أسئلة المحاضرة الرابعة CVS باثولوجي

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Questions and Answers

What is the primary classification of hypertension that accounts for most cases?

Secondary Hypertension

Benign Hypertension

Essential Hypertension (correct)

Malignant Hypertension

Which factor is not considered a common cause of primary hypertension?

Genetic factors

Endocrine disorders (correct)

Stress and obesity

Increased dietary sodium intake

Which condition is considered a secondary cause of hypertension?

Toxemia of pregnancy (correct)

Physical inactivity

Liddle Syndrome

Increased heart rate

How is blood pressure primarily determined in the vascular system?

Cardiac output and peripheral resistance Signup and view all the answers

Which of the following is NOT a humoral vasodilator?

Angiotensin II Signup and view all the answers

In primary hypertension, what happens to the sensitivity of baroreceptors to elevated blood pressure?

They become less sensitive. Signup and view all the answers

Which of the following is a common environmental factor contributing to hypertension?

Smoking Signup and view all the answers

What percentage of hypertension cases is classified as secondary hypertension?

5% Signup and view all the answers

What is the primary physiological effect of autoregulation in hypertension?

Vasoconstriction to protect tissues Signup and view all the answers

In benign hypertension, how does cardiac output change over time?

It returns to normal Signup and view all the answers

Which age group is most likely to develop malignant hypertension?

30-40 years Signup and view all the answers

What is a characteristic feature of decompensated stage in benign hypertension?

Dilated left ventricle with thin walls Signup and view all the answers

Which type of arteriolosclerosis is associated with malignant hypertension?

Hyperplastic arteriolosclerosis Signup and view all the answers

What distinguishes renal changes in benign nephrosclerosis from malignant nephrosclerosis?

Kidneys in benign nephrosclerosis are small and contracted Signup and view all the answers

What is a common progression of pressure in malignantly affected individuals?

Pressure rises rapidly over 200/120 Signup and view all the answers

How does the presence of atheroma in benign versus malignant arteriolosclerosis differ?

Atheroma is less severe in malignant arteriolosclerosis Signup and view all the answers

What is a significant microscopic change observed in the afferent arterioles during hypertensive pathology?

Hyaline arteriolosclerosis Signup and view all the answers

Which of the following is NOT a characteristic of malignant hypertensive encephalopathy?

Retinal exudate Signup and view all the answers

In malignant hypertension, what consequence may arise from retinal hemorrhage?

Blindness Signup and view all the answers

Which finding is typically associated with benign hypertensive nephropathy?

Mild compensatory dilatation Signup and view all the answers

What is a common finding seen in both benign and malignant hypertensive retinopathy?

Retinal hemorrhage Signup and view all the answers

Which of the following describes a change specific to malignant hypertension?

Progressive uremia Signup and view all the answers

What type of aneurysms are related to benign hypertensive changes in the brain?

Intracerebral microaneurysms Signup and view all the answers

Which of the following vascular changes is associated with the base of the pyramids in cases of hypertension?

Thickening and dilation Signup and view all the answers

What primarily contributes to the elevation of blood pressure in terms of cardiac output?

Increased stroke volume Signup and view all the answers

Which of the following factors is most closely associated with primary hypertension?

Genetic predisposition Signup and view all the answers

What characterizes secondary hypertension compared to primary hypertension?

It has a known underlying cause. Signup and view all the answers

Which hormonal factor contributes to increased peripheral resistance in hypertension?

Aldosterone Signup and view all the answers

What environmental factor is NOT recognized as contributing to the development of primary hypertension?

Chronic end-stage renal disease Signup and view all the answers

Which physiological mechanism primarily regulates blood pressure through sensitivity of baroreceptors?

Neural factors Signup and view all the answers

Which condition may lead to a secondary form of hypertension due to hormonal imbalances?

Primary hyperaldosteronism Signup and view all the answers

Which factor is least likely to enhance peripheral resistance in patients with hypertension?

