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FINALS > VASCULAR > Flashcards

VASCULAR Flashcards

1
Q

What are the small vessel Vasculitides?

A

P-ANCA +ve:

  • Goodpasture’s
  • 40% Microscopic polyangitis
  • 60% Churg-Strauss
  • 25% Granulomatosis w/ polyangitis
  • Polyarteritis Nodosa

C-ANCA +ve:

  • 90% Granulomatosis w/ polyangitis
  • 30% of Microscopic polyangitis

ANCA -ve:

IgA ICs
Henoch Schonlein Purpura

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2
Q

What is Microscopic polyangitis?

A

RENAL impairment: Raised creatinine, Haemautria and Proteinuria

P-ANCA

LUNGS: cough, haemoptysis and dyspnoea

SYSTEMIC: lethargy , myalgia, weight loss, fever

PALPABLE PURPURIC RASH

MONEURITIS MULTIPLEX

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3
Q

What is Churgg-Strauss?

A

Eosinophilic granulomatosis with polyangitis

P-ANCA
a-2-globulin

Stage 1:

  • Allergy
  • Bronchial ASTHMA (may be precipitated by Leukotrine Receptor Antagonists) CXR shows pulmonary infiltrates
  • Allergic rhinitis: inflammation of the nasal passage ->polyps
  • Non-specific fever, malaise, anorexia and weight loss

Stage 2: Eosinohillia >10%
Extravascular granuloma formation

Stage 3: Necrotising Vasculitis

  • Organ damage
  • Kidney failure
  • Petechial rash: palpable purpura and cut/subcut nodules
  • Mononeuritis Multiplex: tingling in hands and feet
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4
Q

What is Mononeuritis Multiplex?

A

Peripheral neuropathy, isolated damge to >2 nerve areas, sensory and motor, painful

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5
Q

What is Granulomatosis with Polyangitis?

A

Necrotising granulomatous vasculitis

C-ANCA
Classic triad: U+L respiratory tract and renal involvement

RESPIRATORY tract:
Upper:
- Epistaxis
- Sinusitis (mucosal thickening, air-fluid levels)
- Nasal crusting
SADDLE-SHAPED NOSE

Lower:

  • Dyspnoea
  • Haemoptysis
  • CXR- Ill-defined nodules with cavitation (central lucency) air and fluid
CUTANEOUS:
Vascular lesions:
- ulceration
- nodules
- purpura

EYE: proptosis

CRANIAL NERVE LESIONS

Manage with:

  • steroids
  • cyclophosphamide
  • plasma exchange
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6
Q

What is Henock Schonlein Purpura?

A

Children after infection

  • Palpable purpuric rash with localised oedema over buttocks and extensors
  • abdominal pain
  • Polyarthritis and arthralgia
  • IgA nephropathy -> haematuria and renal failure

Treat: analgesia, support kidneys
Usually self-limiting by 1/3 relapse

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7
Q

What are the types of Mesenteric Ischaemia?

A

Acute Mesenteric Ischameia

Chronic Mesenteric Ischaemia

Ischaemic Colitis

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8
Q

What are the predisposingfactors for Mesenteric Ischaemia?

A 
Age
AF
Other causes of emboli:
- Endocarditis
- Malignancy 
CVD risk factors:
- Smoking
- HTN
- Diabetes 
Cocaine
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9
Q

What are the features of Mesenteric Ischaemia?

A

Abdominal pain
Rectal bleeding
Diarrhoea
Fever

Raised WBC with Lactic Acidosis

ECG consistent with AF

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10
Q

What is Acute Mesenteric Ischaemia?

A

Occlusive embolism of an artery which supplies the small bowel e.g. Superior Mesenteric Artery
Often have a history of AF
Severe onset of pain out-of-keeping with exam findings
Urgent surgery, poor prognosis

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11
Q

What is Chronic Mesenteric Ischaemia?

A

Relatively rare, non-specific ’intestinal angina’

Causes colicky, intermittent abdominal pain

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12
Q

What is Ischaemic Colitis?

A

Acute but transient compromise in blood supply to the large bowel leading to:
- Inflammation
- Ulceration
- Haemorrhage
Occurs in ‘watershed’ areas such as splenic flexure that are located at the borders of the territory supplied by superior and inferior mesenteric arteries
AXR: ‘Thumb printing’ due to mucosal oedema/haemorrage
Supportive management
?surgery if peritonitic/ perforated/ haemorrhage

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13
Q

What is the Aetiology of Aortic Dissection?

