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Vascular world q
usmle
| Question | Answer |
|---|---|
| What is the most specific symptoms for giant cell (temporal) arteritis? | Jaw claudication |
| giant cell arteritis tends to develop in pt. over the age of | 50 |
| Medial granulomas can be seen in? | Takayasu arteritis Giant cell (temporal) arteritis |
| Takayasu arteritis typically affects what vessels? | Aortic arch, though there is involvement of the remainder of the aorta and its branches (including coronary and renal arteries) in 1/3 pt. |
| Takayasu arteritis occurs predominantly in what pt. | females less than 40 |
| What arteritis has pt. that present /w lower blood pressure and pulses in the upper extremities as compared to the lower extremities, and cold or numb fingers | Takayasu arteritis |
| What dz. is characterized by segmental fibrinoid necrosis of the small vessels (arterioles, cap, venules) | Leukocytoclastic vasculitis (microscopic polyangiitis, microscopic polyarteritis, hypersensitivity vasculitis) |
| Aside from their localization to small vessels, the lesions of microscopic polyangiitis are often histologically similar to | polyarteritis nodosa (PAN) |
| What dz. is a segmental transmural necrotizing inflammation of medium to small-sized arteries | polyarteritis nodosa PAN |
| Which dz. produces necrotic tissue and deposits of immune complexes, complement, and plasma proteins which present as smudgy esoinophilic deposits (fibrinoid necrosis) to give a histologic pattern consistent /w immune complex vasculitis | PAN |
| Which disorder is commonly seen among heavy cigarette smokers, which an onset prior to the age of 35 | Thromboangiitis obliterans (Buerger's disease) |
| Thromboangiitis is a thrombosing vasculitis of medium and small-sized arteries, principally the? | Tibial and radial arteries |
| Rheumatoid arteritis is what type of vasculitis | Hypersensitivity vasculitis affecting arterioles and arteries of any size |
| Rheumatoid arteritis produces pathology similar ot | polyarteritis and hypersensitivity angiitis |
| Takayasu arteritis and temporal arteritis involve arterial vessels of different sizes and locations how/where? | (aorta and proximal aortic arterial branch involvement versus more distal carotid artery branch involvement, respectively |
| Takayasu arteritis and temporal arteritis may share a common pathological morphology consisting of | granulomatous inflammation of the media |
| Pt. /w a genetic defect in LPL present /w | Hyperlipidemia Pancreatitis lipemia retinalis eruptive skin xanthomas (small yellowish papules surrounded by erythema tha toccur mainly on extensor surfaces of extremities) hepatosplenomegaly |
| In normal individuals, heparin releases endothelium-bound lipases, encouraging the clearance of | triglycerides form circulation |
| LDL is predominantly composed of | cholesterol |
| What is the main mechanism by which LDL is cleared from the circulation | Receptor-medicated uptake by the liver |
| Defects in the LDL receptor leads to | hypercholesterolemia |
| Are pt that are deficient in LPL at increased risk for coronary artery dz? | No, it is pt. /w hypercholesterolemia that are increased risk for coronary artery dz |
| What is the hallmark of familial hyperhcolesterolemia? | Tubular xanthomas, which are nodular lipid deposits in the tendons (most often seen in Achilles and elbow tendons). Some pt. also have xanthelasma and arcus cornea |
| Medial band-like calcification are characteristic of | Monckeberg's medial calcific sclerosis |
| Homogeneous deposition of material in the intima and media of small arteries and arterioles is characterizes | hyaline arteriolosclerosis |
| Onion-like concentric thickening of the walls of arterioles is seen in | hyperplastic arteriolosclerosis |
| What causes hyperplastic arteriolosclerosis | laminated smooth muscle cells and reduplicated basement membranes. It can result from malignant hypertension (diastolic pressures >120-130 mm Hg) |
| Descrescendo-type diastolic murmur over left sternal border + mediastinal widening suggests | presence of an aortic aneurysm tha thas dilated the aortic annulus |
| Serum FTA-ABS test positive suggests | Syphilis = luetic sneurysm |
| What dz. begins /w vasa vasorum endarteritis and obliteration, resulting in inflammation , ischemia and weakening of the adventitia. | Tertiary syphilis |
| What are the earliest lesions of atherosclerosis | intimal streaks |
| Severe, complicated intimal atheromas can destroy and weaken the underlying media, resulting in aortic aneurysms. The most common site of these lesions; however, is | abdominal aorta- specifically, below the origin of the renal arteries. |
| What is the initiating process of a dissecting aortic aortic hematoma | intimal tear |
| Medial degeneration is characterized by | fragmentation of elastic tissue + separation of the elastic and fibromuscular components of the tunica media by small, cleft-like spaces. Medial degeneration is the most frequent histopaht abnormality (other than an intimal tear = aortic dissections |
| What are fatty streaks | intimal lipid-filled foam cells, derived form macorphages and smooth muscle cells (SMC) that have engulfed lipoprotein (predominantly LDL), which has entered the intima through an injured, leaky endothelium. |
| What makes the foamy appearance in fatty steaks | intracellular lipid-containing phagolysosomes |
| Fatty streaks are the earliest lesions in the progression of? | atherosclerosis |
| Do all fatty streaks become atheromatous plaques | not all fatty streaks progress to these more advanced atherosclerotic plaques |
| Claudication is almost always the result of? | atherosclerosis of larger named arteries |
| What are atheromas | lipid-filled intimal plaques tha tbulge into the arterial lumen |
| Thigh claudication is suggestive of | occlusive dz of the ipsilateral external iliac or common femoral arteries and/or both superficial femoral and profunda femoris arteries. |
