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T2 - Phase 2 - Systems Modules (II) > Cardio - Mechanisms of Disease - Vasculitides; Cardiac Inflammation; Vascular Tumors > Flashcards

Cardio - Mechanisms of Disease - Vasculitides; Cardiac Inflammation; Vascular Tumors Flashcards

1
Q

Most cases of vasculitis ________ (are/are not) infectious.

A

Most cases of vasculitis are not infectious.

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2
Q

Vasculitides (e.g. polyarteritis nodosa) are often associated with __________ necrosis.

A

Vasculitides (e.g. polyarteritis nodosa) are often associated with fibrinoid necrosis.

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3
Q

Name two forms of large-vessel vasculitis.

A

Takayasu arteritis

Temporal (giant cell) arteritis

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4
Q

Name three forms of medium-vessel vasculitis.

A

Polyarteritis nodosa

Kawasaki’s arteritis

Buerger’s disease (thromboangiitis obliterans)

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5
Q

Name two forms of small-vessel vasculitis.

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

Microscopic polyangiitis

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6
Q

Takayasu arteritis is also colloquially known as ‘_________’ disease.

A

Takayasu arteritis is also colloquially known as ‘pulseless’ disease.

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7
Q

Takayasu arteritis typically affects which arteries?

A

Branches of the aorta and pulmonary arteries

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8
Q

Both Takayasu arteritis and temporal arteritis are characterized on histopathology by the presence of _______ cells.

A

Both Takayasu arteritis and temporal arteritis are characterized on histopathology by the presence of giant cells.

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9
Q

Takayasu arteritis typically affects ________ (men/women) ___ (>) 50 years of age.

Temporal arteritis typically affects ________ (men/women) ___ (>) 50 years of age.

A

Takayasu arteritis typically affects women < 50 years of age.

Temporal arteritis typically affects women > 50 years of age.

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10
Q

What is the most common presentation for Takayasu arteritis?

A

Young woman;

visual/neurological changes;

weak/absent pulse in upper extremities

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11
Q

What is the most common presentation for temporal arteritis?

A

Older woman;

headache;

visual changes;

elevated ESR;

polymyalgia rheumatica

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12
Q

An older woman presents with headache, visual changes, highly elevated ESR, and polymyalgia rheumatica.

What do you do?

A

Start high-dose corticosteroids immediately

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13
Q

Why must a biopsy test for giant cell (temporal) arteritis take a fairly long section of artery?

A

The granulomatous inflammation is segmental and easily missed

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14
Q

The blindness associated with giant cell (temporal) arteritis is due to what immediate cause?

A

Ophthalmic artery occlusion

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15
Q

Polyarteritis nodosa is a _________-sized vasculitis associated with ______ and ______ (viruses).

A

Polyarteritis nodosa is a medium-sized vasculitis associated with HBV and HCV.

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16
Q

How does polyarteritis nodosa typically present on histology?

A

Transmural, necrotizing lesions;

‘string-of-pearls’ vascular lesions in small-to-medium vessels

(associated with hypertension, abdominal pain with melena, neurologic disturbances, skin lesions, no involvement of heart or lungs)

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17
Q

Describe the common clinical presentation of polyarteritis nodosa.

A

Hypertension (renal artery involvement), abdominal pain with melena, neurologic disturbances, skin lesions

(no involvement of heart or lungs)

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18
Q

Polyarteritis nodosa is characterized by _________ (layers involved) inflammation of medium vessels.

A

Polyarteritis nodosa is characterized by transmural inflammation of medium vessels.

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19
Q

Polyarteritis nodosa classically spares the ______s.

A

Polyarteritis nodosa classically spares the lungs.

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20
Q

Which vasculitis is associated with hypertension and multiple skin lesions?

A

Polyarteritis nodosa

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21
Q

Which medium-sized vessels are most often affected by polyarteritis nodosa?

A

Renal and mesenteric

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22
Q

What population is affected by Kawasaki disease?

