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www.natures.irMore Free USMLE , MCCEE ,MCQe and AMQ Flashcards
What is diet-derivedtriglyceride?
Chylomicron
Chylomicron is _____ during
fasting absent
Chylomicrons form ______ ifincreased
turbid supranate
What is liver-derivedtriglyceride?
VLDL
Hypertriglyceridemia causesturbidity in ______
plasma
VLDL----> _______ ---->
LDL
IDL
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What transports cholesterol? LDL
What is equation tocalculate LDL?
LDL= CH - HDL - TG/5
Is fasting required for serum
CH?no
What is good cholesterol? HDL
What are source ofapolipoproteins?
HDL
What removes cholesterolfrom plaques for disposal inthe liver?
HDL
High VLDL causes Low
_____
HDL
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What is Type IHyperlipoproteinemia?
- Low CPLor
- Low Apo C-II
What is Type IIHyperlipoproteinemia?
High LDL due to Low LDLreceptors
What is pathognomonic forfamilial
hypercholesterolemia?Achilles tendon xanthoma
What is Type IIIHyperlipoproteinemia
Deficiency of Apo E
What is pathognomonic forType III
Hyperlipoproteinemia?Palmar Xanthoma
What is Type IVHyperlipoproteinemia?
High VLDL`
What is the most commoncause of Type IV
hyperlipoproteinemia?
Alcohol Excess
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What is the most commonlipid disorder?
Type IVHyperlipoproteinemia
What is pathognomonic forType IV
Hyperlipoproteinemia?Eruptive Xanthoma
What is treatment for Type
IV Hyperlipoproteinemia?
- Decrease carbohydrateintake
- Decrease alcohol intake
What is Type Vhyperlipoproteinemia?
High VLDL + Chylomicrons
Type V hyperlipoproteinemiacauses what syndrome?
HyperchylomicronemiaSyndrome
What is Apo B deficiency?
Low
- chylomicrons- VLDL- LDL
What is dystrophiccalcification in muscular
arteries?
Medial calcification
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What is endothelial cellinjury?
Atherosclerosis
What play pivotal roles inatherosclerosis?
- platelet- macrophages
What is pathognomonic
lesion of atherosclerosis?Fibrous cap
What is an excellent markerof disrupted fibrous
plaques?C-reactive Protein
What is the most commonsite for atherosclerosis?
Abdominal aorta (No vasavasorum)
What are complications ofatherosclerosis?
- aneurysms- thrombosis- ischemia
What ares associatedconditions of
arteriolosclerosis?
- Diabetes Mellitus
- Hypertension
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What is the most commonaneurysm in men >55
years?AAA
What is the rupture triad forAAA?
- left flank pain- hypotension
- pulsatile mass
What are fungal vesselinvaders of Mycotic
Aneurysms?
- Aspergillus- Candida- Mucor
What are bacterial vesselinvaders of Mycotic
Aneurysms?
- B. Fragilus- P. Aeruginosa
- Salmonella
Where does CNS berryaneurysms occur?
Junction communicatingbranch with main vessel
What causes aortic archaneurysms?
- Tertiary syphilis- Vasa vasorum Vasculitis
What does syphilic
aneurysms produce?
- aortic regurgitation
- bounding pulses
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What is most common deathin Marfan syndrome and
EDS?Aortic Dissection
What is cystic medialdegeneration?
Aortic Dissection
What are features of aortic
dissection?
- pain radiating to back
- absent pulse
What is most commoncause of death in aortic
dissection?Cardiac Tamponade
What does superficialvaricosities cause?
Valve incompetence
What is the most commoncause of phlebothrombosis?
Stasis of blood flow
What is a sign of DVT? Stasis dermatitis
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What is pain and tendernessoverlying the vein?
Thrombophlebitis
What is compression of SVCby primary lung cancer
called?SVC Syndrome
What is common among
weight lifters?
Thoracic Outlet Syndrome
(tight scalenus muscles)
Acute Lymphangitis isusually due to cellulitis
caused by:Streptococcus pyogenes
Turner's webbed neck is a____ abnormality
lymphatic
Bacillary angiomatsosis iscaused by ?
