Pathology of Vasculitis

Question 1

What population is generally affected by Kawasaki disease?

Answer 1

Young children and infants

Question 2

What is a longterm complication of Kawasaki disease?

Answer 2

Damage to coronary arteries that may cause acute MI in children

Question 3

How can microscopic polyangiitis and polyarteritis nodosa be differentiated histologically?

Answer 3

Granulomatous inflammation is absent with microscopic polyangiitis

Question 4

What population is most affected by Henoch-Schonlein purpura (IgA vasculitis) and when?

Answer 4

Children 1-15yo with peak incidence in the spring

Question 5

These antibodies reflect the degree of inflammatory activity in vasculitis.

Answer 5

Antineutrophilic Cytoplasmic Antibodies (ANCA)

Question 6

What population is typically affected by giant cell arteritis?

Answer 6

Older adults ( >50yo)

Question 7

These antibodies are present in SLE and Kawakasi disease and may predispose individuals to certain types of vasculitis.

Answer 7

Anti-endometrial cell antibodies

Question 8

What population is generally affected by Takayasu arteritis?

Answer 8

Females under 40yo

Question 9

What is the leading cause of acquired heart disease in North America?

Answer 9

Kawasaki disease

Question 10

What anitbodies are associated with granulomatosis with polyangiitis (Wegener granulomatosis)?

Answer 10

PR3-ANCA (c-ANCA)

Question 11

How do antineutrophilic cytoplasmic antibodies contribute to vasculitis?

Answer 11

ANCAs directly activate neutrophils to release ROS and proteolytic enzymes, causing destructive interactions between inflammatory and endothelial cells

Question 12

What vessels are impacted by polyarteritis nodosa?

Answer 12

Small and medium arteries. Smaller arteries, capillaries, venules, and pulmonary vessels are spared

Question 13

What infections are most associated with infectious arteritis?

Answer 13

Bacterial pneumonia and TB. Common species include Pesudomonas, Aspergillus, Mucor

Question 14

Permanent blindness is a complication of this type of vasculitis.

Answer 14

Giant cell arteritis

Question 15

What is the primary cause of morbidity and mortality due to Churg-Strauss (allergic granulomatosis and angitiis?

Answer 15

Coronary arteritis and myocarditis due to eosinophilic infiltration of the heart

Question 16

Hepatitis B antigen is associated with what type of vasculitis?

Answer 16

Polyarteritis nodosa

Question 17

What is the pathophysiology of Takayasu arteritis?

Answer 17

Granulomatous vasculitis of medium and large arteries that may involve with aorta and aortic arch and its branches

Question 18

This type of vasculitis generally follows a viral URI or pharyngitis due to group A strep.

Answer 18

Henoch-Schonlein purpura (IgA vasculitis)

Question 19

What antibodies are present with Churg-Strauss (allergic granulomatosis and angitiis?

Answer 19

MPO-ANCA (p-ANCA)

Question 20

What antibodies are present in Kawasaki disease?

Answer 20

Anti-smooth muscle and anti-endothelial antibodies

Question 21

What antibodes are present with microscopic polyangiitis?

Answer 21

MPO-ANCA (p-ANCA)

Question 22

What is a potential complication of infectious arteritis?

Answer 22

Mycotic aneurysms (weakening of vessel wall due to infection)

Question 23

What histologic findings are presnet with Kawasaki disease?

Answer 23

Segmental transmural necrotizing inflammation with fibrinoid necrosis (same as polyarteritis nodosa)

Question 24

What is the pathophysiology of giant cell arteritis?

Answer 24

Granulomatous inflammation with fragmentation of the internal elastic membrane

Question 25

What vessels are involved in microscopic polyangiitis?

Answer 25

Arteries, capillaries, and venules

Question 26

This type of vasculitis is characterized by necrotizing vasculitis involving the lungs and upper respiratory tract.

Answer 26

Granulomatosis with polyangiitis (Wegener granulomatosis)

Question 27

A 30yo Asian woman presents with confusion, diminished radial pulse, cold arms, and vision problems. The attending tells you she has a type of vasculitis. What is the diagnosis?

Answer 27

Takayasu arteritis - note diminished upper extremity pulse, occular symptoms, and potential neuro symptoms

Question 28

What symptoms are specific for Churg-Strauss (allergic granulomatosis and angitiis?

Answer 28

Allergic rhinitis, bronchial asthma, eosinophilia

Question 29

This type of vasculitis is most common in male smokes under 35yo.

Answer 29

Thromboangiitis obliterans (Buerger disease)

Question 30

Glomerulonephiritis and pulmonary capillaries are potential complications of this type of vasculitis with MPO-ANCA (p-ANCA).

Answer 30

Microscopic polyangiitis - these are primary differences between microscopic polyangiitis and PAN

Question 31

What is the pathophysiology of thromboangiitis obliterans (Buerger disease)?

Answer 31

Inflammation permeates the vessel wall leading to thrombosis that occludes the lumen and contains microabscesses

Question 32

What is the most common cause of death from polyarteritis nodosa?

Answer 32

Vasculitis of the renal artery

Question 33

What is the clinical presentation of polyarteritis nodosa?

Answer 33

Rapidly accelerating hypertension, abdominal pain, and GI hemorrhage in a young adult

Question 34

What are complications of granulomatosis with polyangiitis (Wegener granulomatosis)?

Answer 34

Glomerulonephritis, sinusitis, hemoptysis due to alveolar hemorrhage

Question 35

What are the two types of antineutrophilic cytoplasmic antibodies?

Answer 35

Anti-proteinase 3 (c-ANCA) & Anti-myeloperoxidase (p-ANCA)

Question 36

What population is most affected by polyarteritis nodosa?

Answer 36

Young adults

Question 37

This type of vasculitis is characterized by segmental transmural necrotizing inflammation with fibrinoid necrosis in young adults.

Answer 37

Polyarteritis nodosa