| What can diminish blood flow to the internal pudendal branches of the internal iliac artery, making it difficult to sustain an erection | aortoiliac atherosclerosis |
| Medial band-like calcification occurs in | Monckeberg's medial calcific sclerosis, or medial calcinosis |
| What condition is characterized by calcified deposits in muscular arteries | medial calcinosis |
| What age range do you typically find medial calcinosis | above age 50 |
| Why are medial band-like calcifications palpable on physical exam but asymptomatic | /b they do not narrow the vessel lumen |
| Hyaline arteriolosclerosis is usually a component of what dz | diabetic microangiopathy and can result form nonmalignant hypertension |
| What condition is marked by homogeneous deposition of hyaline material in the intima and media of small arteries and arterioles | hyaline arteriolosclerosis |
| What can cause hyperplastic arteriolosclerosis | malignant hypertension (diastolic >120 mm Hg) |
| Hyperplstic arteriolosclerosis most commonly affects arterioles in what tissue | kidneys, retinas, and intestinal arterioles |
| Hyaline material in hyaline atherolosclerosis is thought to result from | leakage of plasma constituents across the vascular endothelium, and from excessive extracellular matrix production by smooth muscle cells. |
| What lesions histologically appear as sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis in adults? | Cherry hemangiomas |
| What lesion consist of a bright red central papule surrounded by several outwardly radiating vessels. They occur due to dilation of a central arteriole and its superficial cap. network and are estrogen-dependent | Spider angiomas |
| What lesion consists of dilated vascular spaces /w thin-walled endothelial cells | cavernous hemangiomas |
| Cavernous hemangiomas of the brain and viscera are associated /w what disease | von Hippel-Lindau disease |
| A bluish neoplasm occuring underneath the nail bed may be either a | glomus tumor (glomangioma) or a subungual melanoma |
| A glomangioma is a tumor of what | modified smooth muscle cells of a glomus body |
| A tumor of antigen-processing cells would be either a? | histiocytosis or a lymphoma |
| When there is cutaneous involvement in langerhans cell histiocytosis, Pt. present /w | erythematous papules nodules scaling plaques |
| What is the most likely causes of acute-onset dyspena and chest pain in a pt. who recently underwent surgery | pulmonary emboli |
| What disorders are associated /w hypercoagulabiltiy and can trigger pulmonary emobli | trauma cancer pregnancy several chronic diseases associated /w hypercoagulability air travel surgery |
| What is used to prevent pulmonary emboli after surgery | low-dose heparin an anticoagulant that acts by binding to antithrombin III |
| What type of infarct happens in a pulmonary emboli | red (hemorrhagic) infarct /b the lung has a dual blood supply (from both pulmonary and bronchial arteries) |
| Low-dose aspirin, blocks thromboxane A2 synthesis and prevents platelet aggregation, plays an important role in the prevention of what | recurrent coronary artery thrombosis and ischemic stroke but is not enough to prevent deep venous thrombosis/pulmonary embolism in high risk pt (hip surgery ect) |
| Fresh frozen plasma is used to stop hemorrhages doe to? | warfarin overdose |
| What vascular tumor, immunohistochemically test positive for CD 31 cell marker and the pt has been exposed to arsenic, thorotrast, or polyvinyl chloride | liver angiosarcoma |
| CD 31 is what? | A PECAM1 (platelet endothelial cell adhesion molecule)a marker for vascular endothelial cells |
| Hypercoagulability is a very common paraneoplastic syndrome seen most commonly in adenocarcinomas of | pancreas colon or lung |
| Trousseau's syndrome is | migratory superficial thrombophlebitis |
| Risk factors associated with varicose veins | all related to chronic increase in lower extremity venous pressure: long periods of standing age greater than 50 obesity multiple pregnancies |
| Why is thromboembolism very infrequent /w varicose veins | /b they are restricted to the superficial venous system |
| What is Phlegmasia alba dolens | Painful white leg, "milk leg" a consequence of iliofemoral venous thrombosis occurring in peripartum women |
| what causes phlegmasia alba dolens | venous stasis due to the pressure of the gravid uterus on deep pelvic veins and the hypercoagulable state inherently present during pregnancy can result in deep venous thrombosis |
| Venous states ulcers very commonly occur over | medial malleolus |
| Persistent lymphedema (/w chronic dilatation of lymphatic channels) predisposes pt. to the development of what rare malignant neoplasm. | lymphangiosarcoma |
| What typical clinical scenario would lymphangiosarcoma appear | ~10 years following radical mastectomy for breast cancer |
| What lesion is a polypoid form of capillary hemangioma | pyogenic granulomas |
| What are pyogenic granulomas | a rapidly growing, exophytic red nodules attached by a stalk to the gingival or oral mucosa or skin. They bleed easily and may be ulcerated. |
| How do cystic hygroma (cavernous lymphangioma) differ from cavernous hemangiomas? | They lack luminal blood cells |
| Kaposi's sarcoma is a hyperplasia or neoplasm of spindle-shaped cells /w markers of both | smooth muscle and vascular endothelial lineage |
| Which disorder is has acute and chronic inflammation of the arterial walls, often /w thrombosis of the lumen, which cna undergo organization ant recanalizaiton. | Thromboangiitis obliterans |
| A segmental thrombosing vasculitis that often extends into contiguous veins and nerves is characteristic of | thromboangiitis obliterans |
| What are some of the symptoms of thromboangiitis obliterans | calf, foot, or hand intermittent claudicaiton, superficial phlebitis and cold sensitivity (Raynaud's phenomenon). Later complications include ulcerations and gangrene of the toes, feet, or fingers. |
| Transmural inflammation of the arterial wall /w fibrinoid necrosis is characteristic of | polyarteritis nodosa |
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