Bartonella henselae(common in AIDS)
What is ANCA?Antibodies against
components of neutrophils
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What does small vesselvasculitis have?
palpable purpura
What does medium-sizedvessel vasculitis have?
- thrombosis- aneurysm formation
What does large vessel
vasculitis have?
- absent pulse
- stroke
What does systolic BPcorrelate with?
Stroke volume
What does diastolic BPcorrelate with?
tonicity of TPR arterioles
In pathogenesis ofhypertension, what iscommonly involved?
renal retention of sodium
What is most common type
of hypertension?
Essential HTN
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What is the most commoncause of secondary
hypertension?Renovascular hypertension
In men, what causesrenovascular hypertension?
Atherosclerosis
In women, what causes
renovascular hypertension?fibromuscular hyperplasia
What does renovascularhypertension due to?
activation of RAA system
In renovascular HTN, thereis increased ____ activity
Plasma renin activity (PRA)
PRA is high in where? involved kidney
What does fibromuscular
hyperplasia look like?
'beaded' appearance of
renal artery
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What are complications ofHTN in descending order?
1) acute MI2) stroke
3) renal failure
Takayasu arteritis("pulseless disease")
Vasculitis?
Epidemiology/ Etiology?Clinical/Lab
Findings/Treatment?
-Granulomatous largevessel vasculitis involving
aortic archvessels[Vasculitis]
-Young Asian women andchildren
-Absent upper extremitypulseDiscrepancy in blood
pressure between arms > 10mm Hg
Visual defects, stroke
Treatment: corticosteroids
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Giant cell (temporal) arteritisVasculitis?
Epidemiology/ Etiology?Clinical/Lab
Findings/Treatment?
-Granulomatous largevessel vasculitis involvingsuperficial temporal and
ophthalmic arteries.-Adults > 50 years of age
-Temporal headache, jawclaudication (pain when
chewing stretches inflamedartery)
Blindness on ipsilateral sidePolymyalgia rheumatica
(muscle and joint pain;normal serum creatine
kinase)Increased ESR
Treatment: corticosteroids
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Polyarteritis nodosa
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Necrotizing medium-sizedvessel vasculitis involving
renal, coronary, mesentericarteries
-Middle-aged men
Association with HBsAg(30%)
-Vessels at all stages ofacute and chronic
inflammationFocal vasculitis produces
aneurysmsOrgan infarction in kidneys,
heart (acute MI), bowels(bloody diarrhea), skin
(ischemic ulcer), testicleAngiography and biopsy of
lesions confirm thediagnosis.
Treatment: corticosteroids
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Kawasaki disease
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Necrotizing medium-sizedvessel vasculitis involving
coronary arteries-Children < 5 years of age
Boys > girls
Cause unknown (probablyinfectious)
Children of Asian descenthave highest incidence
Surpassed acute rheumaticheart disease as most
common acquired heartdisease in children
-Fever, erythema andedema of hands and feet
convalescing withdesquamated rash; cervicaladenopathy; oral erythema
and cracking of the lipsAbnormal ECG (e.g., acute
MI)Treatment: intravenous
immunoglobulin; aspirin;corticosteroidscontraindicated
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Thromboangiitis obliterans(Buerger's disease)
Vasculitis?
Epidemiology/ Etiology?Clinical/Lab
Findings/Treatment?
-Medium-sized vesselvasculitis with digital vesselthrombosis and damage toneurovascular compartment
-Men 25-50 years of age
who smoke cigarettesMiddle East, Far East, Asia
has highest prevalence-Resting pain on the forefoot
is characteristic, withpossible ischemic ulcers or
gangrene of foot/toes; upperlimb ischemia (40% to 50%of patients) with ulcerationand gangrene; Raynaud's
phenomenon.Treatment: smokingcessation essential;intravenous iloprost
(prostaglandin analogue)
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Raynaud's disease
Vasculitis?Epidemiology/ Etiology?
Clinical/Lab
Findings/Treatment?