A

CHAT

CT disease
Congenital e.g. coarctation
HTN
Aortic atherosclerosis/ aortitis (Takayasu's aortitis, tertiary syphilis)
Trauma
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14
Q

How does Aortic Dissection present?

A

SCAR

Sudden tearing, central pain radiating to back
Coronary artery occlusion-MI or angina or
Carotid obstruction-TIA (hemiparesis, dysphasia, blackouts)
Anterior spinal artery can lead to paraplegia
Renal artery (left) (anuria or renal failure)

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15
Q

How does Aortic dissection present?

A

CHAMP

COLLAPSING PULSE and an early DIASTOLIC murmur above the aortic area: AORTIC REGURG
Hypertension and a discrepancy in the blood pressure between the arms of >20 mmHg
Arm pulses are unequal
Murmur on the back inferior to left scapula, descends to abdomen
Palpable abdominal mass

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16
Q

What are the Medium Vessel Vasculitides?

A

Buerger’s

Polyarteritis Nodosa

Kawasaki’s

17
Q

What is Buerger’s disease?

A

THROMBOANGITIS OBLITERANS diagnosed by angiogram which shows ACUTE HYPERCELLULAR OCCLUISIVE THROMBOSIS

Affects young male smokers

Ischaemia of extremities: ulceration, claudication, Raynaud’s, absent foot pulses

Superficial thrombophlebitis

18
Q

What is Polyarteritis Nodosa?

A

Affects middle aged men ASSOCIATED WITH HEP B

P-ANCA

Systemic features (fever, malaise, arthralgia, weight loss) 
HTN
Testicular pain
Renal 70% HAEMATURIA and MICROANEURYSMS
NECROTISING VASCULITIS

LIVEDO RETICULARIS mottling, purple-lace, vascular pattern

Can cause pancreatitis

19
Q

What is Kawasaki’s disease?

A

Children

HIGH GRADE FEVER RESISTANT TO ANTIPYRETICS

Conjunctival infection
Redness
Adenopathy (cervical lymphadenopathy)
Strawberry tongue red and cracked lips
Hands (palms and soles of feet)

CORNONARY ARTERY ANEURYSM (ECHO)

Give HIGH-DOSE ASPIRIN (usually contraindictaed in children due to Reyes) and IV Ig

20
Q

What are the Large Vessel Vasculitides?

A

Takayasu’s

Giant Cell Arteritis

21
Q

What is Takayasu’s disease?

A

Young (20-40), Asian, Female

Aortic Arch syndrome or pulseless disease:
Occlusion of the aorta and bracnhes-granulomatous thickening of the aortic arch
Aortic Regurgitation in 20%
Obliterative: absent limb pulses (U. Limbs mainly) claudication

  • Systemic (fever, malaise, raised ESR in acute)
  • Unequal BP in upper limbs
  • Carotid bruit
  • Intermittent claudication
  • Pulselessness-absent radial pulse
  • Massive intimal fibrosis: stenosis of renal artery, thrombosis and aneurysms

Steroids

22
Q

What is Giant Cell Arteritis?

A

Overlaps with Polymyalgia Rheumatica

CRANIAL/TEMPORAL arteritis affects CERTAIN SECTIONS - SKIP LESIONS GRANULOMATOUS

> 60 F

  • Rapid onset
  • Headache
  • Jaw claudication
  • Visual distrubances (anterior ischaemic optic neuropathy)
  • Tender, palpable temporal artery (biopsy for skip lesions)
  • Systemic: lethargy, depression, low grade fever, anorexia, night sweats

Raised ESR and CRP

Dramatic response to high dose prednisolone

23
Q

What is Polymyalgia Rhuematica?

A

GIANT CELL VASCULITIS w SKIP LESIONS, MUSCLE BED ARTERIES most affected
>60

  • Rapid onset (<1 month)
  • Morning stiffness of proximal muscles with aching and mild polyarthralgia
  • Systemic: lethargy, depression, low grade pyrexia, anorexia, night sweats
High ESR (>40)
Low CDG+ T cells
Dramatic response to high dose prednisolone
24
Q

What is Behcet’s syndrome?

A

Complex, MULTI-SYSTEM autoimmune of ARTERIES and VEINS

East mediterranean young (20-40) men, FHx

Traid of:

  • GENITAL ULCERS (painful)
  • ORAL ULCERS
  • ANTERIOR UVEITIS
  • Thrombophlebitis
  • Arthritis
  • Neurological: ASEPTIC MENIGITIS
  • GI-Colitis, diarrhoea and pain
  • ERYTHEMA NODOSUM
  • DVT

PATHERGY TEST: needle prick becomes inflamed with pustule

FINALS (13 decks)

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