A

Children < 4 years of age

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23
Q

Describe the S/Sy of Kawasaki disease:

CRASH and burn

A

Conjunctivitis

Rash

Adenopathy

Strawberry tongue

Swollen, erythematous Hands

Burn (5 days of fever)

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24
Q

What disorder is a cause of AMI in children and one of the few situations in which aspirin is indicated for pediatric patients?

A

Kawasaki disease

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25
Q

Which arteries are most affected by the aneurysms of Kawasaki’s disease?

A

The coronary vessels

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26
Q

Which arteries are preferentially involved in Kawasaki’s disease?

A

The coronary arteries

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27
Q

Buerger’s disease is another name for what condition?

A

Thromboangiitis obliterans

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28
Q

Thromboangiitis obliterans (Buerger’s disease) is associated with ___________ (activity) and __________ phenomenon.

A

Thromboangiitis obliterans (Buerger’s disease) is associated with smoking and Raynaud’s phenomenon.

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29
Q

Thromboangiitis obliterans is believed to be caused by direct toxicity against what cell type?

A

Endothelial cells

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30
Q

How is the mainstay treatment of thromboangiitis obliterans (Buerger’s disease)?

A

Smoking cessation

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31
Q

C-ANCAntibodies typically target ________-3.

P-ANCAntibodies typically target ________.

A

C-ANCAntibodies typically target proteinase-3 (PR3-ANCA).

P-ANCAntibodies typically target myeloperoxidase.

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32
Q

What condition associated with smoking may cause auto-amputation of the digits?

A

Thromboangiitis obliterans

(Buerger’s disease)

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33
Q

Describe the histopathology of thromboangiitis obliterans (Buerger’s disease).

A

Neutrophils;

microabcesses

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34
Q

What organs are affected by granulomatosis with polyangitiis (Wegener’s disease)?

A

The nasopharynx;

the lungs;

the kidneys

(think of a Weckner C connecting the nose through the lungs to the kidneys)

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35
Q

Wegener’s granulomatosis (granulomatosis with polyangiitis) is associated with increased levels of serum ________.

A

Wegener’s granulomatosis (granulomatosis with polyangiitis) is associated with increased levels of serum C-ANCA.

(Think Weckner’s)

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36
Q

Granulomatosis with polyangiitis (Wegener’s disease) is typically treated with what two medications/classes?

A

Corticosteroids

+

cyclophosphamide

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37
Q

The histopathology of granulomatosis with polyangiitis (Wegener’s disease) includes the presence of _______ cells.

A

The histopathology of granulomatosis with polyangiitis (Wegener’s disease) includes the presence of giant cells.

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38
Q

Granulomatosis with polyangiitis (Wegener’s disease) most commonly affects what patient population?

A

Men around age 40

39
Q

Granulomatosis with polyangiitis (Wegener’s disease) typically causes what renal pathology?

A

Focal necrotizing and crescentic glomerulonephritis

40
Q

What kidney pathology is associated with granulomatosis with polyangiitis (Wegener’s disease)?

A

Necrotizing glomerulonephritis

41
Q

Which small-vessel vasculitis is not associated with granuloma formation?

A

Microscopic polyangiitis

42
Q

What are the major differences between microscopic polyangiitis and granulomatosis with polyangiitis (Wegener’s disease)?

A

Microscopic polyangiitis:

no nasopharyngeal involvement; no granulomas; P-ANCA instead of C-ANCA

43
Q

How is microscopic polyangiitis treated?

A

Corticosteroids

+

cyclophosphamide

44
Q

Microscopic polyangiitis is associated with _________ infiltrate.

A

Microscopic polyangiitis is associated with neutrophilic infiltrate.

45
Q

Microscopic polyangiitis (hypersensitivity vasculitis) most commonly affects which small vessels?

A

Those in cutaneous and mucous membranes

(may include pulmonary capillitis and necrotizing glomerulonephritis)

46
Q

Which vasculitis is associated with a necrotizing capillaritis in multiple organs but NO GRANULOMAS?

A

Microscopic polyangiitis

47
Q

Which vasculitis may be drug-induced?

