Systems Path Ex 3 Sec 3&4

What is the lumen?

the interior of a vessel

What is the hardening of vessel walls?

arteriosclerosis

What is hardening of vessel due to plaque development in wall?

atherosclerosis

What is a clot in a vessel?

thrombus

What is an object that travels and lodges in a vessel?

embolus

What is the dilation of an artery?

aneurysm

What is the tearing of a vessel?

dissection

What is the accumulation of fluid within the pericardial space?

cardiac tamponade

What is an : injury/irritation to endothelium that causes a proinflammatory/procoagulant state --Triggered by Atherosclerosis, HTN, diabetes, auto-immune vasculitis, & injury?

endothelial activation

What is an abnormal accumulation of LDL cholesterol, calcium, macrophages (foam cells), fibrous connective tissue, and smooth muscle within the walls of an artery. Hardening + weakening walls?

athermatous plaque

What is tortuous and dilated vessels?

varicosity

What is atheroma with a thick fibrous cap & low inflammatory conditions?

stable plaque

What is atheroma with a thin fibrous cap & high inflammatory conditions (↑ CRP)?

vulnerable plaque

What are Dead macrophages that ingested LDL cholesterols (within atheromatous plaques)?

foam cells

What is the inflammation/infection of lymph vessels?

lymphangitis

What redirects blood around a vessel occlusion?

vascular graft

What is the mesh tube which supports the walls of vessel that has been occluded?

vascular stent

What is HTN due to a fibrous dysplasia of the renal artery?

renovascular hypertension

What is optic disc swelling due to ↑intracranial pressure/malignant hypertension?

papilladema

What is Narrowing of medium sized arteries that reduce blood flow. MC stimulates renovascular hypertension & kidney dysfunction, this causes stenosis of arteries (MC renal)?

fibromuscular dysplasia

Who is affected by fibromuscular dysplasia?

young women

What is high BP (at least 130/80), due to stress/injury to vessel walls?

hypertension

Who is at risk for hypertension?

older adults/african americans

Why does hypertension occur?

poor lifestyle/diet

What makes up 90% of HTN cases?

essential HTN

What HTN is caused by fibromuscular dysplasia of the kidney?

renovascular HTN

What HTN is caused by an underlyig condition with a spike of BP (180/120mmHG)?

malignant HTN

What is an Adrenal gland tumor ↑ BP (heart rate, headaches, sweating) that is due to catecholamines stimulating the SNS?

pheochromocytoma

What is the hardening of small arteries that causes high stress on the walls?

arteriolosclerosis

What type of arteriolosclerosis is due to long term benign HTN or diabetes?

hyaline arteriolosclerosis

What type of arteriolosclerosis is due to malignant hypertension?

hyperplastic arteriolosclerosis

What is an incidental finding on imaging with calcification that only occurs in the ELDERLY?

Mönckeberg Medial Sclerosis

What is the hardening of arterial walls due to atheromatous plaque build up, that slowly occludes the lumen and weakens the vessel walls making the vessel at risk for rupture?

atherosclerosis

The high thickness of the vessel walls in atherosclerosis does what?

restricts diffusion of O2 and nutrients

Who is MC affected by atherosclerosis?

older individuals with a poor lifestyle/diet

Why does atherosclerosis occur?

Poor diet (High LDL, processed meat, fried foods, high sugar), smoking, ↑BP, metabolic syndrome, lack of exercise, systemic inflammation (measured by C-reactive protein)

What is the dilation & weakening of abdominal aorta (3cm +), commonly between the renal arteries and iliac bifurcation, this causes a weakening/ballooning of the vascular wall?

abdominal aortic aneurysm (AAA)

Who is at risk for AAA?

white males over 50 with a history of risk factors

What are the risk factors for AAA (why)?

smoking, HTN, atherosclerosis, diabetes, dyslipidemia, EDS, Marfan, polycystic kidney disease

What is the tearing of tunica intima and/or tunica media: w/ associated bleeding. Concern for vascular clotting or occlusion. Sharp well-localized pain that depends on the site of dissection?

thoracic dissection

Where does Type A thoracic dissection occur?

proximal to subclavian

Where does Type B thoracic dissection occur?

distal to subclavian

Who is at risk for a thoracic dissection?

40-60+ with HTN, Marfan's, EDS, vasculitis

What are the warning signs of cervical artery dissection? (5 Ds and 3 Ns)

Diplopia, dizziness, drop attacks, dysarthria, dysphagia, numbness, nausea, nystagmus

What is autoimmune vasculitis of small/medium arteries of head/neck regions causing headaches and visual disturbances due to T cell mediated (type 4) hypersensitivity producing chronic inflammation (PATCHY GRANULOMAS!!!!)?

temporal arteritis (giant cell arteritis)

What is autoimmune vasulitis of medium/large arteries from the aortic arch, due to chronic inflammation causing stenosis of involved arteries, decreasing pulse pressure?

takayasu arteritis (pulseless disease)

Who does takayasu arteritis impact?

younger females (MC 30), asian and indian

What is the systemic autoimmune vasculitis affecting kidneys, heart, liver, GI tract causing episodes of fever, malaise, weight loss, myalgia, peripheral nerve damage, kidney failure, HA due to type 3 (immune complex) hypersensitivity causing fibrinoid necrosis with a ROSARY SIGN!!!!!?

polyarteritis nodosa

Temporal arteritis is a type _____ hypersensitivity, while polyarteritis nodosa is a type _____ hypersensitivity

4 (t cell mediated); 3 (immune complex)

What is the MC cause of death in those with polyarteritis nodosa?

kidney failure

Though polyarteritis is mostly idiopathic, what are 1/3 of cases associated with?

hep B

What is pediatric vasculitis that damages medium/large (coronary) arteries due to auto-antibodies against endothelial cells and vascular walls, causing aneurysms in 20% of cases?