-Medium-sized vesselvasculitis involving digital
vessels in fingers and toes;also tip of nose and ears in
some cases
-Young womenExaggerated vasomotor
response to cold or stress-Paroxysmal digital colorchanges (white-blue-red
sequence)
Ulceration and gangrene inchronic cases
Treatment: avoid coldtemperatures (gloves);
calcium channel blockers(e.g., nifedipine)
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Raynaud's phenomenon
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Medium-sized vesselvasculitis involving digital
vessels in fingers and toes;also tip of nose and ears in
some cases
-Adult men and womenSecondary to other diseases
(e.g., systemic sclerosis,CREST syndrome, SLE)-Systemic sclerosis and
CREST syndrome: digital
vasculitis with vesselfibrosis, dystrophic
calcification, ulceration,gangrene
Treatment: see above
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Wegener's granulomatosis
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Necrotizing medium andsmall-sized vessel vasculitisinvolving lung (infarctions,
renal vessels)-Childhood to middle age
-Necrotizing granulomas inskin, upper respiratory tract(nasopharynx-saddle nosedeformity, chronic sinusitis,collapse of trachea), lowerrespiratory tract (cavitating
nodular lesions)Necrotizing vasculitis in
lungs (infarction,hemoptysis), kidneys
(crescenticglomerulonephritis) c-ANCAantibodies (>90% of cases)
correlate erratically withtherapy
Treatment: corticosteroids,cyclo-phosphamide
3 Cs: c-ANCA,corticosteroids,cyclophosphamide
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Microscopic polyangiitis
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Small vessel vasculitisinvolving skin, lung, brain,GI tract, and postcapillaryvenules and glomerular
capillaries
-Children and adultsPrecipitated by drugs (e.g.,penicillin), infections (e.g.,
streptococci), immunedisorders (e.g., SLE)
-Vessels at same stage of
inflammationPalpable purpura,glomerulonephritis
p-ANCA antibodies (>80%of cases)
Churg-Strauss syndrome
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Small vessel vasculitisinvolving skin, lung, heart
vessels-Children and adults
-Allergic rhinitis, asthmap-ANCA antibodies (70% of
cases), eosinophilia
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Henoch-Schnlein purpura
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Small vessel vasculitisinvolving skin, GI, renal, joint
vessels-Children and young adults
Males > females
Most common vasculitis inchildren
IgA-anti-IgAimmunocomplexes
-Often follows a viral URI,group A streptococcal
pharyngeal infection-pathogens may act as an
antigen trigger that causesantibody formation leading
to immunocomplexformation
Palpable purpura of buttocksand lower extremitiesPolyarthritis (80%),
nephropathy (80%), GIbleeding
Recurrence may occur inone third of casesMost have spontaneous
recovery in 4 months withouttherapy.
Treatment: corticosteroids
mainly used if severe GIdisease or renal disease
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Cryoglobulinemia
Vasculitis?Epidemiology/ Etiology?
Clinical/LabFindings/Treatment?
-Small vessel vasculitisinvolving skin, GI tract, renal
vesselsDifferent types of
cryoglobulinemia (mixed,
monoclonal, polyclonal)-Adults
Association with HCV, type IMPGN, multiple myeloma
(monoclonal type)-Cryoglobulins:
immunoglobulins that gel atcold temperatures
Palpable purpura, acralcyanosis of nose and ears
and Raynaud'sphenomenon (reverseswhen in warm room);
glomerulonephritis; arthritis;abdominal pain
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Infectious vasculitis
Vasculitis?
Epidemiology/ Etiology?Clinical/Lab
Findings/Treatment?
