Cardiovascular Path 7

Question 1

what kinds of end organ damage can you see with malignant HTN ?

Answer 1

• renal failure
• left ventricular failure
• hypertensive encephalopathy

Question 2

the homogenous pink thickening of the walls of the arterioles in _____ arteriolosclerosis is due to ______

Answer 2

hyaline;
leakage of plasma components across vascular endothelium and ↑’ing extracellular matrix production by smooth muscle cells

Question 3

chronic hemodynamic stress in HTN or the metabolic stress in DM can cause ______ arteriosclerosis

Answer 3

hyaline

Question 4

______ arteriolosclerosis is related to more acute or severe elevations of BP

Answer 4

hyperplastic

Question 5

necrotizing arteriolitis is seen in _____ arteriolosclerosis

Answer 5

hyperplastic

Question 6

describe the histology appearance of a hyperplastic arteriosclerosis

Answer 6

onion skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumen

Question 7

depots of _______ and acute necrosis fo the vessel wall is seen in hyperplastic arteriosclerosis

Answer 7

fibrinoid material

Question 8

what are two outcomes of the vessels in vasculitis?

Answer 8

stenosis or aneurysm

Question 9

what are 3 main etiologies of vasculitis?

Answer 9

• immunological
• direct infection
• unknown: giant cell (temporal), takayasu, PAN

Question 10

what are some classes of immunological causes of vasculitis?

Answer 10

• immune complex mediated: hep B/C, SLE/RA, drugs
• ANCA mediated: Wegener’s granulomatosis and Churgg Strauss
• direct antibody mediated: Kawasaki (anti endothelial cell ab’s)
• cell mediated: allograft organ rejection

Question 11

________ antibodies is the cause of Kawasaki’s disease

Answer 11

anti-endothelial cell antibodies

Question 12

what are examples of immune complex mediated causes of vasculitis?

Answer 12

• Hep B/C
• SLE
• Rheumatoid arthritis
• drug induced

Question 13

SLE is a type _____ cause of vasculitis

Answer 13

type 3: immune response against antigen-antibody complexes

Question 14

pauci immune vasculitis is seen in _______

Answer 14

ANCA mediated even though there are antibodies (they are against the neutrophils)

Question 15

what are the two main types of ANCA

Answer 15

• c ANCA (PR3-ANCA)

- p ANCA (MPO- ANCA)

Question 16

pr3 ANCA is the same as ____ ANCA

Answer 16

c- ANCA

Question 17

___ ANCA is seen in microscopic polyangitis

Answer 17

P-ANCA

Question 18

_____ ANCA is seen in Churgg Strauss and Wegener’s

Answer 18

C-ANCA

Question 19

what arteries are mainly affected in giant cell arteritis?

Answer 19

• aorta
• temporal (most common)
• vertebral
• ophthalmic (can lead to blindness)

Question 20

what is the difference between takayasu arteritis and giant cell arteritis?

Answer 20

• only the AGE;
  < 50 = takayasu
  > 50 = giant cell/temporal

Question 21

most symptoms in giant cell arteritis are vague, but there can also be _____ symptoms such as:

Answer 21

ocular; diplopia, progressive hazy vision, loss of vision

Question 22

fragmentation of internal elastic lamina is seen in the histology of what vasculitis disease?

Answer 22

giant cell vasculitis (along with giant cells in the intima and inner media)

Question 23

is there reduction of the lumen in giant cell arteritis?

Answer 23

yes; focal, nodular thickening with reduction of the lumen

Question 24

why must you take multiple sections in the temporal artery biopsy in diagnosing giant cell arteritis?

Answer 24

this disease has segmental narrowing so can get a segment that seem normal

Question 25

giant cell arteritis is associated with ________-

Answer 25

polymyalgia rheumatica (inflammatory disorder that causes muscle pain and stiffness)

Question 26

a 30 year old female patient complaining of visual disturbances, headaches and dizziness is found to have no pulse in her upper extremities and numbness in her fingers. what could this person have?

