醫學二：100題 ( 包括生理學,生化學,藥理學,病理學等科目及其臨床相關知識 )題庫下載題庫

Aneurysm of the arch of the aorta – MCC = tertiary syphilis.  Pathology of syphilis is vasculitis of arterioles. Chancre, too. Its painless b/c if you section it, you will see little arterioles surrounded by plasma cells and the lumen of the vessel is completely shut, so it is ischemic necrosis.  In other words, it is ischemia of the overlying tissue undergoing necrosis.  B/c nerves are next to vessels, they are knocked off, too, and it is painless.  All of syphilis is a vasculitis.  That is what the Treponema infects – small vessels and arterioles.  What are they affecting in the arch...

Aneurysm of the arch of the aorta – MCC = tertiary syphilis.  Pathology of syphilis is vasculitis of arterioles. Chancre, too. Its painless b/c if you section it, you will see little arterioles surrounded by plasma cells and the lumen of the vessel is completely shut, so it is ischemic necrosis.  In other words, it is ischemia of the overlying tissue undergoing necrosis.  B/c nerves are next to vessels, they are knocked off, too, and it is painless.  All of syphilis is a vasculitis.  That is what the Treponema infects – small vessels and arterioles.  What are they affecting in the arch of the aorta? The vasa vasorum; the richest supply of vasa vasorum is in the arch, so its logical that the Treponema will pick it – leads to endarteritis obliterans (they are obliterating the lumen), ischemia, weakening under systolic pressures, leads to depression in the arch of the aorta (looks like a catcher’s mitt).  What will that do to the aortic valve ring? It will stretch it – which murmur will this lead to? Aortic regurg.  Murmurs can occur b/c there is valvular damage or b/c the valvular ring is stretched.  So, there can be stretching of the ring and nothing wrong with the valves, and have a murmur, or you can have damage to the valves and have a murmur.  Syphilis is an example of stretching of the aortic valve ring leading to a murmur and aortic regurg.