-Small vessel vasculitisinvolving skin vessels-Children and adultsInvolves all microbial
pathogens
-Involves all microbialpathogens Rocky Mountain
spotted fever: ticktransmission of Rickettsia
rickettsiaeOrganisms invade
endothelial cells producingvasculitis Petechiae onpalms spread to trunk
Disseminatedmeningococcemia due toNeisseria meningitidesCapillary thrombosis
produces hemorrhage intoskin and confluent
ecchymoses
Lab findings in PAN p-anca. HBsAg+ in 30%,anemia, leukocytosis
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Microscopic features of PAN
Segmental necrotizingvasculitis in three stages:
fibrinoid necrosis withneutrophils, fibroblast
proliferation, nodular fibrosis
with loss of internal elasticlamina
Lab findings in PANp-anca. HBsAg+ in 30%,
anemia, leukocytosis
Microscopic features of PAN
Segmental necrotizingvasculitis in three stages:
fibrinoid necrosis withneutrophils, fibroblast
proliferation, nodular fibrosis
with loss of internal elasticlamina
Clinical features of PAN
Affects all organs exceptlungs. Fever,
hematuria/renalfailure/hypertension,
abdominal pain/GI bleeding,myalgia/arthralgia
Clinical features of Wegnergranulomatosis
Bilateral pneumonitis withnodular and cavitary
infiltrates, chronic sinusitis,nasopharyngeal ulcerations,
renal disease
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Microscopic features ofWegner granulomatosis
Necrotizing vasculitis ofsmall vessels (granulomas),necrotizing granulomas of
respiratory tract, focalnecrotizing
glomerulonephritis
Lab findings in Wegnergranulomatosis
c-anca
Treatment of Wegnergranulomatosis
cyclophosphimide
Clinical features of temporal
arteritis
Throbbing unilateralheadache, visual
disturbances, jawclaudication
Microscopic features of
temporal arteritis
Segmental granulomatousvasculitis with
multinucleated giant cellsand fragmentation of the
internal elastic lamina withintimal fibrosis and luminal
thickening
Diagnosis, lab findings andtreatment of temporal
arteritis
Dx.: biopsy of temporalartery. Lab: increased ESR.
Rx.: steroids
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Clinical features ofTakayasu asteritis
Loss of pulse in upperextremities, visual
disturbances, neurologicabnormalities
Microscopic features ofTakayasu arteritis
Granulomatous vasculitiswith massive intimal fibrosis,thickening of the aortic archand narrowing of the major
arterial branches
Clinical features ofBuerger's disease
Severe pain in affected
extremity, thrombophlebitis,Raynaud phenomenon,ulceration and gangrene.Associated with heavy
cigarette smoking
Microscopic features ofBuerger's disease
Recurrent neutrophilic
vasculitis withmicroabseses, segmentalthrombosis and vascular
insuficiency
Clinical features ofKawasaki disease
Affects children < 4. Acutefebrile illness, conjuctivitis,
maculopapular rash,lymphadenopathy, coronaryaneurysms in 70% of cases
Microscopic features ofKawasaki disease
Segmental necrotizingvasculitis with coronary
aneurysms
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Diseases that featureRaynaud phenomenon
SLE, CREST, Buerger,atherosclerosis
Raynaud diseasse
Small artery vasospasmresulting in blanching
cyanosis of fingers and toesprecipitated by cold
temperature and emotions
Henoch-Schonlein purpura
IgA-C3 immunocomplexes,
IgA nephropathy (Bergerdisease), palpable purpura
on buttocks
Major risk factors foratherosclerosis
Hyperlipidemia,hypertension, smoking,
diabetes
Most common sites foratherosclerosis
Abdominal aorta followed bycoronary arteries
Complications ofatherosclerosis
Ischemic heart disease,abdominal aortic aneurysm,peripheral vascular disease
(pain, pulselessness,paresthesia, claudication),
TIA (vertebral basilar
oclussion), renovascularhypertension (high renin).
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Pathophysiology of essential
hypertension
Retention of sodium andwater with increase in strokevolume (systolic pressure).Sodium in smooth muscle
opens up calcium channels
with vasoconstriction ofarterioles (increased
diastolic pressure). Lowrenin hypertension.
Complications ofhypertension
Concentric ventricularhypertrophy, AMI, hyaline
arteriosclerosis,nephrosclerosis and CRF,
intracranial bleeds,athersoclerosis
Renovascular hypertension
Atherosclerosis of renalartery orifice in males or
fibromuscular hyperplasia inwomen. Severe
hypertension, epigastricbruit. High renin
hypertension. Screen with
captopril.
