Chapter 11 Robins

Question 1

A patient comes in with subarachnoid hemorrhage.

What can we suspect is the cause?

Answer 1

90% of causes of subarachnoid hemorrhage are rupture of a Berry aneurism.

Question 2

Fibromusclar dysplasia can lead to what?

Answer 2

Stenosis and aneurism that may rupture.

Question 3

Alteration of endothelial phenotype seen in endothelial dysfunction is responsible for what pathologlogical changes?

Answer 3

• 1. Thrombus formation
• 2. Atherosclerosis
• 3. Vascular lesions of HTN

Question 4

• High blood pressure (BP) can cause what?
• What is it a major risk factor for?

Answer 4

• End-organ damage
• Atherosclerosis

Question 5

Fibromusclar dysplasia of the media and intime occurs in what arteries

Answer 5

medium and large (carotid, splanchnic, verterbral and renal)

Question 6

How does HTN change vascular pathology in small, large and medium arteries?

Answer 6

Medium and large arteries: degrade walls, aortic dissection and CV hemorrhage

Small arteries: hyaline arteriolosclerosis and hyperplastic arteriolosclerosis

Question 7

Nephrosclerosis due to chronic HTN is a form of what type of arteriosclerosis?

Answer 7

Hyaline arteriolosclerosis

Question 8

What type of small blood vessel disease occurs with SEVERE HTN?

Answer 8

Hyperplastic arteriolosclerosis

Question 9

Mockenberg medial sclerosis

Answer 9

Calcification of internal elastic lamina in muscular arteries => does not narrow lumen => not clinically important

Pts are over 50

Question 10

What increases changes of getting CAD?

Answer 10

1. high systolic BP

2. Cholestrol
3. Low HDL-C
4. DB
5. Cigs
6. LVH

Question 11

atherosclerosis occurs in what types of BVs?

Answer 11

Medium and large musclar and elastic vessels

Question 12

Can we guess how someone with essential HTN will die?

Answer 12

Yes:

1/2 die from ischemic heart disease.

1/2 due from a stroke

Question 13

What are the signs someone has malignant HTN

Answer 13

1. renal failure
2. Retinal hemorrhages
3. papilledema
4. SEVERE htn
   - hyperplastic arteriolosclerosis (fibroid deposits + necrotizing arteriolitis)

Question 14

arteriolosclerosis

Answer 14

Hardening of small arteries and arterioles, which can cause lack of O2 to organs => ischemic injury

Question 15

What is extremely common in the developed world and causes more morbidity and mortality (almost HALF of all deaths) in the western world?

Answer 15

Atherosclerosis

Question 16

At what age are people more at risk for atherosclerosis.

Who is somewhat protected from atherosclerosis?

Answer 16

40-60 Y

Young women d/t estrogen

Question 17

People who have metabolic syndrome and obesity are more at risk for…

Answer 17

thrombus formation and endothelial dysfunction

Question 18

What factors make ppl with metabolic syndrome and obesity more at risk for thrombus formation and endothelial dysfunction?

Answer 18

1. Insulin resistance
2. Dyslipidemia (high LDL and low HDL)
3. Pro-inflammatory
4. Pro-coagulants
5. HTN

Question 19

DB patients are 2x more likely to get what?

Answer 19

MI

Question 20

What causes a fatty streak to become a mature atheroma?

Answer 20

Smooth muscle proliferation and ECM

-formed d/t IL-1=>

Question 21

What growth factors do SMC release so that they can proliferate, make ECM and collagen and form a mature plaque?

Answer 21

1. PDGF
2. FBF
3. TGF-a

Question 22

if we find fatty streaks in the in a infant or adolescent, does this mean they are on their way to forming a atheroma?

Answer 22

NO.

Fatty streaks are common in [aorta of infants and almost all adolescents]

Question 23

What can cause aneurism and rupture of an atherosclerotic plaque? ***

Answer 23

1. Mural thrombis: thrombi that attaches to the wall of the BV

2. Embolization

3. Wall weakening

Question 24

What can cause occlusion by thrombus of an atherosclerotic plaque? *** (5)

Answer 24

1. Plaque Rupture 2. Plaque Erosion 3. Plaque Hemorrhage 4. Mural thrombosis 5. Embolization

Question 25

What can cause an aneurism by weakening the vascular wall by ischemia?

Answer 25

1. Atherosclerosis: inner media 2. HTN: outer media 3. Tertiary syphillus: outer media of thoracic aorta

Question 26

How can syphillus cause an aneurism

Answer 26

Cause obliterans endartitis (inflammation of adventitia, where vasa vassorum is located) =\> decrease O2 to outer media of **THORACIC AORTA =\> aneyrm and sometimes aortic valve regurg**

Question 27

A patient comes in with an aortic aneurism. This can is commonly due to.

Answer 27

1. Atherosclerosis 2. HTN

Question 28

MCC of abdominal aortic aneurism

Answer 28

Atherosclerosis

Question 29

MCC of ascending aortic aneurism

Answer 29

**HTN** (aorta is pusing out blood)

Question 30

60 YO man who has been smoking for 40 years has atherosclerosis. This patient is prime beef to get what?

Answer 30

Abdominal aortic aneurism M 60 YO smoker

Question 31

What is the MAIN risk factor for aortic dissections?

Answer 31

HTN

Question 32

What patient would we see and go BAM: AORTIC DISSECTION?

Answer 32

Severe anterior CP that radiates to the back between scapula and goes down the aorta