Kawasaki disease (asian pediatrics)

What is multiple site autoimmune vasculitis, MC IN LUNGS AND KIDNEYS, resulting in necrotizing granulomas due to type 3 (immune complex) and 4 (t cell mediated) hypersensitivity?

Wegener granulomatosis (granulomatosis with polyangitis)

What are necrotizing granulomas called in the lungs?

hemoptysis (wegener granulomatosis)

What are necrotizing granulomas called in the kidney?

hematuria (wegener granulomatosis)

Who is at risk for wegener?

middle age male

What is peripheral vascular disease MC occurring in hands and feet via radial and tibial arteries due to endothelial injury/clotting due to smoking?

buerger disease

Who is buerger disease MC in?

20-40 year old male smokers

What is it called when skin/tissue loses perfusion leading to discomfort and sensory loss due to inappropriate vasoconstriction?

Raynaud

What causes secondary Raynauds?

other vascular pathologies (lupus and buerger)

What are the dilated tortuous veins in the lower extremities due to prolonged venous pressure causing valve insufficiency?

varicose veins

Who gets varicose veins?

women 55+ (pregnant, obese)

What is the chronic inflammatory skin condition with discoloration, thickening, flaking, erythematous appearance in the lower extremities due to chronic venous insufficiency?

stasis dermatitis

What is the inflammation of a vein associated with clotting (DVT) caused by endothelial injury/activation?

thrombophlebitis

Who is at risk of thrombophlebitis?

those taking BC, smoking, HTN

What does obstruction of SVC lead to?

headaches, dizziness, jugular congestion

What does IVC obstruction lead to?

pitting edema, cyanosis in feet, dysfunctional kidneys, proteinuria

What is the MC cause of SVC/IVC obstruction?

tumor growth

Who is at risk of SVC/IVS obstruction?

tumors and pregnant

What is the congenital/inherited agenesis/hypoplasia of lymphatics leading to edema of lower extremities due to FLT4 gene mutation?

primary lymphedema (milroy disease)

What is edema building up in localized areas due to lymphatic obstruction caused by infection, tumor growth, surgical scarring, removal of lymphatics (mastectomy)?

secondary lymphedema (MC THAN PRIMARY)

What is a benign tumor of capillary endothlial cells, common on the skin, and is a blood filled growth that will resolve on its own?

hemangioma (juvenile or interosseous)

T/F: vertebral/interosseous hemangiomas are symptomatic

FALSE, asymptomatic

What is thought to be lymphatic endothelial malignancy with characteristic raised red/purple color on skin of back, face and lower limbs?

Kaposi sarcoma

What causes kaposi sarcoma?

herpes virus 8 is no longer held dormant and attacks immune system

Who is at risk for kaposi sarcoma?

immunosuppressed AIDS

What is the aggressive malignant endothelial tumor MC on skin with red nodules, that can progress to necrosis/gangrene or hemorrhage?

angiosarcoma

Where does angiosarcoma spread rapidly?

lungs and liver via blood

What predisposes someone to angiosarcoma?

soft tissue trauma, chronic inflammation, PVC toxin exposure

How many minutes of ischemia are needed to cause infarction of CNS neurons? What is this known as?

5 mins; selective vulnerablity

What is the most numerous glial cell?

Astrocytes

CNS injury to astrocytes and microglia results in __________

Proliferation

What are the phagocytes of CNS?

Microglia

What is caused when ICP increases, resulting in shifting and protrusion of CNS tissue?

CNS herniation

What type of CNS herniation is the MOST COMMON, and occurs under the falx, resulting in abnormal posturing or coma?

Subfalcine

What type of CNS herniation occurs during the tentorial and causes "blown pupil" (hemiparesis) when involved with CN III?

Transtentorial

What type of CNS herniation is the MOST LETHAL and compresses the cardiorespiratory centers?

Tonsillar

What is the MC cause of subarachnoid hemorrhage and is associated with polycystic kidney disease?

Saccular "berry" aneurysm

What vascular structure allows for some collateral blood flow to the brain?

Circle of Willis

What is the MC location for a berry aneurysm?

Circle of Willis branch points

What is disrupted BBB due to trauma, infection, inflammation, or tumors that causes increased ICP?

Vasogenic edema

What is injured CNS tissue due to hypoxia, causing the neurons/glial cells to swell and increasing ICP?

Cytotoxic edema

What is pupillary dilation associated with a transtentorial herniation?

Mydriasis

What is defined as transient cerebral dysfunction that does not cause cell death, but may be an indication of an impending stroke?

Transient ischemic attack (TIA)

What is the MC cause of facial drooping due to paralysis of cranial nerve VII (facial), affecting both the forehead and lower face?

Bell's palsy

What is a cerebral capillary hemorrhage called and where is it MC?

Cerebral contusion; gyri due to head trauma

What is a tearing injury to CNS tissue?

Cerebral laceration

What is a contusion at the impact site?

Coup injury

What is a contusion opposite the site of impact?

Contrecoup injury

What is the largest source of blood the brain?

Middle cerebral artery