USMLE Step 1 Web Prep — Vascular Pathology
138370 > 0:00:00
SLIDE 1 of 30
Chapter 11: Vascular Pathology
VASCULITIS
GENERAL
  • Male> female
  • Fibrinoid necrosis
  • If untreated, blindness and death
  • Treat with steroids or immunosuppressive agents
138375 > 0:00:49
SLIDE 2 of 30
POLYATERITIS NODOSA
  • Involves any organ, except lungs!
  • Variable clinical features, depend on organ involved
  • Systemic, necrotizing vasculitis
  • 3 stages
  • Acute lesions * slide image of kidney
  • Necrotic artery- pink homogeneous appearance
  • Healing lesions
  • Healed lesion
/

138380 > 0:03:12
SLIDE 3 of 30
POLYARTERITIS NODOSA
  • Sequela
  • Thrombosis + infarction
  • Aneurysms
  • Labs
  • 30% HbsAg
  • ***autoantibodies- p-ANCA against myeloperoxidase
  • Diagnosis
  • Biopsy
  • Treatment
  • Steroids + cyclophosphamide
  • Prognosis
  • Fatal, if untreated
  • 90% remission, if treated
138385 > 0:04:24
SLIDE 4 of 30
CHURG-STRAUSS SYNDROME
 Variant of PAN
 Associated with asthma
 Granulomas + eosinophils
138390 > 0:04:40
SLIDE 5 of 30
WEGENER’S GRANULOMATOSIS
 Males, 40-60 years of age
 Necrotizing vasculitis with granulomas
 ***Nose, sinus, lungs + kidneys
 Pneumonia- nodules + cavities
 Sinusitis + nasopharyngeal ulcerations
 Renal disease
138395 > 0:05:51
SLIDE 6 of 30
WEGENER’S GRANULOMATOSIS CON’T
Micro
  • Fibrinoid necrosis
  • Neutrophils
  • Granulomas
Lab
  • *** Autoantibodies- c-ANCA against proteinase 3
138400 > 0:06:17
SLIDE 7 of 30
WEGENER’S GRANULOMATOSIS CON’T
Diagnosis
  • Biopsy
Treatment
  • Steroids
Prognosis
  • Poor, if untreated
  • Very well, if treated
138405 > 0:06:28
SLIDE 8 of 30
TEMPORAL ARTERITIS
  • Most common vasculitis
  • Elderly women
  • HLA-DR4
  • Distribution- aortic arch cranial arteries
  • Clinical
  • Headache
  • Pain over temporal artery
  • Visual changes
  • Polymyalgia Rheumatica
138410 > 0:07:33
SLIDE 9 of 30
TEMPORAL ARTERITIS CON’T
Lab
  • Elevated ESR
Pathology
  • Segmental granulomatous vasculitis
  • Giant cells along internal elastic lamina
Diagnosis + treatment
  • Temporal artery biopsy
  • Steroids, empirically dramatic response
  • Blindness if untreated
/

138415 > 0:08:33
SLIDE 10 of 30
TAKAYASU’S ARTERITIS
Epidemiology
  • Young, Asian female
Distribution
  • Ostia of aortic arch branches
138420 > 0:09:03
SLIDE 11 of 30
TAKAYASU’S ARTERITIS CON’T
Pathology
  • *Narrows arterial ostia decrease blood flow
Clinical
  • Loss of pulse in upper extremities
Treatment
  • Steroids
Prognosis
  • Variable
138425 > 0:10:02
SLIDE 12 of 30
BUERGER’S DISEASE
Epidemiology
  • Young males
  • Smokers
  • Israel, India Japan, S. America
Distribution
  • Extremities- hands + feet
Pathology
  • Vascular inflammation thrombosis
  • Microabscesses
138430 > 0:10:43
SLIDE 13 of 30
BUERGER’S DISEASE CON’T
Clinical
  • Claudication
  • Thrombophlebitis
  • Raynaud’s
  • Ulceration + gangrene
Treatment
  • Smoking cessation
138435 > 0:11:08
SLIDE 14 of 30
KAWASAKI’S DISEASE
Epidemology
  • Children < 4 years of age
  • Postviral
  • Japan, Hawaii, + US
Clinical
  • Fever
  • Conjunctivitis
  • Skin rash
  • Lymphadenopathy
138440 > 0:11:52
SLIDE 15 of 30
KAWASAKI’S DISEASE CON’T
Distribution
  • Coronary artery
Prognosis
  • 1-2% with coronary artery involvement aneurysm rupture death
138445 > 0:12:28
SLIDE 16 of 30
ATHEROSCLEROSIS
3 FORMS
 Monckeberg’s medial calcific stenosis
 Arteriolosclerosis
 Atherosclerosis
138450 > 0:12:47
SLIDE 17 of 30
MONCKEBERG’S MEDIAL CALCIFIC STENOSIS
 Calcification of media without luminal narrowing
 Incidental X-ray finding
138455 > 0:13:17
SLIDE 18 of 30
ARTERIOLOSCLEROSIS
 Diabetics, HTN, + elderly
 2 forms
  • Hyaline arteriolosclerosis- “glassy”
  • Hyperplastic arteriosclerosis- “onion-skin”
/