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Captopril screening test forrenovascular hypertension
In renovascularhypertension there's
decreased RPF and highlevels of renin and
angiotensin II. With captopril
(ACE inhibitor), there's lossof negative feedback on
renin and exagerated highlevels of renin post-
stimulation. The test has thepotential for renal failure if
bilateral renal arterystenosis is present as AII isresponsible for maintaining
renal blood flow.
Ahterosclerotic aneurysms
MC site is abdominal aortabelow renal arteries (novasa vasorum). Pulsitile
mass with pain andabdominal bruit
Syphilitic aneurysm
Obliterative endarteritis ofvasa vasorum with ischemia
and atrophy of ascendingaorta, aortic insuficiency,airway encroachment andlaryngeal nerve involvment
(brassy cough)
Associated diseases ofdissecting aortic aneurysm
Marfan, Ehlers-Danlos,copper deficiency (no lysyl
oxidase)
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Signs and symptoms ofdissecting aortic aneurysm
Acute retrosternal severechest pain, aortic
insuficiency and cardiactamponade
Phlebothrombosis Vs.Thrombophlebitis
Phlebothrombosis is venousthrombosis of deep veins
without inflamation orinfection. Thrombophlebitis
is venous thrombosis ofsuperficial veins due to
inflamation and infection
Signs, symptoms, diagnosis
and complications of DVT
Leg swelling, warmth,erythema. Increased venous
pressure from deep tosuperficial veins (which
drain in deep veins)
produces varicosities insuperficial system.Complications arethromboembolism,
thrombophlebitis. Dx.:Doppler
Signs, symptoms andcauses of thrombophlebitis
Palpable cord, pain,induration, warmth,erythema. MCC is
superficial varicose veins,phlebothrombosis,
catherthers, drug abuse
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Clinical features of varicoseveins
Edema, thrombosis, stasisdermatitis, ulcerations
Clinical features of superiorvena cava syndrome
Compression of SVN byprimary lung cancer. Bluediscoloration of the face,
arms and shoulders,dizziness, convulsions,
visual disturbances,
distended jugular veins
Clinical features of Kaposisarcoma
Malignant endothelial celltumor caused by HHV-8.
Multiple red-purple patches,plaques or nodules. Spindle
shaped cells
What does Chylomicron do?
Transports diet derivedTG(triglyceride) in the blood
When is Chylomicron
absent? during fasting
Chylomicron forms intowhat?
turbid supranate
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(VLDL) Very low densitylipoprotein transports what
to the blood?
it transports liver-synthesized (TG) to the
blood
What doeshypertriglyceridemia cause
in plasma?
hypertriglyceridemia causesturbidity in plasma
what is the source of fattyacids an glycerol?
VLDL (very low densitylipoprotein ) -> IDL
(intermediate-densitylipoprotein) -> LDL (low-
density lipoprotein)
what does LDL (Low-densitylipoprotein) transport?
cholesterol
How is LDL (Low-densitylipoprotein) calculated?
LDL = CH (cholesterol) -HDL (High-densitylipoprotein) - TG(triglyceride)/5
Serum CH (cholesterol)does it need fasting?
serum CH does not needfasting
High density lipoprotein
(HDL) is good or badcholesterol?
"good CH"
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HDL is a source of ____? source of apolipoproteins
HDL removes cholesterolfrom where?
HDL removes cholesterolfrom plaques for disposal in
the liver
an increase of VLDL causes
what in HDL? VLDL causes HDL
Type 1 hyperlipoproteinemiacauses what change in CPL(capillary lipoprotein lipase)and apo CII(apolipoprotein
CII)?
CPL (capillary lipoproteinlipase)
or apo CII
Type 2 hyperlipoproteinemiawhat happens to LDL (Low-
density lipoprotein)?
LDL causes LDLreceptors
what is pathognomonic forfamilial
hypercholesterolemiaAchilles tendon xanthoma
type IIIhypercholesterolemia, if
there is a deficiency in apoE (apolipoprotein E) whathappens to the remnants?
remnants
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type IIIhypercholesterolemiacauses what physical
change?
palmar xanthomax
type IV hyperlipoproteinemiais the most common lipiddisorder what happens to
the VLDL?