Humoral vasodilators Signup and view all the answers

What is a hallmark characteristic of the compensated stage in benign hypertension?

Concentric left ventricular hypertrophy with bulge of interventricular septum. Signup and view all the answers

Which type of arteriolosclerosis is characterized by onion skin appearance of the vessels?

Hyperplastic arteriolosclerosis. Signup and view all the answers

In malignant hypertension, what effect does it typically have on renal size?

Results in nephromegaly with a normal or enlarged size. Signup and view all the answers

How does the progression of blood pressure in malignant hypertension typically manifest?

Rapidly escalates to levels over 200/120. Signup and view all the answers

What type of renal changes is specifically associated with benign nephrosclerosis?

Small and contracted kidneys. Signup and view all the answers

Which condition indicates that malignant hypertension may develop in previously normotensive individuals?

Immediate onset of a hypertensive crisis. Signup and view all the answers

How does the formation of atheroma in benign arteriosclerosis compare to malignant arteriosclerosis?

Less severe in malignant conditions. Signup and view all the answers

What is the likely outcome of hypertension on the left atrium in benign cases?

Hypertrophy followed by dilation. Signup and view all the answers

What is a likely outcome of malignant hypertensive retinopathy?

Complete blindness Signup and view all the answers

Which change is indicative of necrosis in the nephron due to malignant hypertension?

Necrotising arteriolitis Signup and view all the answers

Which characteristic is shared between benign and malignant hypertension in terms of heart failure?

Left ventricular failure Signup and view all the answers

In the context of cerebral impacts from malignant hypertension, what is a common consequence?

Cerebral edema Signup and view all the answers

Which finding is more indicative of benign than malignant hypertensive nephropathy?

Minimal fibrosis with few lymphocytes Signup and view all the answers

What type of vascular changes occurs at the base of the pyramids in cases of hypertension?

Thick and dilated arteries Signup and view all the answers

What type of microscopic vessel changes is associated with benign hypertension?

Hyaline arteriolosclerosis Signup and view all the answers

Which pathological change is seen in malignant hypertensive encephalopathy that is not typically found in benign cases?

Encephalomalacia Signup and view all the answers

Study Notes

Definition

Persistent elevation of systemic blood pressure above 140/90 mmHg.

Classification

Primary (Essential) Hypertension: Unknown cause, accounts for 95% of cases.
- Etiology:
  - Genetic Factors:
    - Gene defects affecting enzymes involved in aldosterone metabolism.
    - Mutation in proteins affecting renal sodium reabsorption.
  - Environmental Factors:
    - Increased dietary sodium intake.
    - Stress, obesity, smoking, physical inactivity.
Secondary Hypertension: 5% of cases, due to other diseases.
- Causes:
  - Renal: Renal diseases, renal ischemia.
  - Endocrine: Hyperaldosteronism, pheochromocytoma, Cushing’s Syndrome.
  - Coarctation of the aorta.
  - Polycythemia rubra vera.
  - Toxemia of pregnancy.
  - Contraceptive pills

Blood Pressure

BP is the function of cardiac output and peripheral vascular resistance.
Cardiac Output:
- Increased by:
  - Increased blood volume.
  - Increased heart rate.
  - Increased cardiac contractility.
Peripheral Resistance:
- Determined mainly at the level of arterioles.
- Regulated by:
  - Humoral vasoconstrictors: Angiotensin II, catecholamines, endothelin.
  - Humoral vasodilators: Kinin, prostaglandins, nitric oxide (NO).
  - Neural factors: Through arterial baroreceptors. In primary hypertension, baroreceptors become less sensitive to elevated BP.
  - Autoregulation: Increased blood flow leads to vasoconstriction to protect tissue from overperfusion.

