Pathology Flashcards
You have a 62 y/o f patient c/o headache, and jaw pain. Blood test reveal an elevated ESR and CRP. You suspect she may have some arthritis and on physical exam when looking at her scalp you notice one of the arteries in her head is a bit elevated. Based on these findings how might you treat her?
How might you reclassify the name of this condition if your patient had RA?
High dose corticosteroids, prior to having a biopsy of her temporal artery, b/c of the potential for blindness if this vasculitis affects her opthalmic artery.
If a patient has joint problems this can be classified as polymyalgia rheumatica.
This condition affects young women, often asian and results in granulomatous thickening of the aortic arch and proximal great vessels. What is it?
A) PAN B) Wegeners C) Temporal (giant cell) arteritis D) HSP E) Takayasu arteritis
E- Takayasu arteritis aka pulseless disease. Very similar to Temporal arteritis. Patient may also have visual changes and myalgias.
You have a 28 y/o m patient present with abdominal pain and with melena in his stool. Lungs are CTA bilaterally, he has RRR, bp 144/90. History is significant for Hep b a few years back. Blood test from a recent doctors visit indicated elevated CK, BUN and other abnormal renal labs. What test should you order and what are you looking for?
A) pelvic x-ray, looking for renal stenosis
B) Arteriogram looking for microaneurysms
C) CT scan of the abdomen looking for ischemia in the bowel
D) More blood work looking for IgA elevation
B- Arteriogram looking for microaneurysms.
This is Polyarthritis nodosa, characterized by the “string of pearls” in the kidneys which are multiple aneurysms between fibrosed vasculature. This condition is immune complex mediated and results in transmural inflammation of the arterial wall with fibrinoid necrosis.
Treat with corticosteroids and cyclophosphamide
A 35 y/o m patient with a 12 yr pack history is c/o painful hands that he thinks maybe the early signs of arthritis. You notice his finger tips are a little blue, what’s your tentative diagnosis?
Could be Raynauds, but with his complaints of pain and his smoking history it maybe burger disease. The pain in his hand is likely claudication and can lead to gangrene and autoamputation of his digits.
A 38 y/o f comes into your office concerned about some recent blood she coughed up, thinking she might have cancer of the lung or something equally serious. She has an unremarkable history with a few recent episodes of sinusitis which she mentioned were self resolving after a few weeks. She also took some antibiotics for a suspected UTI last month because she had some blood in her urine.
What test would you order to confirm your suspicion of a vasculitis? Why?
Looks like Wegeners (granulomatosis with polyangiitis)
WeCeners- C is for: Cyclophosphamide, C-ANCA, and C shaped distribution of problems: nasopharyx, lungs, and kidneys (draw a C to connect these on a stick figure).
Test is to add her serum to a slide with ethanol fixed PMNs and see if Ab form and where. If they form in the cytoplams of the PMNs then she has C-ANCA (cytoplasmic anti-neutrophic cytoplasmic antibodies).
This necrotizing vasculitis involves the lung, kidneys, skin and has a palpable purpura. P-ANCA , No granulomas, and does not affect the nasopharyx. What is it?
A) PAN
B) Wegeners
C) Microscopic polyangiitis
D) Churg-strauss
C- Microscopic polyangiitis
How do you distinguish Microscopic polyangiitis from Churg-strauss syndrome?
Microscopic polyangiitis and Churg-Strauss syndrome both have: P-ANCA, involve the kidneys and can lead to pauci immune glomerulonephritis.
Churg Strauss is unique because it has: No granulomas, and is associated with Asthma and eosinophilia.
You met a guy in med school that says as a kid he got over an URI one winter and then got a crazy purple rash on his ass and legs and his stomach hurt a lot and he had blood in his stool. He felt achy for a while but his symptoms eventually resolved on their own. What is the reason why this condition followed his URI?
A) Increase in WBC count lead to an autoimmune response
B) Increase in IgA lead to immune complex deposition in his kidneys
C) Bacterial infection of the lungs is a precursor to Churg-Strauss syndrome which he likely had
D) Weakened immune system left his susceptible to a viral infection of the GI tract such as b.fragilis.
B- Increase in IgA. He had HSP and his vasculitis was secondary to IgA complex deposition.
You’re helping the coroner with an autopsy of a 3 y/o asian child who had an MI. You notice a rash on the childs hands and around their mouth and creepily they have sort of red eyes. What simple treatment may have saved this child’s life?
Aspirin, they had kawasaki disease.
Fever, cervical lymphadenitis, and red rash on hands, feet, mouth, stawberry tounge.
Buerger disease is also known as?
Thromboangiitis obliterans
Wegeners disease is also known as?
Granulomatosis with polyangiitis
