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Flashcards by Jessica Margaux Mercado, updated more than 1 year ago
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Created by Jessica Margaux Mercado
almost 9 years ago
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| Question | Answer |
| spherical dilatations; usually seen at bifurcation of the branches of Circle of Willis | Berry Aneurysms |
| direct (abnormal) communication between venous and arterial vessels that bypass the intervening capillary bed | Arteriovenous Fistula |
| Segments of the vessel wall are focally thickened by a combination of medial and intimal hyperplasia and fibrosis, resulting in luminal stenosis | Fibromuscular Dysplasia |
| Neointimal smooth muscle cell growth stimulated by: | PDGF, endothelin-1, thrombin, FGF, IL-1, IFN- γ |
| Neointimal growth antagonized by: | Heparan sulfate, NO, TGF-B |
| Basic lesion: fibro-fatty plaque; primarily involves intimal layer of arteries | Atherosclerosis |
| Atherosclerosis: preferential locations | Aorta, the large elastic artery & its tributaries (carotid, iliac) and large, medium size muscular arteries (coronary, renal, popliteal); not found in vein; arterioles are not affected |
| made up of fat, cellular elements (leukocytes, monocytes, foam cells or macrophages) and fibrous tissues that encloses the central lipid core | Atheroma |
| Earliest precursor lesion, no clinical significance, may occur early in newborns and children, usually seen from 0-30 y/o; Flat, yellow spots or streaks; absence of component of smooth muscle cells | Fatty Streak |
| Focal intimal plaque with central core of lipid and covering fibrous cap; affects abdominal aorta, coronary, popliteal, descending thoracic aorta, internal carotid, and circle of Willis | fibro-fatty plaque, atheroma, or fibro-lipid; basic lesion/uncomplicated lesion |
| A basic lesion becomes altered through: | Calcification; Rupture, ulceration, rupture; Cholesterol embolization; Hemorrhage into a plaque; Thrombosis |
| Calcium deposits in the media (intima if calcified atherosclerosis) of medium-sized muscular arteries (uterine, testicular arteries); >50y/o | Monckeberg medial calcific sclerosis |
| Old age, DM; associated with benign hypertension (systolic hypertension)/benign nephrosclerosis; leakage of plasma components across injured endothelium with hyaline deposition by smooth muscle | Hyaline Arteriolosclerosis |
| Homogenous,pink hyaline deposits in media of arterioles; thickening and hyalinization of the walls | Hyaline Arteriolosclerosis |
| Symptoms: renal insufficiency, uremia, moderate reductions in renal plasma flow with normal or slightly reduced GFR, mild proteinuria | Hyaline Arteriolonephrosclerosis |
| Onion-skin arteriole; concentric proliferation of the intimal and smooth muscle cells of an arteriole; occurs in younger pop.; associated w/ fibrinoid necrosis = necrotizing arteriolitis | Hyperplastic Arteriolosclerosis |
| Location of Aneurysm: most likely atherosclerotic in nature unless proven otherwise | Abdominal Aorta |
| Location of Aneurysm: syphilitic in nature unless proven otherwise | Thoracic Aorta |
| Location of Aneurysm: developmental and congenital | Bifurcation |
| Location of Aneurysm: Mycotic | Anywhere in the blood vessel |
| Fusiform dilatation associated with severely atherosclerotic aorta; larger aneurysms, >7-8cm in transverse diameter, associated with mural thrombus; majority caused by atherosclerosis; elderly, usually >50y/p | Abdominal Aortic Aneurysm |
| If symptomatic: pulsatile mass, back pain, severe abdominal pain = a sign of imminent rupture; clinically present with a palpable pulsatile mass with bruits and sounds | Abdominal Aortic Aneurysm |
| Complications of AAA | Rupture, occlusion, embolism, impingement of adjacent structures, pseudo-tumor |
| Typically occur in younger patients who often present with back pain and elevated inflammatory markers; Cause: presumed localized immune response to the abdominal aortic wall; May be a vascular manifestation of immunoglobulin G4 (IgG4)-related disease | Inflammatory AAA |
| Type of AAA: Lesions that have become infected by the lodging of circulating microorganisms in the wall | Mycotic AAA |
| complication of tertiary syphilis with obliterative endarteritis of vasa vasorum → tree barking of aorta (intimal destruction) | Syphilitic Aneurysm |
| Complications of Syphilitic Aneurysm | Rupture → hemopericardium, hemothorax; Respiratory/GIT difficulties; AV dilatation, regurgitation; Coronary ostia obstruction → secondary ischemia; Bone erosion |
