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Vascular world q

usmle

QuestionAnswer
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
Created by: schrla