertension
|
- concentric, "onion-skinned" thickening of the smooth muscle (hyperplasia)
- Fibrinoid Necrosis - No inflammation |
|
Vascular Pathology in Hypertension:
-Accelerates __1__ -Potentiates __2__ and __3__ |
1. Atherogenesis
2. Aortic Dissection 3. Cerebrovascular Hemorrhage |
|
Hyaline changes in arteriolar walls indicate _______
|
Hyaline Arteriosclerosis = Benign HTN
|
|
"Onion-skin" lesions with Fibrinoid Necrosis indicate ________
|
Hyperplastic Arteriosclerosis = Malignant HTN
|
|
Factors indicating Adverse Prognosis in HTN:
-Race: __1__ -Age: __2__ -Sex: __3__ -Persistent Diastolic pressure > __4__ |
1. black
2. younger age 3. males 4. 115 |