| Tree barking of aorta; superimposed atherosclerosis; 2˚ AV regurgitation and dilatation, LV hypertrophy; obliterative endarteritis of vasa vasorum (due to surrounding inflammation) → diminished blood supply to the blood vessel → progressive dilatation | Syphilitic Aneurysm |
| Occurs when blood separates the laminar planes of the media to form a blood-filled channel within the aortic wall | Aortic Dissection/ Dissecting Aneurysm |
| Sudden, severe unbearable pain either located in the chest (thoracic aneurysm) or in the abdomen or back (abdominal aneurysm)radiating to the back and downwards | Aortic Dissection/ Dissecting Aneurysm |
| Intimal tear → Medial cleavage by dissecting hematoma → “Double-barreled aorta“ → Cystic medial degeneration or necrosis | Aortic Dissection/ Dissecting Aneurysm |
| General term for inflammation of blood vessel wall | Vasculitis |
| Common pathogenic mechanisms of vasculitis | Immune-mediated inflammation; Direct injury to the blood vessel |
| Large Vessel Vasculitis | Giant Cell Arteritis; Takayasu Arteritis |
| Medium Vessel Vasculitis | Polyarteritis Nodosa; Kawasaki Disease |
| Small Vessel Vasculitis: ANCA Positive | Wegener Granulomatosis; Microscopic Polyangitis; Churg-Strauss Syndrome |
| Small Vessel Vasculitis: ANCA Negative | Henoch Schoenlin Purpura; Cryoglobulinaemic vasculitis; Cutaneous leukocytoclastic vasculitis; Anti GBM disease |
| Formation of Ag-Ab complexes and subsequent deposition in blood vessels | Vasculitis: Immune Complex Deposition |
| group of autoantibodies directed against azurophil or primary granules of neutrophils, lysosomes of monocytes, and endothelial cells | Anti-neutrophil Cytoplasmic Antibodies (ANCAs) |
| cytoplasmic location of immunofluorescence stain; also known as Anti-proteinase 3 or PR3-ANCA; associated with Wegener granulomatosis | c-ANCA |
| perinuclear location of immunofluorescence stain; also known as Anti-myeloperoxidase or MPO-ANCA; associated with microscopic polyangiitis, PAN, and Churg-Strauss syndrome | p-ANCA |
| Antibodies to endothelial cells, perhaps induced by defects in immune regulation; associated with Kawasaki disease | Antiendothelial Cell Antibodies |
| Most common vasculitis in elderly females; Chronic, granulomatous inflammation that affects small and medium sized arteries in the head and neck especially temporal arteries | Giant Cell or Temporal (Cranial) Arteritis |
| T-cell mediated immunologic reaction against the arterial wall leading to a granulomatous reaction; S/S: Unilateral throbbing headache (affected temporal artery), facial pain, ocular symptoms | Giant Cell or Temporal (Cranial) Arteritis |
| Patients may also have systemic manifestations like muscle pains/aches that appears to be rheumatic in nature called polymyalgia rheumatica | Giant Cell or Temporal (Cranial) Arteritis |
| Gross: nodular intimal thickening of the involved artery that reduces the luminal diameter; Histology: medial granulomatous inflammation w/ multinucleated giant cells that leads to internal elastic lamina fragmentation | Giant Cell or Temporal (Cranial) Arteritis |
| Granulomatous vasculitis of medium and large arteries (aorta); Common in women, < 40 yrs. Old | Takayasu Arteritis |
| Ocular disturbance (visual defects, retinal detachment, blindness); Pulseless disease in the upper extremities (if the brachiocephalic artery is involved) | Takayasu Arteritis |
| involves aortic arch plus tributaries and branches; Irregularly thickened intima (hyperplasia), fibrous aortic wall, narrowed lumen due to inflammation = weakened peripheral pulse | Takayasu Arteritis |
| granuloma with giant cells, similar to temporal arteritis; patchy necrosis of the media of aorta (medial necrosis); may lead to collagenous scarring; aortic involvement may cause aortic valve insufficiency | Takayasu Arteritis |
| Transmural (from adventitia to intima) vasculitis of small or medium muscular arteries (not including arterioles, capillaries, or venules); occurs in young, male adults | Polyarteritis Nodosa |
| Acute Phase: transmural neutrophilic inflammation w/ fibrinoid necrosis & thrombotic occlusion; Healing Phase: fibrous thickening & mononuclear inflammation; Healed Phase: marked fibrosis w/ minimal inflammation & nodular consistency | Polyarteritis Nodosa |
| Necrotizing vasculitis; affects arterioles, capillaries and venules; all lesions are of the same histologic age; ANCA positive in majority of cases | Microscopic Polyangiitis (Leukocytoclastic vasculitis) |