VLDL
type IV hyperlipoproteinemiais most commonly caused
by?alcohol excess
what are the symptom(s) oftype IV
hyperlipoproteinemia?eruptive xanthomas
type IV Rx what should bedone as treatment?
carbohydrate and alcoholintake
Type V hyperlipoproteinemiawhat happens to VLDL andchylomicrons?
VLDL + chylomicrons
What syndrome results fromType V
hyperlipoproteinemia?
hyperchylomicronemia
syndrome
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in Apolipoprotein B (apo B)deficiency what happens to
the chylomicrons, VLD,LDL?
in Apolipoprotein Bdeficiency:
chylomicrons, VLD, LDL
medical calcification ofarteriosclerosis = ?
dystrophic calcification inmuscular arteries
in atherosclerosis whathappens to cause cell
injury?
platelets/ macrophagespivotal roles
[they adhere to damagedendothelium...]
fibrous cap = ?pathognomonic lesion of
atherosclerosis
What does the C-reactiveprotein used for predicting?
excellent marker ofdisrupted fibrous plaques
Where is the most commonsite for atherosclerosis?
Abdominal aorta; no vasavasorum
What are complications thatdevelope from
atherosclerosis?
aneurysms, thrombosis,
ischemia
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hyaline arteriolosclerosishas what associated
conditions?
diabetes mellitushypertension
who is abdominal aorticaneurysm most common in?
aneurysm is most commonin men older than 55 years
What is the most commoncomplication of abdominal
aortic aneurysm and whathappens?
rupture triad:left flank pain; hypotension;
pulsatile mass
what fungi invade vessels inmycotic aneurysm? (3)
aspergilluscandidamucor
what bacteria invadevessels in mycotic
aneurysm? (3)
Bacteroides fragilispseudomonas aeruginosa
salmonella
CNS berry aneurysms occurwhere?
junction communicatingbranch with main vessel
aortic arch aneurysm infects
how = ?
tertiary syhilis;
vasa vasorum vasculitis
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syphilitic aneurysmproduces whats?
produces aorticregurgitation;
bounding pulses
what is the most commoncause of death in Marfan
syndrome and EDS?aortic dissection
aortic dissection is caused
by?
cystic medial degeneration
(CMD)
Aortic dissection has whatclinical findings?
pain radiates into the back;absent pulse
what is the most commoncause of Aortic dissection ?
cardiac tamponade
superficial varicositiescauses?
valve incompetence
phlebothrombosis is caused
by?
stasis of blood flow
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Stasis dermatitis is a sign of?
DVT (deep veinthromboses)
thrombophlebitis causespain where?
pain and tendernessoverlying the vein
SVC (Superior vena cava)
syndrome = ?
compression of Superiorvena cava by primary lung
cancer
Thoracic outlet syndrome iscommon among what
group?
weight lifters- tight scalenus muscles
acute lymphangitis iscaused by?
streptococcus pyogenescellulitis
What is Turner's webbedneck caused by?
lymphatic abnormality
bacillary angiomatosis, what
are the clinical findings?
bartonella henselae;
common in AIDS
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ANCA (Antineutrophilcytoplasmic antibodies)
causes what?
antibodies againstcomponents of neutrophils
small vessel vasculitisappears as what?
palpable purpura
medium-sized vessel
vasculitis causes what?
thrombosis
aneurysm formation
large vessel vasculitiscauses what?
absent pulse, stroke
systolic blood pressurecorrelates with what?
stroke volume
Diastolic blood pressurecorrelates with what?
tonicity of TPR (totalperipheral resistance)arterioles
pathogenesis of
hypertension =?
renal retention of sodium
commonly involved
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what is the most commontype of hypertension?
essential hypertension
what is the most commontype of secondary
hypertension?renovascular hypertension
renovascular hypertension
causes what?
atherosclerosis in menfibromuscular hyperplasia in
women
How does renovascularhypertension pathogenesis
= ?
activation of RAA (renin-angiotensin-aldosterone)
system
PRA (plasma renin activity)relates to renovascular
hypertension how?
in involved kidney in unaffected kidney
fibromuscular hyperplasiaappearance = ?
"beaded" appearance ofrenal artery
what are the complicationsdescending order
-acute MI