Vasculitides, Hypertensive diseases and hemodynamics

Question 1

what is vasculitis?

Answer 1

Inflammation attacking the wall of the vessel

Question 2

examples of large vessels

Answer 2

aorta and its major branches and the analogous veins

Question 3

examples of medium vessels

Answer 3

main visceral

Question 4

examples of small vessels

Answer 4

intraparenchymal

Question 5

T/F: all 3 major categories of vasculitis can affect any size artery

Answer 5

true

Question 6

Small vessel vasculitis predominantly affects small vessels, but –

Answer 6

medium arteries and veins may be affected

Question 7

all vessel types may be affected by –

Answer 7

variable vessel vasculities

Question 8

large vessel vasculitis

Answer 8

Giant cell (temporal) arteritis (GCA)

Takayasu arteritis

Question 9

medium vessel vasculitis

Answer 9

Kawasaki disease

Polyarteritis nodosa (PAN)

Question 10

small vessel vasculitis

Answer 10

Microscopic polyangiitis (MPA)

Granulomatosis with polyangiitis (aka Wegener’s granulomatosis, GPA)

Churg-Strauss syndrome (CSS)

Question 11

all size vessels vasculitis

Answer 11

Behçet’s disease

Question 12

Most common systemic vasculitis in older adults (rare before 50 years of age)

Answer 12

giant cell/temporal arteritis

Question 13

symptoms of giant cell arteritis

Answer 13

headache, polymyalgia rheumatic (stiffness), visual loss, pain with chewing (jaw claudication)

Question 14

histology of giant cell arteritis

Answer 14

Chronic inflammation with multinucleated giant cells

don’t need giant cells to be diagnosed

Question 15

gold standard for diagnosis of giant cell arteritis

Answer 15

temporal artery biopsy

Question 16

another name for Takayasu arteritis

Answer 16

pulseless disease

Question 17

Takayasu arteritis mostly affects –

Answer 17

women < 40 years old

Question 18

what structure does the Takayasu arteritis usually involve?

Answer 18

aortic arch +/- great vessels

Question 19

Takayasu arteritis: inflammation leads to –>

Answer 19

vessel wall thickening and stenosis

Question 20

early symptoms of Takayasu arteritis

Answer 20

systemic phase: fever, malaise, arthralgia, myalgia

Question 21

late occlusive phase of Takayasu arteritis causes symptoms due to –

Answer 21

ischemia (low O2 to tissues)

Question 22

Takayasu arteritis is histologically similar to –

Answer 22

giant cell arteritis

Question 23

– rarely affects arteries

Answer 23

immune complex small vessel vasculitis

Question 24

who does polyarteritis nodosa affect?

Answer 24

(systemic vasculitis of) adults

Question 25

what structures does polyarteritis nodosa involve?

Answer 25

small to medium arteries, typically renal, GI, skin

Question 26

acute phase of polyarteritis nodosa

Answer 26

Segmental transmural necrotizing acute inflammation with fibrinoid necrosis and luminal thrombosis

Question 27

chronic phase of polyarteritis nodosa

Answer 27

Fibrous thickening of vessel wall and aneurysm formation at branch points

Question 28

stages of activity for polyarteritis nodosa

Answer 28

All stages of activity may coexist in same or different vessels

Question 29

clinical manifestations of polyarteritis nodosa are due to --

Answer 29

distal organ ischemia/infarction

Question 30

prevalence of Wegener granulomatosis

Answer 30

affects males > females

Question 31

Wegener granulomatosis peak incidience in --

Answer 31

5th decade

Question 32

histologic features of Wegener granulomatosis

Answer 32

``` “blue” necrosis Vasculitis of small to medium-sized vessels Granulomatous inflammation Eosinophils Neutrophilic microabscesses ```

Question 33

what is present in 95% patients with active Wegener granulomatosis

Answer 33

C-ANCA (autoantibody)

Question 34

Wegener granulomatosis often affects --

Answer 34

lung and kidney

Question 35

symptoms of Wegener granulomatosis

Answer 35

Ulcerative/destructive lesions in sinonasal area and oral cavity

Question 36

what is microscopic polyangiitis?

Answer 36

Necrotizing vasculitis affecting small arteries, arterioles, capillaries, and venules

Question 37

what organs does microscopic polyangitiis affect?

Answer 37

kidney (90%), lung, skin, GI, nervous system, | ear/nose/throat (30%)

Question 38

ENT symptoms of microscopic polyangitiis

Answer 38

mouth ulcers, epistaxis, sinusitis

Question 39

ANCA-association of microscopic polyangiitis

Answer 39

P-ANCA/anti-MPO (70%)

Question 40

what is not associated with microscopic polyangiitis?

Answer 40

giant cells, granulomas, immunoglobulin deposition