| Associated with necrotizing glomerulonephritis and pulmonary capilliritis; Associated with drug hypersensitivity (leukocyte cytoplastic vasculitis) | Microscopic Polyangiitis (Leukocytoclastic vasculitis) |
| Hemoptysis; hematuria, and proteinuria; bowel pain or bleeding, muscle pain or weakness; and palpable cutaneous purpura | Microscopic Polyangiitis (Leukocytoclastic vasculitis) |
| Segmented fibrinoid necrosis of the media with focal transmural necrotizing lesions; Little or no immunoglobulin can be seen in most lesions = Pauci-immune injury | Microscopic Polyangiitis (Leukocytoclastic vasculitis) |
| affects large and medium sized arteries with mucocutaneous syndrome; leading cause of acquired heart disease in children; results from delayed hypersensitivity reaction of T- cells | Kawasaki Disease |
| Young children and infants with coronary artery involvement → aneurysms → rupture of thrombus → Acute MI | Kawasaki Disease |
| T-cell and macrophage activation → cytokine production and macrophage activation; polyclonal B cell activation → formation of autoantibodies to endothelial and smooth muscle cells → Acute vasculitis | Kawasaki Disease |
| S/S: fever; mucocutaneous lymph syndrome (conjunctival and oral erythema and erosion, erythema of the palms and soles, edema of the hands and feet, desquamated rash and cervical lymphadenopathy) | Kawasaki Disease |
| Segmented, necrotizing, fibrinoid (less prominent), panarteritis; inflammation affecting entire thickness of vessel wall; proliferation of autoantibodies | Kawasaki Disease |
| Triad: Acute necrotizing granulomas of URT/LRT, Focal necrotizing granulomas and vasculitis of small and medium sized arteries, Proliferative / crescentric glomerulonephritis | Wegener’s Granulomatosis |
| Presence of crescents in the Bowman’s capsule of the glomerulus, related to the proliferation of the epithelial cells of the Bowman capsule → results to obliteration | Proliferative / crescentric glomerulonephritis (GN) [Wegener’s Granulomatosis] |
| persistent pneumonitis, cavitation, sinusitis, mucosal erosions of RT, renal disease, fever, muscle pains; necrotizing granulomas of nose, palate, pharynx, lungs | Wegener’s Granulomatosis |
| Necrotizing, granulomatous vasculitis of small arteries, veins and capillaries; Renal lesions: Focal necrotizing GN, Crescentic GN | Wegener’s Granulomatosis |
| Destruction of mucous membranes in the nose and lips due to vasculitis, Aphthous stomatitis, Saddle nose deformity, Pulmonary nodules | Wegener’s Granulomatosis |
| c-ANCA: speckled pattern in cytoplasm | Wegener's granulomatosis |
| Segmental, acute and chronic inflammation of medium and small arteries, occasionally veins and nerves; accompanied by luminal thrombosis; associated w/ heavy cigarette smoking, usually seen exclusively in middle-aged (and also young) males | Thromboangitis Obliterans/ Buerger Disease |
| intermittent claudication, pain in the lower extremities, ischemic pain, and then suddenly gangrene sets in, in the lower extremities or in the distal digits, sometimes they may present with autoamputation | Thromboangitis Obliterans/ Buerger Disease |
| Abnormal dilatation and tortuosity of the veins | Varicose Veins |
| Caused by the venous dilatation of the anal venous plexus | Hemorrhoids |
| Affects superficial veins of the upper and lower extremities; caused by a prolonged increase intraluminal pressure and loss of vessel support due to the weakening of vein walls | Superficial varicosity |
| Renders the venous valves incompetent and leads to lower extremity stasis, congestion, edema, pain, and thrombosis | Varicose Veins |
| Complications of Varicose Veins | Stasis dermatitis and ulcers; Thrombosis |
| Acute inflammatory process caused by bacterial seeding of the lymphatic vessels; Affected lymphatics are dilated and filled with an exudate of neutrophils and monocytes | Lymphedema |
| Manifested by red, painful subcutaneous streaks and painful enlargement of the draining lymph nodes | Lymphangitis |
| Due to the blockade of lymphatics by filarial worms which mainly affects fatty channels; Associated with fibrosis of the lymph nodes -> blockade -> lymphedema | Elephantiasis |
| most common vascular tumor; tumor of pediatric age group; most regress spontaneously | Hemangioma |
| Most common variant; tends to be superficially located: skin, subcutaneous tissue, mucous membranes of oral cavities and lips; spontaneously regress (75%-90% regression through time); luscious red in appearance | Capillary Hemangioma/ Strawberry Hemangioma/ Juvenile Hemangioma |