A

Microscopic polyangiitis (hypersensitivity vasculitis)

48
Q

Which vasculitis may be associated with smoking and Raynaud’s phenomenon?

A

Thromboangiitis obliterans (Buerger’s disease)

49
Q

Which vasculitis may be associated with HBV and/or HCV?

A

Polyarteritis nodosa

50
Q

Which small-vessel vasculitis is characterized by concurrent asthma, eosinophilia, and granulomatous disease?

A

Eosinophilic granulomatosis with polyangiitis

(Churg-Strauss)

51
Q

Churg-Strauss (eosinophilic granulomatosis with polyangiitis) typically shows a characteristic increase in ___-ANCA.

A

Churg-Strauss (eosinophilic granulomatosis with polyangiitis) typically shows a characteristic increase in P-ANCA.

52
Q

Name two vasculitides associated with elevated P-ANCA.

A

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

53
Q

Name the most common pediatric vasculitis.

A

Henoch-Shlönlein purpura

54
Q

Henoch-Schlönlein purpura usually occurs following what inciting event?

A

Upper respiratory tract infection

55
Q

Henoch-Schlönlein purpura is entirely a disorder of ______ deposition.

A

Henoch-Schlönlein purpura is entirely a disorder of IgA deposition.

56
Q

Name a small-vessel vasculitis most likely to affect the kidneys and skin of children (leading to IgA nephropathy and palpable purpura over the buttocks and legs).

A

Henoch-Shönlein purpura

57
Q

Isolated IgA nephropathy is also known as _________ disease.

A

Isolated IgA nephropathy is also known as Berger’s disease.

58
Q

Roughly 15% of individuals with cryoglobulinemia (may be associated with HCV, Mycoplasma pneumoniae, and other causes) will develop what small-vessel vasculitis?

A

Cryoglobulinemic vasculitis

59
Q

True/False.

SLE is commonly associated with an SLE-induced medium-vessel vasculitis.

A

False.

SLE is commonly associated with an SLE-induced small-vessel vasculitis.

60
Q

Endocarditis is usually a result of what?

A

Microbial infection

61
Q

Non-infectious endocarditis is caused by damage to the endocardium which causes tiny _________ that form vegetations on valves and this is called Nonbacterial Thrombotic Endocarditis or NBTE.

A

Non-infectious endocarditis is caused by damage to the endocardium which causes tiny thrombi that form vegetations on valves and this is called Nonbacterial Thrombotic Endocarditis or NBTE.

62
Q

Name a few causes of non-bacterial thrombotic endocarditis.

A

Hypercoagulable states;

malignancies;

SLE

63
Q

Infective endocarditis is usually caused by low-virulence _________ streptococci which attack valves that have had some previous damage.

A

Infective endocarditis is usually caused by low-virulence viridans streptococci which attack valves that have had some previous damage.

64
Q

Most cases of endocarditis are due to what infectious agent?

What about in IV drug use?

And on prosthetic valves?

A

Viridans streptococci (e.g. Streptococcus sanguinis);

  • Staphylococcus aureus*;
  • Staphylococcus epidermidis*
65
Q

You diagnose a patient with a case of endocarditis caused by Streptococcus gallolyticus. What is the next step in management?

A

Colonoscopy

(Streptococcus gallolyticus is the new name for S. bovis)

66
Q

What microbes are part of the HACEK causes of culture-negative endocarditis?

A

Haemophilus

Aggregatibacter

Cardiobacteria

Eikenella

Kingella

67
Q

What do HACEK, Bartonella, Candida, and Coxiella have in common as causes of endocarditis?

A

They are all culture-negative.

68
Q

What mnemonic can be used to remember the signs/symptoms of endocarditis?

A

FROM

JANE

69
Q

What are the signs/symptoms of endocarditis?

(Use the FROM JANE mnemonic.)

A

Fever

Roth’s spots

Osler’s nodes

Murmur

Janeway lesions

Anemia

Nail-bed emboli

Emboli

70
Q

The anemia associated with endocarditis is what type of anemia?