Early Events Leading to Established Hypertension

Salt & water retention leads to increased blood volume and cardiac output.
Additional sodium is excreted by the kidneys to match intake and prevent further fluid retention.
Cardiac output returns to normal.
Increased peripheral resistance (increased arteriolar tone) develops.

Benign Hypertension

Incidence: 90-95%
Age of onset: Usually after 40 years old.
Course: Prolonged for many years, gradual rise in pressure to 180/100 mmHg.

Malignant Hypertension

Incidence: 5-10%
Age of onset: 30-40 years old.
Course: Rapid rise in pressure over 200/120 mmHg, can occur on top of existing benign HTN.

Cardiac Changes

Benign Hypertension:
- Compensated Stage:
  - Concentric left ventricular hypertrophy with bulging of the interventricular septum.
- Decompensated Stage:
  - Left ventricular dilation with a thin wall.
  - Left atrial hypertrophy then dilation, pulmonary hypertension, and right-sided heart failure.
Malignant Hypertension: Minimal effect due to the short course, unless superimposed on pre-existing benign HTN.

Vascular Changes

Benign Hypertension:
- Hyaline arteriolosclerosis.
- Elastosis.
- Atheroma is more severe.
Malignant Hypertension:
- Necrotizing arteriolitis (fibrinoid necrosis).
- Cellular hyperplasia (hyperplastic arteriolosclerosis with "onion skin" appearance of the vessels).
- Atheroma is less severe.

Renal Changes

Benign Nephrosclerosis:
- Gross:
  - Size: Small (primary contracted kidney).
  - Capsule: Adherent, strips easily and shows areas of subcapsular hemorrhage.
  - C/S: Reduced cortex and medulla, not demarcated from each other. Arteries at the base of the pyramids are thick and dilated.
- Microscopic:
  - Blood vessels: Hyaline arteriolosclerosis of afferent arterioles.
  - Nephrons: Non-functioning: Atrophy, fibrosis, and hyalinization. Functioning: Compensatory hypertrophy.
  - Interstitium: Fibrosis and few lymphocytes.
Malignant Nephrosclerosis:
- Gross:
  - Size: Normal or enlarged.
  - Capsule: Strips easily, noticeable areas of subcapsular hemorrhage.
  - C/S: Areas of hemorrhage, arteries at the base of the pyramids are dilated.
- Microscopic:
  - Blood Vessels: Necrotizing arteriolitis of afferent arterioles.
  - Nephrons: Non-functioning: Necrosis and fibrosis. Functioning: Mild compensatory dilatation.
  - Interstitium: Minimal fibrosis and hemorrhage.

Brain Changes

Benign Hypertensive Encephalopathy:
- Intracerebral microaneurysms, related to small vessels of the basal ganglia, multiple and small.
- May rupture and cause massive spontaneous cerebral hemorrhage.
Malignant Hypertensive Encephalopathy:
- Arterial spasm leads to:
  - Cerebral edema.
  - Papilledema.
  - Encephalomalacia (liquefactive necrosis due to ischemia).
- Massive spontaneous cerebral hemorrhage.

Retinal Changes

Benign Hypertensive Retinopathy: Retinal hemorrhage and exudate.
Malignant Hypertensive Retinopathy: Retinal hemorrhage, edema, and necrosis, may lead to blindness.

Late Complications

Benign Hypertension: Left ventricular failure, cerebral hemorrhage, chronic uremia.
Malignant Hypertension: Progressive uremia, left ventricular failure, cerebral hemorrhage.

Hypertension

Persistent elevation of systemic blood pressure above 140/90 mmHg.
Classified into two main types: Primary (essential) and Secondary hypertension.
Primary hypertension is the most common (95%) while secondary hypertension is less common (5%).
Primary hypertension has unknown cause, while secondary hypertension is caused by other diseases.

