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  #1  
Old 08-11-2012
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Vascular Pathogenesis of Aortic Aneurysm?

A 69-year-old man died of ischemic heart disease. He had a history of peripheral vascular disease. At autopsy his aorta was removed and was found to have an opened lesion (aneurysm) proximal to the aortic bifurcation. Which mechanism is most likely involved in the pathogenesis of this lesion?

a) Accumulation of mucopolysaccharides in media
b) Defect in collagen synthesis
c) Destruction and thinning of media
d) Lipid accumulation in the intima
e) Vasculitis of vasa vasora
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  #2  
Old 08-11-2012
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i tink its d..
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Old 08-11-2012
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Between C n D but I think I would go with D
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Old 08-11-2012
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Default C or D

but would like to know. aortic bifurcation = abdominal aorta bifurcation or where brachiocephalic artery and subclavin artery divide from aortic arch?
(I know may be it sounds silly question but its better to clear doubt)
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bifurcation only in abdomen in thorax only give rise to branches
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Old 08-11-2012
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Ee...lack of vasa vasorum
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Old 08-11-2012
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the guy has atherosclerosis....and thats the major risk factor for abdominal aortic aneurysms + he has evidence of peripheral vascular disease and IHD too
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Old 08-11-2012
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Answer is C
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Answer is C
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Goljan audio;lack of vasa vasorum in abdominal aorta is cause of aneurism.
But vasculitis of vasa v. is confusing?
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i think that if the lesion is distal not in the abdominal aorta its caused by syphilis which lead to inflammation of vasavasorum than weakening of the media which lead to aneurism but if the abdominal aorta is affected is due atherosclerosis so i think the answer is e
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lesion is proximal sry
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My first choice would be C.

The word "Proximal to Aorta " rings the bell.
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Old 08-11-2012
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C.
Atherosclerosis (which this patient seems to have had as well) is the commonest pathology behind an aneurysm.
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E) Vasculitis of vasa vasora
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  #16  
Old 08-11-2012
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Missed typed...I wanted to say "My first choice would be E
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In abdominal aortic aneurysm there is no vasa vasorum.
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Old 08-12-2012
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The answer is EE

the aneurysm is PROXIMAL to bifurcation of aorta. So it is THORACIC aortic aneurysm. The only one that cause this is syphilis. The pathogenesis behind that is vasculitis of vasa vasorum of media >>> get media atrophy >>> aneurysm

If the question said DISTAL to bifurcation of aorta so it would be ABDOMINAL aneurysm which caused by atherosclerosis.
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!the question is about abdominal aorta!!!!!!
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Oh! I missed up ! " What happened to me! The bifurcation really mean to branch to Two common iliac arteries. so it is abdominal aneurysm! I hated when I misunderstand the question ! It happen to me a lot.
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  #21  
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So the answer is DDD
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Quote:
Originally Posted by Casandra View Post
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!the question is about abdominal aorta!!!!!!
Then the answer is CCCCCCCCCC
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  #23  
Old 08-12-2012
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Guy the question ask "most likely", though both D & C are correct but MCC of AA is 2nd from atherosclerosis, so D is the EXACT one, C is 2nd from syphilis, but it is not as common as atherosclerosis right now in US (UWorld)
regarding C thinning of media happening to saccular/ berry aneurysm, most often in wilis circle, 2nd to HTN and increase risk rupture, though it is not the MCC of AA.
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  #24  
Old 08-12-2012
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D........ ......
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  #25  
Old 08-14-2012
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Which one is the correct answer ?
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  #26  
Old 08-14-2012
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I think it's C.
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  #27  
Old 08-14-2012
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Default My Answer!!!!

Guyz this is the correct answer.
its c) ....

from medscape.com

AAAs arise as a result of a failure of the major structural proteins of the aorta (elastin and collagen). The inciting factors are not known, but a genetic predisposition clearly exists. Although aneurysms represent a dilatation in all layers of the vessel wall, AAAs develop following degeneration of the media. The degeneration ultimately may lead to widening of the vessel lumen and loss of structural integrity.
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  #28  
Old 08-16-2012
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D
Atherosclerosis
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  #29  
Old 08-16-2012
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Quote:
Originally Posted by Casandra View Post
A 69-year-old man died of ischemic heart disease. He had a history of peripheral vascular disease. At autopsy his aorta was removed and was found to have an opened lesion (aneurysm) proximal to the aortic bifurcation. Which mechanism is most likely involved in the pathogenesis of this lesion?

a) Accumulation of mucopolysaccharides in media
b) Defect in collagen synthesis
c) Destruction and thinning of media
d) Lipid accumulation in the intima
e) Vasculitis of vasa vasora
I Hate it when someone posts a q ....obviously having the right answer and refusing to share it with us ok CASSANDRA!!!! we've argued enuf about this question so pls just pose the answer stop leaving us hanging,... Thats the essence of this forum. Suppose we meet the question in the future or in our step..???
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  #30  
Old 08-17-2012
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Default correct answer

The answer is c) Destruction and thinning of media

The atherosclerotic plagues in the intima may be present all over the aorta, including areas away from the dilated segment (aneurysm). The mechanism for development of this dilation is secondary damage to media, which weakens the wall. The pressure of the column of blood in the lumen will push this weakened wall out, producing the aneurysm.

As for D - This is a feature of all atherosclerotic lesions and does not explain the aneurysm.
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  #31  
Old 08-17-2012
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Quote:
Originally Posted by obinocle View Post
I Hate it when someone posts a q ....obviously having the right answer and refusing to share it with us ok CASSANDRA!!!! we've argued enuf about this question so pls just pose the answer stop leaving us hanging,... Thats the essence of this forum. Suppose we meet the question in the future or in our step..???
@ obinocle - no offense dude but I think you've been long enough in this forum to know that I always post answers the very next day I post a question. since it didn't happen like this this one time you don't have to jump into conclusion and say that I obviously know the answer and refuse posting the answer! sometimes there are some circumstances you can't help - that's called life.
I have shared several question in this forum and never refused to give an answer if I had known it, so drop that frustration attitude...
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  #32  
Old 08-17-2012
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Quote:
Originally Posted by Casandra View Post
@ obinocle - no offense dude but I think you've been long enough in this forum to know that I always post answers the very next day I post a question. since it didn't happen like this this one time you don't have to jump into conclusion and say that I obviously know the answer and refuse posting the answer! sometimes there are some circumstances you can't help - that's called life.
I have shared several question in this forum and never refused to give an answer if I had known it, so drop that frustration attitude...
easy easy easy there... meant no harm, sorry for jumping to conclusionz. my bad. still keep the q's coming girl. Gud luck!
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  #33  
Old 08-17-2012
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Quote:
Originally Posted by obinocle View Post
easy easy easy there... meant no harm, sorry for jumping to conclusionz. my bad. still keep the q's coming girl. Gud luck!
;PPPP
I'm posting answers to some qs today. The rest is for tomorrow
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