| Gross: bright red to blue, flat, elevated or pedunculated lesion; Histology: lobular proliferation of closely packed, thin-walled blood filled capillaries lined by flattened endothelium.+/- thrombosis | Capillary Hemangioma |
| Composed of large, dilated vascular channels; larger, more infiltrative; no regression because they are deeply situated | Cavernous Hemangioma |
| systemic hemangioma in the cerebellum, brain stem, eye, pancreas, and liver | von Hippel-Lindau disease |
| mass is unencapsulated, has infiltrative borders, and is composed of large, cavernous blood-filled vascular spaces separated by connective tissue stroma | Cavernous Hemangioma |
| pseudotumor; present as rapidly growing red pedunculated lesions on the skin, gingival, or oral mucosa; bleed easily and often ulcerated; 1/3 develop after trauma; associated with acute and chronic inflammation | Pyogenic Granulomas; Lobular Capillary Hemangioma, or Granuloma Gravidarum / Pregnancy Gravida Tumor |
| benign lymphatic counterpart of hemangiomas; proliferation of blood vessels devoid of blood inside; occurs in the subcutaneous tissue, head, axilla, and neck (can be large in the pediatric age) | Lymphangioma |
| notable lateral neck cystic mass; nothing more than a lymphangioma | Cystic hygroma |
| benign, but extremely painful; arise from glomus bodies; common site: sub-ungal | Glomus Tumor / Glomagioma |
| Characterized by localized dilation of preexisting vessels | Vascular Ectasias |
| most common form of ectasia; usual location : head and neck (superficial); flat, light pink to purple irregular lesion; majority ultimately fade and regress spontaneously thru time | Nevus flammeus |
| only dilation of vessels (with normal volume) in the dermis which are non-neoplastic | Nevus flammeus |
| May be associated with the Sturge-Weber syndrome aka encephalotrigeminal angiomatosis with distribution along trigeminal nerve | Port wine nevus |
| Multiple venous angiomatous masses in the leptomeninges and cortex; Port wine nevi in ipsilateral face; Mental retardation, seizures; Neurologic abnormalities (i.e. hemiplegia, and radiopacities in the skull) | Sturge-Weber syndrome |
| Radial, pulsatile network of dilated subcutaneous arteries which blanches on pressure at the center; usual location: face, neck, or upper chest; associated with pregnancy and cirrhosis | Spider Telangiectasia (Arterial Spider) |
| Autosomal dominant; genetic malformations associated with dilated cap & veins; widely distributed: skin, mucous membranes of the oral cavity, lips, and respiratory tract, GIT, and urinary tract | Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease) |
| Most common AIDS associated cancer; Scaly very red, elevated with irregular and varying sizes on the skin | Kaposi Sarcoma |
| Commonly seen (90%) in older men of Eastern European (esp. Ashke-nazi Jews) or Mediterranean descent; multiple red to purple skin plaques or nodules in the arms or legs | Chronic (Classic or European KS) |
| South Africa , young Bantu children; skin and visceral lesions; local or general lymphadenopathy, skin lesions are sparse; aggressive clinical course | Lymphadenopathic (African or endemic KS) |
| Occurs following organ transplant recipient with high doses of immunosuppressive therapy; skin is involved to a lesser extent; aggressive and involves lymph node, mucosa, and visceral organs (primarily involved) | Transplant-associated (Immunosuppression-associated) KS |
| Skin lesions : 3 stages : multiple red (hemorrhagic), purple patch, plaque, and macules in the extremities | Kaposi Sarcoma |
| malignant vascular tumor; common site: skin, soft tissue, breast, liver; etiogenesis: carcinogenic (arsenic, thorotrast, polyvinyl chloride), chronic lymphedema, radiation, foreign body; clinical behavior: local invasion and high risk for distal metastasis, poor outcome, aggressive | Angiosarcoma |
| Histology: poorly developed vascular channels with red blood cells in the slits, lined by atypical looking (malignant) hyperchromatic spindle cells | Angiosarcoma |
| Malignant vascular tumor with characteristic thin-walled branching ("staghorn") vascular pattern microscopically | Hemangiopericytoma |
| Histogenesis : pericytes; Anastomosing vascular channels lined by benign looking endothelial cells; staghorn pattern | Hemangiopericytoma |
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