Path slide set 1

Question 1

what causes a thoracic aortic aneurysm?

Answer 1

HTN

Question 2

young women, renal artery, beads on string

Answer 2

Fibromuscular dysplasia

Question 3

occurs when blood enter defect in intima and travels through tissue plane within layers of aortic media

Answer 3

Aortic dissection

Question 4

What is the most frequent preexisting histologically detectable lesion of an aortic dissection?

Answer 4

cystic medial degeneration. inflammation generally absent

Question 5

Where are most dissections?

Answer 5

Ascending aorta

Question 6

what causes and abdominal aorta aneurysm

Answer 6

atherosclerosis

Question 7

HTN has increased prevalence in who?

Answer 7

advancing age and african americans

Question 8

What is the cause of most HTN?

Answer 8

idiopathic (essential HTN; 90-95%

Question 9

vascular morphological changes of HTN?

Answer 9

hyaline or hyperplastic arteriolosclerosis

Question 10

In the pathogenesis of an Aneurysm, what weakens the vascular wall by ischemia of inner media?

Answer 10

Atherosclerosis

Question 11

prolonged activation of endothelium may lead to endothelial dysfunction, often characterized by what?

Answer 11

• procoagulation
• proinflammation
• smooth muscle stimulation

Question 12

In tact but thinned muscular wall at site of dilation

Answer 12

“true” aneurysm

Question 13

what can an AAA impinge?

Answer 13

ureter or erosion of vertebrae

Question 14

Other non major modifiable risk factors

Answer 14

• inflammation (levels of C-reactive protein)
• hyperhomocystinemia (>100umol/L)
• metobolic syndrome

Question 15

major modifiable risk factors of atherosclerosis

Answer 15

• hyperlipidemia (LDL) based on diet and exercise
• HTN
• Smoking
• DM

Question 16

Most common locations for atherosclerotic lesions in decreasing frequency?

Answer 16

• abdominal aorta
• coronary arteries
• popliteal arteries
• Internal carotid arteries
• Circle of Willis

Question 17

Activated state of endothelium is characterized by expression of what?

Answer 17

• adhesion molecules
• procoagulants and anticoagulants
• voasoactive factors, growth factors

Question 18

Constitutional risk factors for atherosclerosis

Answer 18

• Family history
• Age
• gender

Question 19

Congenital conditions predisposing to aneurysm

Answer 19

• Marfan syndrome - fibrillin
• Ehlers Danlos - type 3 collagen
• Loeys-Dietz - TGF beta receptor - synthesis of elastin and COL 1 and 3

Question 20

explain the gender predisposition for atherosclerosis

Answer 20

Males more than females until women hit menopause then increases and they eventually pass men

Question 21

Advanced glycation end products can cause activation of endothelium due to what disorder?

Answer 21

uncontrolled diabetes

Question 22

besides HTN, when else would you see hyaline arteriolosclerosis?

Answer 22

long standing diabetes

Question 23

in the pathogenesis of an aneurysm, loss of vascular wall elastic tissue or ineffective elastin synthesis leads to what?

Answer 23

cystic medial degeneration

Question 24

describe cystic medial degeneration

Answer 24

disrupted and disorganized elastin filaments and increased ground substance (proteoglycans)

Question 25

what gives a "pulsating hematoma"

Answer 25

False aneurysm

Question 26

defect though wall of vessel or heart, communicating with an extravascular hematoma?

Answer 26

"false" aneurysm

Question 27

severe chest pain, radiating to back b/t scapulae

Answer 27

Aortic dissection

Question 28

When oxidized LDL accumulated within macrophages and smooth muscle cells it forms what?

Answer 28

foam cells and a "fatty streak"

Question 29

Clinically significant effects of large or multiple arteriovenous fistulas?

Answer 29

shunting of blood from arterial to venous and forcing heart to pump additional volume --> high-output cardiac failure

Question 30

Describe Hyaline arteriolosclerosis

Answer 30

- increase smooth muscle matrix synthesis - plasma protein leakage across damaged endothelium - homogeneous pink thickening of vessel wall with luminal narrowing

Question 31

complications of atherosclerotic plaques

Answer 31

- Rupture and ulceration - hemorrhage - embolism - Aneurysm

Question 32

what congenital vascular disorder are berry aneurysms associated with?

Answer 32

Autosomal dominant polycystic kidney disease

Question 33

primary risk factor for aortic dissection

Answer 33

HTN

Question 34

Accumulation of cholesterol crystals within macrophages is recognized by what? leading to what?

Answer 34

inflammasome, leading to IL-1 secretion and further macrophage and T cell recruitment and activation

Question 35

explain intimal thickening

Answer 35

-smooth muscle cells from media go to intima where they proliferate and elaborate ECM

Question 36

what is the more frequent epidemiology for an AAA

Answer 36

smoking men in their 50s

Question 37

descibe hyperplastic arteriolosclerosis

Answer 37

- occurs in severe HTN | - smooth muscle cells form concentric lamellations ("onion skinning") with resultant luminal narrowing

Question 38

Describe the Response to injury model for pathogenesis of atherosclerosis

Answer 38

1: chronic endothelial "injury" 2: endothelial dysfunction, monocyte adhesion and emigration 3: macrophage activation and smooth muscle recruitment 4: macrophages and smooth muscle cells engulf lipid, forming "foam cells" 5: smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid

Question 39

HTN is what blood pressure?

Answer 39

>140/90

Question 40

clinical sign of AAA

Answer 40

pulsating mass in abdomen

Question 41

epidemiology of aortic dissection

Answer 41

- hypertensive males 40-60 | - marfans

Question 42

Tertiary Syphilis affects what location?

Answer 42

Vaso vasorum of thoracic Aorta leading to ischemia of outer media

Question 43

Focal thickening of INTIMA and MEDIA of medium to large muscular arteries resulting in stenosis

Answer 43

fibromuscular dysplasia

Question 44

What is the stereotypical response to vascular injury?

Answer 44

intimal thickening

Question 45

Loss of endothelial cells secondary to tissue damage or prolonged endothelial dysfunction leads to what?

Answer 45

vascular injury

Question 46

Where is ACE found?

Answer 46

endothelial cells everywhere but especially in lungs

Question 47

In the pathogenesis of an Aneurysm, what weakens the vascular wall by ischemia of outer media?

Answer 47

HTN and Tertiary syphilis

Question 48

Clinical presentation of Thoracic Aortic aneurysm?

Answer 48

impingement of lower respiratory tree, esophagus, and recurrent laryngeal nerves - respiratory difficulty, difficulty swallowing and persistent cough