Answer 26

takayasu arteritis: look at the age (<50), PULSELESS/low BP in upper limb, ocular changes presents just like giant cell and same histo, just age is different

Question 27

what arteries are typically affected in PAN (polyarteritis nodosa)

Answer 27

- renal, visceral, and coronary, but SPARES THE PULMONARY CIRCULATION and arterioles, capillaries and venules

Question 28

what type of inflammation in see in the small or medium sized arteries affected in PAN?

Answer 28

SEGMENTAL transmural necrotizing with fibrinoid necrosis at the inner half of the vessel wall ; (not like the segmental granulomatous type seen in giant cell or takayasu's)

Question 29

are the lungs affected in PAN?

Answer 29

NO

Question 30

what are the most common sites of injury in PAN?

Answer 30

most frequent to least: | - kidney, heart, liver, GIT

Question 31

what is a characteristic feature of PAN?

Answer 31

all stages of activity may coexist in different vessel or even within the same vessel (heterogenous) DOES NOT AFFECT LUNGS

Question 32

what can you expect to see on histology of someone with PAN?

Answer 32

BOTH: transmural inflammation with fibrinoid necrosis AND inflammation that is replaced by fibrous thickening of the vessel wall

Question 33

_____ Infection is most often associated with PAN

Answer 33

hepatits B (immune complex mediated)

Question 34

Kawasaki disease presents and looks just like ______ except for pathogenesis and the invovlemtn of ______

Answer 34

PAN; Kawasaki is due to antibodies against the endothelial cells Kawasaki involves the mucocutaneous lymph nodes

Question 35

patient comes in with fever, conjunctival and oral erythema, edema on hands and feet, skin rash with desquamation, and enlargement of cervical lymph nodes. what do they have and how would you treat?

Answer 35

``` MCLNS (Kawasaki's) and treat with: aspirin and immunoglobulins CRASH and BURN C: conjunctival injetion R: rash (polymorphous → desquamating) A: adenopathy (cervical) S: strawberry tongue (oral mucositis) H: hand-foot changes (edema, erythema) BURN: fever ```

Question 36

MI in a young age group such as < 10 year olds, should start to think ______ disease

Answer 36

Kawasaki disease because of its involvement with the coronary vessels that can leading to contrary aneurysm formation and associated thrombosis with MI

Question 37

what vessels are mainly involved in Buerger disease

Answer 37

mainly the tibial and radial arteries and can sometimes secondarily extend to the veins and nerves of the extremities

Question 38

______ is the largest predisposing factor of Buergers disease

Answer 38

smoking; HS reaction to tobacco → direct endothelial injury

Question 39

what are some clinal symptoms of someone with Buerger disease

Answer 39

- superficial nodular phlebitis - cold sensitivity aka Raynaud's which is the the extremities go from pale to blue to red - claudication pain on instep - progressive pain on exercise and rest - ulceration of toes, feet or fingers followed by gangrene

Question 40

Raynaud's phenomenon is a clinical feature of _______

Answer 40

Buerger's disease, SLE, thromboangitis obliterans

Question 41

how can you tell the difference between thromboangitis and atherosclerosis?

Answer 41

the pain in atherosclerosis is associated with activity but twitch Buerger's disease for example, it can also affect the nerves so can get claudication on rest

Question 42

thrombus that contains small micro abscesses marked by central focus of _____ surrounded by )____ inflammation is seen in the histology of ______

Answer 42

neutrophils surrounded by granulomatous inflammation is seen in Buerger's disease

Question 43

what is a complication of kawsaki disease / Mucocutaneous lymph node syndrome?

Answer 43

may develop coronary aneurysm formation associated with thrombosis with MI → death; Kawasaki's disease often involves the coronary arteries

Question 44

how would you treat giant cell arteritis?

Answer 44

give high dose corticosteroids before temporal artery biopsy to prevent blindness

Question 45

Takayasu arteritis most commonly affects _________ and on gross image you will see ___________

Answer 45

arch of the aorta; | irregular thickening of the aorta or branch vessel wall with intimal wrinkling and narrowing of the lumen

Question 46

collagenous fibrosis involving all layers of the vessel wall and ____nuclear infiltrate of the media with granulomatous change with patchy necrosis of the media is seen in ______

Answer 46

mononuclear; takayasu arteritis