37 Takayasu and other vasculitides

Question 1

T/F Imaging is a mandatory criterion for Takayasu arteritis (TA)

Answer 1

T

Question 2

Associated in the initiation of TA

Answer 2

Tb infection
HIV infection
Postinfluenza
Hep B vaccination

Question 3

Criteria for TA

Answer 3

Angio abn + 1/5
Pulse deficit or claudication
BP discrepancy >10 between ext
Bruit
Htn
Elevated ESR/CRP

Question 4

Stages of blood vessel disease in TA

Answer 4

Acute, stenotic, fibrotic

Question 5

MC presentation of TA in children (triad)

Answer 5

Constitutional (fever, wt loss, malaise/fatigue)
Htn
Elevated APRs

Question 6

TA disease commonly assoc with CNS manif

Answer 6

Supradiaphragmatic aortic arch disease

Question 7

T/F Majority of children with TA have supra and infra diaphragmatic dse

Answer 7

T

Question 8

middle aortic syndrom characteristic of infra diaphragmatic TA

Answer 8

Htn, abdominal bruit, abdominal pain

Question 8

Single MC manif of TA

Answer 8

Renovascular htn

Question 9

Claudication in TA, MC in adult vs child

Answer 9

Adult

Question 10

Most important and common PE findings in TA

Answer 10

DEcreased/absent periph pulses
BP discrepancy
Bruit
Htn

Question 11

Htn in TA, MC in adult vs child

Answer 11

Child

Question 12

Patho finding in TA

Answer 12

Intramural multinucleated giant cells

Question 13

Preferred imaging modality for TA, esp for serial ff up

Answer 13

MRI/MRA

Question 14

Seen in MRI/MRA of active TA

Answer 14

Gadolinium enhancement

Question 15

MC imaging feature in pediatric TA

Answer 15

Stenosis

Question 16

RF for dissection in TA

Answer 16

Higher PVAS
Lower alb
Higher neutrophil levels

Question 17

Of much greater importance in following disease activity than vessel wall thickness in imagingof TA

Answer 17

Development of new lesions

Question 18

Gold std of lumen imaging in TA

Answer 18

Conventional angio

Question 19

TA types

Answer 19

Pg 595

Question 20

MC TA type in children

Answer 20

IV and V

Question 21

NIH defines active TA as new onset or worsening of 2/4 of the ff

Answer 21

Constitutional w/o other explanation
Inflamm markers
Features of ischemia
Vascular lesions on imaging

Question 22

TA treatment

Answer 22

immunosupp
anti-htn
anti-plt
surgery

Question 23

Mainstay of tx of TA

Answer 23

CS

Question 24

MC Steroid sparing agt for TA

Answer 24

MTX, CYC for severe dse

Question 25

Should be used with caution in treating TA-related htn because bilateral renal blood flow may be further compromised

Answer 25

ACEi

Question 26

Indication for surg in TA

Answer 26

Significant stenosis or aneurysms in INACTIVE disease

Question 27

T/F TA is commonly monophasic

Answer 27

F, chronic relapsing disease, monophasic in only 20-25%

Question 28

MCC of death in TA

Answer 28

CV

Question 29

Morbidity in TA is usually due to

Answer 29

Complications caused by stenotic vessels

Question 30

Constitutes “atypical” Cogan

Answer 30

Ophtha manif other than interstitial keratitis
>2 y between ocular and vestibulo-auditory sympt
Signs of large vessel vasculitis particularly of proximal aorta and AV insufficiency