3: Vasculitis

Question 1

What are vasculitides

Answer 1

Disorders characterised by inflammation of vessels resulting in down-stream ischaemia

Question 2

How are vasculitides classified

Answer 2

Depending on size of the vessel they affect

Question 3

What are the two large-vessel vasculitides

Answer 3

GCA

Takayasu’s arteritis

Question 4

What are the three medium-vessel vasculitis

Answer 4

Kawasaki
Polyarteritis Nodosa
Thromboangitis obliterans

Question 5

What are the 3 ANCA-associated small-vessel vasculitis

Answer 5

• Granulomatosis with polyangitis (Wegner’s)
• Eosinophillic granulomatous with polyangitis (Churg-Strauss)
• Microscopic polyangitis

Question 6

What are the 3 non-ANCA associated small-vessel vasculitis

Answer 6

• Henoch-Schonlein Purpura
• Behcet’s
• Cryoglobulinaemic vasculitis

Question 7

What is takayasu arteritis also known as

Answer 7

Aortic arch syndrome

Question 8

what is takayasu arteritis

Answer 8

Inflammation aortic arch and it’s branches

Question 9

which demographic does takayasu arteritis tend to occur

Answer 9

Asian women under 40 years-old

Question 10

what are the clinical symptoms of takayasu’s arteritis

Answer 10

• Unequal BP between upper limbs
• Decrease brachial and radial pulse
• Carotid bruit
• Systemic features: malaise, arthralgia, fever

Question 11

what are 20% of causes of takayasu’s arteritis associated with

Answer 11

Renal-artery stenosis

Aortic regurgitation

Question 12

what does renal artery stenosis lead to

Answer 12

Secondary HTN

Question 13

what investigation is ordered initially in takayasu arteritis

Answer 13

ESR

CTA

Question 14

what is gold-standard investigation in takayasu’s arteritis s

Answer 14

CT angiography

Question 15

how is takayasu arteritis managed

Answer 15

Corticosteroids

Question 16

what infections is polyarteritis nodes associated with

Answer 16

Hepatitis B and C

Question 17

when should polyarteritis nodosa be considered

Answer 17

Young patient presenting with an MI or Stroke

Question 18

what are the neurological symptoms of PAN

Answer 18

• Stroke

- Mononeuritis multiplex

Question 19

what are the coronary symptoms of PAN

Answer 19

MI

Question 20

what are the non-specific symptoms of PAN

Answer 20

Arthralgia
Muscle Pain
Joint Pain

Question 21

what organ does PAN usually spare

Answer 21

Lungs

Question 22

what are the ‘PANs’ of Polyarteritis nodes

Answer 22

Pulmonary Artery Not Involved
PANmural inflammation
Associated with HePANitis B and C

Question 23

what investigation is ordered for PAN

Answer 23

ESR

Question 24

what serology is ordered and why

Answer 24

Hep B and Hep C

Question 25

what may be seen on angiogram

Answer 25

String of beads

Question 26

how is PAN managed

Answer 26

Steroids | DMARDs

Question 27

what is thrombophlebitis obliterans called

Answer 27

Buerger's disease

Question 28

what is the stereotype of burger's (thrombophlebitis obliterans) disease

Answer 28

Young male smoker

Question 29

what gender is Burger disease more common

Answer 29

Male

Question 30

what age is Burger disease more common

Answer 30

< 40 year-olds

Question 31

what is the main RF for Burger disease

Answer 31

Smoking

Question 32

how does Burger's disease present in early stages

Answer 32

- Raynaud's - Superficial Thrombophlebitis = tender nodules along course of the vein - Intermittent claudication (PAD)

Question 33

how does Burger's disease present in late stages

Answer 33

ischaemic ulcers

Question 34

what is ordered in Buerger's disease

Answer 34

ABPI | Arteriography

Question 35

what is used to manage Buerger's disease

Answer 35

Smoking cessation | Nifedipine

Question 36

what is polyangitis with granulomatosis also called

Answer 36

Wegner's granulomatosis

Question 37

what is polyangitis with granulomatosis

Answer 37

Inflammation small vessels, ANCA positive

Question 38

what is the classic presentation of granulomatosis with polyangitis

Answer 38

- Respiratory tract symptoms (nasal crusting) | - Glomerulonephritis

Question 39

what is the first clinical-manifestation of granulomatosis with polyangitis

Answer 39

ENT (95%)

Question 40

what is the main ENT manifestation of granulomatosis with polyangitis

Answer 40

- Chronic/Recurrent sinusitis that leads to a saddle-shape nose deformity

Question 41

what % of cases have respiratory tract involvement

Answer 41

95%

Question 42

what are the typical 'respiratory' features of granulomatosis with polyangitis

Answer 42

- Nasal crusting - Epistaxis - Dyspnoea - Haemoptysis

Question 43

what % of granulomatosis with polyangitis have renal involvement

Answer 43

80%

Question 44

what are the renal symptoms of granulomatosis with polyangitis

Answer 44

Glomerulonephritis

Question 45

what antibody test is associated with granulomatosis with polyangitis

Answer 45

cANCA

Question 46

what may be seen on renal biopsy in cANCA

Answer 46

crescents in bowman's capsule

Question 47

how is granulomatosis with polyangitis managed

Answer 47

corticosteroids | cyclophosphamide

Question 48

what is eosinophilic granulomatosis with polyangitis called

Answer 48

Churg-Stauss

Question 49

what is a feature of churg-strauss

Answer 49

Eosinophillia

Question 50

what may precipitate eosinophilic granulomatosis with polyangitis

Answer 50

LTRA

Question 51

what condition is churg-strauss disease associated with

Answer 51

Asthma

Question 52

what is the main symptom of churg-strauss

Answer 52

Severe allergic asthma attacks

Question 53

how does churg-strauss present

Answer 53

- Allergic rhinitis - Severe allergic asthma - Skin nodules -

Question 54

what are the features of Churg Strauss

Answer 54

- Asthma - Mononeuritis multiplex - Paranasal sinusitis

Question 55

what investigations are ordered in Churg Strauss syndrome

Answer 55

pANCA

Question 56

how is Churg Strauss managed

Answer 56

corticosteroids | cyclophosphamide