Primary Hypertension Causes

Genetic factors:
- Gene defects affecting aldosterone metabolism enzymes
- Mutation in proteins affecting renal sodium reabsorption
Environmental factors:
- Increased dietary sodium intake
- Stress, obesity
- Smoking, physical inactivity

Secondary Hypertension Causes

Renal: Renal diseases, ischemia
Endocrine: Hyperaldosteronism, pheochromocytoma, Cushing syndrome
Coarctation of the aorta
Polycythemia rubra vera
Toxemia of pregnancy
Contraceptive pills

Blood Pressure Regulation

Cardiac Output:
- Increased through:
  - Increased blood volume
  - Increased heart rate
  - Increased cardiac contractility
Peripheral Resistance:
- Determined by:
  - Humoral vasoconstrictors: angiotensin II, catecholamine, endothelin
  - Humoral vasodilators: kinin, prostaglandins, nitric oxide (NO)
  - Neural factors: through arterial baroreceptors
  - Autoregulation: increased blood flow leading to vasoconstriction to protect tissues
- In primary hypertension, baroreceptors become less sensitive to elevated blood pressure.

Early Initiating Events in Primary Hypertension

Salt and water retention resulting in increased blood volume and cardiac output
Kidneys excrete additional sodium to prevent further fluid retention

Established Primary Hypertension

Cardiac output returns to normal.
Increased peripheral resistance (increased arteriolar tone).

Benign Hypertension

Incidence: 90-95%
Age: Starts after 40 years.
Onset: Pressure rises gradually to 180/100 mmHg.
Course: Prolonged for many years.

Malignant Hypertension

Incidence: 5-10%
Age: 30-40 years.
Onset: Pressure rises rapidly over 200/120 mmHg. Occurs in normotensive individuals or superimposed on existing benign hypertension.
Course: Short for months or 1-2 years.

Cardiovascular Changes in Hypertension

Benign Hypertension

Cardiac: Concentric left ventricular hypertrophy in the compensated stage, followed by dilated left ventricle with thin wall and hypertrophy/dilation of the left atrium in the decompensated stage.
Vascular: Hyaline arteriolosclerosis, elastosis, with more severe atheroma.
Renal: Small, contracted kidney with adherent capsule, reduced cortex/medulla, and thickened arteries at the base of pyramids. Microscopically, hyaline arteriolosclerosis of afferent arterioles, non-functioning nephrons with atrophy, fibrosis, and hyalinitis. Functioning nephrons show compensatory hypertrophy. Interstitial tissue shows fibrosis and few lymphocytes.

Malignant Hypertension

Cardiac: Minimal effect unless superimposed on benign hypertension.
Vascular: Necrotizing arteriolitis with fibrinoid necrosis, cellular hyperplasia (onion skin appearance), with less severe atheroma.
Renal: Normal or enlarged kidney with easily stripped capsule, areas of subcapsular hemorrhage. Microscopically, necrotizing arteriolitis of afferent arterioles, non-functioning nephrons with necrosis and fibrosis, mild compensatory dilatation of functioning nephrons. Interstitial tissue shows minimal fibrosis and hemorrhage.

Brain Changes in Hypertension

Benign Hypertension

Microaneurysms in small vessels of basal ganglia.
Multiple, small aneurysms can rupture causing spontaneous cerebral hemorrhage.

Malignant Hypertension

Arterial spasms leading to:
- Cerebral edema
- Papilledema
- Encephalomalcia (liquefactive necrosis due to ischemia)
- Massive spontaneous cerebral hemorrhage

Retinal Changes in Hypertension

Benign Hypertension

Retinal hemorrhage and exudate

Malignant Hypertension

Retinal hemorrhage, edema, and necrosis leading to blindness

Complications of Hypertension

Benign Hypertension

Left ventricular failure
Cerebral hemorrhage
Chronic uremia

Malignant Hypertension

Progressive uremia
Left ventricular failure
Cerebral hemorrhage

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Podcast

Questions and Answers

What is the primary classification of hypertension that accounts for most cases?

