Polyarteritis Nodosa - MEDIUM CELL

Question 1

Polyarteritis nodosa (PAN) is typically a medium size vessel (can affect small arteries as well), but can affect small vessels as well. What is the incidence of PAN?

1 - 3.1/100,000
2 - 31/100,000
3 - 311/100,000
4 - 3111/100,000

Answer 1

1 - 3.1/100,000

1 - hepatitis B

Question 2

Polyarteritis nodosa (PAN) is typically a medium size vessel, but can affect small vessels as well. Is this more common in men or women?

Answer 2

• men
• 1.5 :1

Question 3

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN immune cells damage the endothelium of blood vessels confusing self antigens with foreign antigens. Linked with all of the following, which is PAN most commonly linked with as being a key cause?

1 - hepatitis B
2 - hairy cell leukaemia
3 - hepatitis C
4 - all are equal

Answer 3

1 - hepatitis B

Question 4

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN which layers of the blood vessels are affected?

1 - tunic intima
2 - tunica media
3 - tunica adventitia
4 - all layers

Answer 4

4 - all layers
- has a transmural effect like crohns
- typically affects muscular arteries

Question 5

Does Polyarteritis nodosa (PAN) affect arteries and veins?

Answer 5

• no
• just arteries

Question 6

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN there is a transmural affect of all layers. Which of the following can happen to the inflamed blood vessels?

1 - blood vessels become thicker
2 - vessel wall and intimal proliferate
3 - luminal narrowing
4 - reduced blood flow
5 - increased risk of thrombosis
6 - all of the above

Answer 6

6 - all of the above

• homogeneous, eosinophilic appearance is referred to as fibrinoid necrosis

Question 7

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN there is a transmural affect of all layers. What then happens to the vessel wall?

1 - leads to vascular wall death
2 - fibrosis is laid down
3 - blood vessels become stiff called fibrinoid necrosis
4 - fibrinosed vessel wall becomes weak and is at risk of aneurysms

Answer 7

4 - fibrinosed vessel wall becomes weak and is at risk of aneurysms

Question 8

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN there is a transmural affect of all layers. This can cause vessel wall death that become stiff, narrow and at risk of aneurysm. Which of the following is an example of what PAN can cause?

1 - hypertension if renal arteries are involved
2 - mesenteric ischemia causing pain and bleeding if mesenteric artery is affected
3 - neurological symptoms if blood vessels to the brain are affected
4 - skin lesions if blood vessels supplying the skin are affected
5 - systemic symptoms (fever, malaise, weight loss)
6 - all of the above

Answer 8

6 - all of the above
- essentially can cause end organ ischaemia and the symptoms relate to this

Question 9

Polyarteritis nodosa (PAN) is a vasculitis that affects medium size blood vessels, particularly muscular arteries. In PAN there is a transmural affect of all layers. This can cause vessel wall death that become stiff, narrow and at risk of aneurysm. All of the following can occur in PAN, but which 2 are the most common?

1 - hypertension if renal arteries are involved
2 - mesenteric ischemia causing pain and bleeding if mesenteric artery is affected
3 - neurological symptoms if blood vessels to the brain are affected
4 - skin lesions if blood vessels supplying the skin are affected
5 - systemic symptoms (fever, malaise, weight loss)
6 - renal disease
7 - GIT disease
8 - Arthralgia and myalgia

Answer 9

5 - systemic symptoms (fever, malaise, weight loss) =85% of patients

3 - neurological symptoms if blood vessels to the brain are affected = 75% of patients

Question 10

When trying to diagnose Polyarteritis nodosa (PAN) arteries, which 2 markers are commonly raised?

1 - iron
2 - ESR
3 - albumin
4 - CRP

Answer 10

2 - ESR
4 - CRP

• both raised in inflammation

Question 11

When trying to diagnose Polyarteritis nodosa (PAN) arteries, which 2 of the following may be present on Arteriography (X-ray with dye of blood vessels)?

1 - microaneurysms
2 - abrupt occlusions
3 - aortic dissection
4 - necrosis

Answer 11

1 - microaneurysms
2 - abrupt occlusions

• renal biopsy may show pathognomonic inflammation of the medium-sized arteries

Question 12

How can we treat non severe Polyarteritis nodosa (PAN)?

1 - NSAIDS given immediately
2 - glucocorticoids and a steroid-sparing agent
3 - DMARDs given immediately
4 - biologics given immediately

Answer 12

2 - glucocorticoids and a steroid-sparing agent

If patient has viral hepatitis-associated diseasewith mild PAN initial treatment with antivirals only

Question 13

How can we treat severe Polyarteritis nodosa (PAN)?

1 - NSAIDS given immediately
2 - glucocorticoids and a steroid-sparing agent
3 - DMARDs given immediately
4 - glucocorticoids and Cyclophophamide

Answer 13

4 - glucocorticoids and Cyclophophamide

Question 14

What is the 5 year survival of treated polyarteritis nodosa (PAN)?

1 - 100%
2 - 80%
3 - 60%
4 - 40%

Answer 14

2 - 80%

Question 15

Once treated, do patients with polyarteritis nodosa (PAN) typically relapse?

Answer 15

• no

Question 16

Which of the following is NOT associated with increased mortality in polyarteritis nodosa (PAN)?

1 - older age
2 - male gender
3 - kidney failure
4 - mesenteric and cardiac infarctions

Answer 16

2 - male gender