cvs 1

What is the FULL sequence of atherosclerosis development?

Endothelial injury → LDL entry/oxidation → monocyte adhesion → foam cells → smooth muscle migration/proliferation → fibrous plaque → rupture/thrombosis

What is the MOST important initiating event in atherosclerosis?

Endothelial injury/dysfunction

What causes foam cell formation?

Macrophages ingest oxidized LDL

What do smooth muscle cells do in atherosclerosis?

Migrate into intima, proliferate, produce extracellular matrix/collagen

What makes a plaque vulnerable to rupture?

Thin fibrous cap + inflammation + large lipid core

What is the major immediate consequence of plaque rupture?

Thrombosis

What is the earliest visible atherosclerotic lesion?

Fatty streak

Which lipoprotein is most strongly associated with atherosclerosis?

LDL

Which lipoprotein is protective against atherosclerosis?

HDL

What are the NONMODIFIABLE risk factors for atherosclerosis?

Increasing age, male sex, family history/genetics

What are the MAJOR modifiable risk factors for atherosclerosis?

Hyperlipidemia, Hypertension, Smoking, Diabetes

Which risk factor has the strongest association with atherosclerosis?

Hyperlipidemia (especially high LDL)

Smoking is strongly associated with which vascular diseases?

Atherosclerosis, AAA, Buerger disease

Diabetes accelerates atherosclerosis by causing what?

Endothelial dysfunction and dyslipidemia

What vascular lesion is classically seen in benign hypertension?

Hyaline arteriolosclerosis

What vascular lesion is classically seen in malignant hypertension?

Hyperplastic arteriolosclerosis (“onion-skin”)

Fibrinoid necrosis of arterioles suggests what?

Malignant hypertension

Which hypertension type causes rapid organ failure?

Malignant hypertension

Which organ is especially damaged in malignant hypertension?

Kidney

What kidney surface appearance is seen in benign nephrosclerosis?

Finely granular cortical surface

Renal artery stenosis causes what type of hypertension?

Renovascular hypertension

Mechanism of renovascular hypertension?

↓ renal perfusion → ↑ renin → RAAS activation → HTN

Most common cause of renal artery stenosis in older adults?

Atherosclerosis

Most common cause of renal artery stenosis in young women?

Fibromuscular dysplasia

What renal vascular lesion is seen in malignant nephrosclerosis?

Onion-skin hyperplastic arteriolosclerosis

FIRST step in solving vasculitis questions?

Classify by vessel size

Which vasculitides affect LARGE vessels?

Takayasu arteritis, Giant cell arteritis

Which vasculitides affect MEDIUM vessels?

PAN, Kawasaki disease, Buerger disease

Which vasculitides affect SMALL vessels?

GPA/Wegener, Microscopic polyangiitis, HSP (IgA vasculitis)

“Pulseless young woman” suggests what diagnosis?

Takayasu arteritis

Temporal headache + jaw claudication + vision symptoms suggests what?

Giant cell arteritis

HBV is classically associated with what vasculitis?

Polyarteritis nodosa (PAN)

Which organ is classically spared in PAN?

Lung

Kawasaki disease is associated with what major complication?

Coronary artery aneurysm

Smoking-associated vasculitis in young men?

Buerger disease (thromboangiitis obliterans)

What is the hallmark association of Buerger disease?

Heavy smoking

c-ANCA positivity strongly suggests what disease?

GPA/Wegener

Classic triad of GPA/Wegener?

Upper airway + lungs + kidneys

Child with palpable purpura and IgA deposition has what disease?

HSP (IgA vasculitis)

Which immunoglobulin is elevated in HSP?

IgA

Most common cause of abdominal aortic aneurysm (AAA)?

Atherosclerosis

Strongest lifestyle risk factor for AAA?

Smoking

Most common location of AAA?

Below renal arteries

Major complication of AAA?

Rupture

Young patient with aortic dissection should make you think of what syndrome?

Marfan syndrome

Most important risk factor for aortic dissection in older adults?

Hypertension

Classic symptom of aortic dissection?

Sudden tearing chest pain radiating to the back

What causes varicose veins?

Increased venous pressure with valve incompetence

Virchow triad components?

Endothelial injury, Stasis/turbulence, Hypercoagulability

Most dangerous complication of DVT?

Pulmonary embolism

What is lymphedema?

Accumulation of lymph due to impaired lymphatic drainage

Common causes of lymphedema?

Tumor obstruction, Surgery, Radiation, Filariasis

Chronic lymphedema predisposes to which malignancy?

Lymphangiosarcoma

Most common vascular tumor of infancy?

Hemangioma

HHV-8 is associated with which vascular tumor?

Kaposi sarcoma

Vinyl chloride exposure is associated with what tumor?

Hepatic angiosarcoma

Highly aggressive malignant vascular tumor?

Angiosarcoma

HBV → ?

PAN

HHV-8 → ?

Kaposi sarcoma

Vinyl chloride → ?

Angiosarcoma

Smoking → ?

AAA, Buerger disease, Atherosclerosis

Kawasaki disease → ?

Coronary artery aneurysm

c-ANCA → ?

GPA/Wegener

IgA purpura in child → ?

HSP

Benign HTN vs malignant HTN vascular lesions?

Benign → hyaline arteriolosclerosis; Malignant → hyperplastic “onion-skin”

Arterial occlusive disease prototype?

Atherosclerosis

Venous disorder examples?

Varicose veins, thrombophlebitis

Lymphatic disorder prototype?

Lymphedema

Medium-vessel vasculitis strongly associated with smokers?

Buerger disease