A

Anemia of chronic disease

71
Q

Identify the basic mechanism by which each of the following are caused by endocarditis:

Osler’s nodes

Janeway lesions

Roth’s spots

Pulmonary damage

Cerebral damage

Splinter hemorrhages

Glomerulonephritis

A

Identify the basic mechanism by which each of the following are caused by endocarditis:

Osler’s nodes (type III hypersensitivity)

Janeway lesions (septic emboli)

Roth’s spots (type III hypersensitivity)

Pulmonary damage (septic emboli)

Cerebral damage (septic emboli)

Splinter hemorrhages (septic emboli)

Glomerulonephritis (type III hypersensitivity)

72
Q

Which signs/symptoms of endocarditis are results of type III hypersensitivity?

A

Osler’s nodes

Roth’s spots

Glomerulonephritis

73
Q

Which signs/symptoms of endocarditis are results of septic emboli?

A

Splinter hemorrhages

Janeway lesions

(also infarcts of other organs; e.g. the lungs and brain)

74
Q

What are the two main diagnostic features of endocarditis?

A

(1) Blood cultures and (2) echocardiography

75
Q

What is the most common cause of myocarditis in the U.S.?

A

Coxsackievirus

76
Q

Paradoxical emboli occur when emboli cross from the right heart to left through what?

A

A patent ASD

77
Q

Name a common cause of myocarditis in South America.

A

Chagas disease

78
Q

Name a few immunological causes of myocarditis.

A

SLE;

polymyositis;

drug reactions

79
Q

How might myocarditis appear on an electrocardiogram?

A

Sinus tachycardia;

T-wave inversions and “saddle-shaped” ST-segment elevation

80
Q

Name a few examples of immunological pericardial disease.

A

SLE;

rheumatoid arthritis

81
Q

In high-income countries, constrictive pericarditis is typically either _________ or caused by the ____________ virus.

A

In high-income countries, pericarditis is typically either idiopathic or caused by the Coxsackie B virus.

82
Q

Name (1) an ischemic cardiac pathology and (2) a renal pathology that are both associated with pericarditis.

A

(1) Dressler syndrome

​(2) Uremic syndrome

83
Q

In low-income countries, constrictive pericarditis is typically caused by _____________.

A

In low-income countries, constrictive pericarditis is typically caused by Tuberculosis.

84
Q

Constrictive pericarditis is associated with what type of cancer treatment?

A

Radiation therapy

85
Q

Kussmaul’s sign: during inspiration, the jugular venous pressure will paradoxically _____.

A

Kussmaul’s sign: during inspiration, the jugular venous pressure will paradoxically rise.

86
Q

Kussmaul’s sign is characterized by a(n) 10 mmHg __________ (increase/decrease) in jugular venous pressure upon inspiration.

Pulsus paradoxus is characterized by a(n) 10 mmHg __________ (increase/decrease) in systolic blood pressure upon inspiration.

A

Kussmaul’s sign is characterized by a(n) 10 mmHg increase in jugular venous pressure upon inspiration.

Pulsus paradoxus is characterized by a(n) 10 mmHg decrease in systolic blood pressure upon inspiration.

87
Q

On ECG, constrictive pericarditis often manifests as what?

A

Widespread ST segment elevation in several leads

88
Q

Hemangiomas are most commonly found in which organs?

A

Skin;

liver

89
Q

Do hemangiomas blanch with pressure?

A

Yes.

(The blood is still within vessels that can be compressed.)

90
Q

Name a few common sites of angiosarcoma development.

A

Skin;

breast;

liver

91
Q

Hepatic angiosarcomas are associated with what three substances?

A

PVC;

arsenic;

Thorotrast (thorium contrast)

92
Q

Do the lesions associated with Kaposi sarcoma blanch with pressure?

A

No.

(The blood is within the cutaneous interstitium, NOT within vessels that can be compressed.)

93
Q

Do purpura blanch with pressure?

A

No.

(The blood is within the cutaneous interstitium, NOT within vessels that can be compressed.)

T2 - Phase 2 - Systems Modules (II) (22 decks)

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