Which factor is not considered a common cause of primary hypertension?

Which condition is considered a secondary cause of hypertension?

How is blood pressure primarily determined in the vascular system?

Which of the following is NOT a humoral vasodilator?

In primary hypertension, what happens to the sensitivity of baroreceptors to elevated blood pressure?

Which of the following is a common environmental factor contributing to hypertension?

What percentage of hypertension cases is classified as secondary hypertension?

What is the primary physiological effect of autoregulation in hypertension?

In benign hypertension, how does cardiac output change over time?

Which age group is most likely to develop malignant hypertension?

What is a characteristic feature of decompensated stage in benign hypertension?

Which type of arteriolosclerosis is associated with malignant hypertension?

What distinguishes renal changes in benign nephrosclerosis from malignant nephrosclerosis?

What is a common progression of pressure in malignantly affected individuals?

How does the presence of atheroma in benign versus malignant arteriolosclerosis differ?

What is a significant microscopic change observed in the afferent arterioles during hypertensive pathology?

Which of the following is NOT a characteristic of malignant hypertensive encephalopathy?

In malignant hypertension, what consequence may arise from retinal hemorrhage?

Which finding is typically associated with benign hypertensive nephropathy?

What is a common finding seen in both benign and malignant hypertensive retinopathy?

Which of the following describes a change specific to malignant hypertension?

What type of aneurysms are related to benign hypertensive changes in the brain?

Which of the following vascular changes is associated with the base of the pyramids in cases of hypertension?

What primarily contributes to the elevation of blood pressure in terms of cardiac output?

Which of the following factors is most closely associated with primary hypertension?

What characterizes secondary hypertension compared to primary hypertension?

Which hormonal factor contributes to increased peripheral resistance in hypertension?

What environmental factor is NOT recognized as contributing to the development of primary hypertension?

Which physiological mechanism primarily regulates blood pressure through sensitivity of baroreceptors?

Which condition may lead to a secondary form of hypertension due to hormonal imbalances?

Which factor is least likely to enhance peripheral resistance in patients with hypertension?

What is a hallmark characteristic of the compensated stage in benign hypertension?

Which type of arteriolosclerosis is characterized by onion skin appearance of the vessels?

In malignant hypertension, what effect does it typically have on renal size?

How does the progression of blood pressure in malignant hypertension typically manifest?

What type of renal changes is specifically associated with benign nephrosclerosis?

Which condition indicates that malignant hypertension may develop in previously normotensive individuals?

How does the formation of atheroma in benign arteriosclerosis compare to malignant arteriosclerosis?

What is the likely outcome of hypertension on the left atrium in benign cases?

What is a likely outcome of malignant hypertensive retinopathy?

Which change is indicative of necrosis in the nephron due to malignant hypertension?

Which characteristic is shared between benign and malignant hypertension in terms of heart failure?

In the context of cerebral impacts from malignant hypertension, what is a common consequence?

Which finding is more indicative of benign than malignant hypertensive nephropathy?

What type of vascular changes occurs at the base of the pyramids in cases of hypertension?

What type of microscopic vessel changes is associated with benign hypertension?

Which pathological change is seen in malignant hypertensive encephalopathy that is not typically found in benign cases?

Study Notes

Definition

Classification

Blood Pressure

Early Events Leading to Established Hypertension

Benign Hypertension

Malignant Hypertension

Cardiac Changes

Vascular Changes

Renal Changes

Brain Changes

Retinal Changes

Late Complications

Hypertension

Primary Hypertension Causes

Secondary Hypertension Causes

Blood Pressure Regulation

Early Initiating Events in Primary Hypertension

Established Primary Hypertension

Benign Hypertension

Malignant Hypertension

Cardiovascular Changes in Hypertension

Benign Hypertension

Malignant Hypertension

Brain Changes in Hypertension

Benign Hypertension

Malignant Hypertension

Retinal Changes in Hypertension