Vascular path

Question 1

3 vessel layers?

Answer 1

1. Intima: endothelial / BM
2. Media: muscle
3. Adventitia: connective outer

Question 2

TGA location?

Answer 2

Branches of carotic

Question 3

Vasculitis in branches of carotid?

Answer 3

TGA

Question 4

Signs of TGA?

Answer 4

1. Headache: temporal
2. Blurred vision: ophthalmic
3. Jaw claudication
4. Polymyalgia rheumatica: joint / muscle pain
5. Elevated ESR

Question 5

Elevated ESR and polymyalgia rheumatica?

Answer 5

TGA

Question 6

Inflamed vessel wall with giant cells and intimal fibrosis?

Answer 6

TGA

- This is a granulomatous inflammation

Question 7

Biopsy in TGA?

Answer 7

Must take very long piece of vessel as lesions can be small and segmental so easy to miss
*Negative biopsy does not exclude disease as would be easy to miss

Question 8

TGA Rx?

Answer 8

Immediate corticosteroids to prevent blindness

Question 9

Takayasu?

Answer 9

• Granulomatous in asian female

Question 10

Age in TGA and takayasu?

Answer 10

TGA: > 50
Takayasu:

Question 11

• Granulomatous in asian female

Answer 11

Takayasu

Question 12

Takayasu presentation?

Answer 12

1. Weak pulse in upper extremity “pulseless disease”
2. Visual signs
3. Neuro signs
4. Elevated ESR

Question 13

“pulseless disease”

Answer 13

Takayasu

Question 14

Where are medium sized vessel vasculitides occurring?

Answer 14

Muscular arteries

Question 15

Polyarteritis nodosa?

Answer 15

• Necrotizing vasculitis involving most organs but sparing lungs
• High association with HBV
• Lesions of varying state: “string of pearls”
  
  • Fibrosis and altnerating aneurysm
• Transmural inflammation with fibrinoid necrosis

Question 16

Necrotizing vasculitis involving most organs sparing lungs?

Answer 16

Polyarteritis nodosa

Question 17

Presentation of polyarteritis?

Answer 17

1. HTN: renal artery
2. Abdominal pain w/ melena: mesenterics
3. Skin lesions

Question 18

“string of pearls”

Answer 18

polyarteritis nodosa

Question 19

Transmural inflammation with fibrinoid necrosis?

Answer 19

polyarteritis nodosa

Question 20

Artery in kawasaki?

Answer 20

Coronary: MI in child

Question 21

MI in young kid?

Answer 21

Kawasaki’s

Question 22

Only time to give ASA to kid?

Answer 22

Kawasaki

Question 23

What is TXA2 important for?

Answer 23

Aggregation of platelets

Question 24

Buerger disease?

Answer 24

• Necrotizing vasculitis of digits
• Caused by smoking: cured if stopped
• Smoking decreases Vitamin A causing this

Question 25

Necrotizing vasculitis of digits?

Answer 25

Buerger's: stop smoking

Question 26

Wegener's?

Answer 26

- Necrotizing small vessel vasculitis of kidney, lung, nose - C-ANCA RPGN with crescents - Large necrotizing granulomas with adjacent necrotizing vasculitis

Question 27

Wegener's Rx?

Answer 27

Cyclophosphamide

Question 28

Large necrotizing granulomas with adjacent necrotizing vasculitis in small vessel?

Answer 28

Wegener

Question 29

Microscopic polyangiitis?

Answer 29

- Small vessel necrotizing vasculitis of lung and kidney - Negative granulomas and involvement of nose - P anca

Question 30

- Small vessel necrotizing vasculitis of kidney w/o granuloma?

Answer 30

Microscopic polyangiitis

Question 31

Churg strauss?

Answer 31

- Necrotizing small vessel vasculitis with EOS and granulomas - Lungs and heart - Asthma and eosinophilia seen - P ance

Question 32

Necrotizing small vessel vasculitis with EOS and granulomas?

Answer 32

Churg strauss

Question 33

How to tell Churg strauss from microscopic?

Answer 33

Churg: EOS, granulomas, and asthma | ***Both have p anca

Question 34

HSP?

Answer 34

"Henoch shuren purpura" - IgA IC vasculitis - Palpable purpura on butt / legs - Hematuria from IgA nephropathy - Post URI

Question 35

- IgA IC vasculitis - Palpable purpura on butt / legs - Hematuria from IgA nephropathy - Post URI

Answer 35

HSP

Question 36

Renal artery stenosis in young female?

Answer 36

Fibromuscular dysplasia

Question 37

What thickens in atherosclerosis?

Answer 37

Intima of medium and large size vessels

Question 38

Composition of plaque?

Answer 38

1. Necrotic lipid core: cholesterol 2. Fibromuscular plaque 3. Can become calcified

Question 39

Modifiable risk for atherosclerosis?

Answer 39

1. High cholesterol 2. HTN 3. Diabetes 4. Smoking

Question 40

Non Modifiable risk for atherosclerosis?

Answer 40

1. Age 2. Gender 3. Genetics

Question 41

What happens to lipids in intima?

Answer 41

Becomes oxidized then taken up by macs which can't digest it = fatty streaks

Question 42

Hallmark of atherosclerotic emboli?

Answer 42

Cholesterol clefts

Question 43

Hyaline arteriolosclerosis? Cause?

Answer 43

1. Benign HTN 2. TIIDM - Proteins leak into vessel wall = vascular thickening - Pink hyaline on microscopy

Question 44

Hyperplastic arteriolosclerosis? Cause?

Answer 44

1. Malignant HTN - Thickening of small vessels from HYPERplasia of small vessels - Fibrinoid necrosis can occur "Onion skin appearance"

Question 45

"Onion skin appearance"

Answer 45

Hyperplastic arteriolosclerosis

Question 46

Acute renal failure with flea bitten appearance?

Answer 46

Hyperplastic arteriolosclerosis

Question 47

Where does blood go in dissection?

Answer 47

Tearing of intima allowing blood to access media

Question 48

Prognosis of hemangioma?

Answer 48

Present at birth usually regress in childhood

Question 49

How to tell hemangioma from purpura?

Answer 49

Hemangioma will blanch when pressure is applied

Question 50

Causes of liver angiosarcoma?

Answer 50

1. PVC 2. Thorotrast 3. Arsenic

Question 51

Kaposi sarcoma?

Answer 51

Low grade proliferation of endothelial cells from HHV-8 | - Purple but does not blanch as is not vascular