138460 > 0:13:59
SLIDE 19 of 30
ATHEROSCLEROSIS
Definition
  • Lipid deposition within intima
Distribution
  • Aorta, carotid, coronary, cerebral, iliac, etc.
138465 > 0:14:24
SLIDE 20 of 30
ATHEROSCLEROSIS CON’T
Major and minor risk factors for atherosclerosis
Most important major risk factor is hypertension

138470 > 0:15:04
SLIDE 21 of 30
ATHEROSCLEROSIS CON’T
Pathology
  • Fatty streak
  • Atheromatous plaque
  • Complicated atheromatous plaque
  • *Slide image of abdominal aorta
  • yellow atheromas, “ egg-shell” brittleness
  • ulceration
  • thrombus thromboembolus
/

138475 > 0:17:53
SLIDE 22 of 30
ATHEROSCLEROSIS CON’T
Clinical complications
  • MI
  • CVA + TIA
  • Aneurysms
  • PVD
  • Mesenteric artery occlusion
138480 > 0:18:17
SLIDE 23 of 30
HYPERTENSION
Definition
  • dBP> 90 +/or sBP >140 mm Hg
Incidence
  • ј of US population
  • African American > Caucasian
  • Risk increases with age
Etiology
  • Idiopathic primary HTN
  • Secondary HTN
138485 > 0:19:15
SLIDE 24 of 30
BENIGN HYPERTENSION
 95% of HTN
 Mild- moderate
 Silent
 All organs
 Micro- hyaline arteriolosclerosis
138490 > 0:19:45
SLIDE 25 of 30
BENIGN HYPERTENSION CON’T
Late manifestations
  • Left concentric ventricular hypertrophy
  • CHF
  • MI
  • Increased risk of atherosclerosis
  • Intracranial hemorrhage
/

138495 > 0:20:09
SLIDE 26 of 30
MALIGNANT HYPERTENSION
 5% of HTN
 Markedly elevated BP
 Headaches, papilledema, retinal hemorrhages
 “flea-bitten” kidneys
 Micro- hyperplastic arteriolosclerosis + fibrinoid arteriolitis
 Medical emergency /

138500 > 0:21:33
SLIDE 27 of 30
ANEURYSMS
Definition
  • Weakness of media of wall dilatation
Types
  • Atherosclerotic
  • Abdominal aorta
  • HTN
  • >6cm risk of rupture
  • Syphilitic
  • Ascending aorta
  • Vasa vasorum-obliterative endarteritis
  • Aortic dissection
  • Cystic medial necrosis
  • Severe, tearing chest pain
  • HTN, pregnancy + Marfan’s
  • Berry
  • Congenital, PCKD
  • Rupture “worst headache of my life”
138505 > 0:24:02
SLIDE 28 of 30
VASCULAR NEOPLASMS
Hemangiomas
  • Benign
  • Liver +skin
  • May spontaneous regression
Hemangioblastomas
  • vonHippel Lindau disease
Glomus tumor
  • Under nailbed
  • Painful
/

138510 > 0:25:24
SLIDE 29 of 30
VASCULAR NEOPLASMS CON’T
Kaposi’s Sarcoma
  • Low-grade malignancy
  • Human herpes virus 8
  • Skin + internal organs
  • Red-purple plaques, nodules, + patches
  • Micro
  • Spindle epithelial cells + slit-like vascular spaces
138515 > 0:26:04
SLIDE 30 of 30
KAPOSI’S SARCOMA CON’T
4 CLINICAL FORMS
Classic European form
  • Older men
  • Skin- lower extremities
Transplant-associated form
  • Skin + viscera
  • Tends to regress if lower immunosuppressive dose
African form
  • Children + young men
  • Skin + lymph nodes
AIDS-associated form
  • Homosexual males
  • Skin + viscera
  • Tends to respond to chemo + a interferon