Vasculitis Flashcards
Vasculitis is an autoimmune inflammatory condition where immune cells mistake antigens on the endothelium for foreign antigens. What is the called?
1 - immune tolerance
2 - molecular mimicry
3 - cross reactivity
4 - all of the above
2 - molecular mimicry
In vasculitis damaged endothelium tries to repair itself. Which of the does not occur during this healing process?
1 - tissue factor and collagen are exposed to coagulation factors
2 - increased risk of coagulation
3 - walls become thinner and weaker, increasing risk of aneurysms
4 - fibrin is deposited into vessel walls
5 - walls become more elastic
5 - walls become more elastic
- walls actually become stiffer due to all the other factors such as fibrin deposits
Which of the following is NOT a general symptom of vasculitis?
1 - fever
2 - weight loss
3 - anaemia
4 - fatigue
5 - myalgia/arthralgia
3 - anaemia
There are generic symptoms patients with vasculitis can present with, such as fever, weight loss and fatigue. Which of the following specific organs can be affected?
1 - ENT = nasal bridge collapse
2 - Skin = purpura rash (non-blanching), can cause necrosis
3 - Oral = mucus membrane ulcers, necrosis and haemorrhage in gums
4 - Neural = cerebral vasculitis (white matter on T2 scan)
5 - all of the above
5 - all of the above
Vasculitis is an autoimmune inflammatiion of the blood vessels. Vasculitis can be classified into 3 categories. Which of the following is NOT one of these categories?
1 - Large Vessel
2 - Medium Vessel
3 - Moderate Vessel
4 - Small Vessel
3 - Moderate Vessel
- Large Vessel = Takayasu’s, Giant Cell arteries
- Medium Vessel = Polyarteritis nodosa, Kawasaki’s
- Small = Henoch Schonlein purpura, EGPA and GPA, MPA
What is the most common vasculitis?
1 - Takayasu’s
2 - Giant Cell arteritis
2 - Polyarteritis nodosa
4 - Kawasaki’s
2 - Giant Cell arteritis
- form of large vessel vasculitis
Giant cell arteritis, a form of large vessel vasculitis is the most common vasculitis. What age does this occur in most commonly?
1 - 20-35 y/o
2 - 35-50 y/o
3 - >50 y/o
4 - >60 y/o
- > 50 years
- peak 70-79
Patients with giant cell arteritis can experience headaches and tenderness of the skull. Which blood vessel and its location is most commonly affected?
1 - internal carotid artery near the ear
2 - temporal artery at temple of head
3 - ophthalmic artery near eyes
4 - facial artery near mandible bone
2 - temporal artery at temple of head
Patients with giant cell arteritis can experience headaches and tenderness of the skull, with the temporal artery at temple of head most commonly affected. However, if the ophthalmic artery near eyes is affected what can this cause?
1 - blindness
2 - diplopia
3 - painless
4 - all of the above
4 - all of the above
- if not treated quickly with corticosteroids this can cause ischaemia and blindness
Patients with giant cell arteritis can experience headaches and tenderness of the skull, with the temporal artery at temple of head most commonly affected. However, if the facial artery near mandible bone is affected what can this cause?
1 - pain called claudication
2 - paralysis
3 - hypoesthesia
4 - all of the above
1 - pain called claudication
What blood measures can be elevated in giant cell arteritis, a form of large cell vasculitis?
1 - ESR and creatine kinase
2 - CRP and lactate dehydrogenase
3 - CRP and creatine kinase
4 - CRP and ESR
4 - CRP and ESR
- ESR is really high
If a biopsy was taken from a patient with suspected giant cell vasculitis we would see giant cells. What are these cells though?
1 - megakaryocytes
2 - lymphocytes grouped together
3 - reed-sternberg cells
4 - monocytes packed together
4 - monocytes packed together
- form a granuloma
- found in internal elastic lamina
In giant cell arteritis, a form of large vessel vasculitis why can ultrasound and/or biopsy not be definitive form of diagnosis when assessing the temporal artery?
1 - operator dependent skill set
2 - part of artery sampled may be healthy
3 - not sufficient to effectively diagnose
2 - part of artery sampled may be healthy
- vasculitis is segmental, so parts are healthy
- so may miss the damaged arteries
How can we diagnose vasculitis using imagery?
1 - biopsy or ultrasound
2 - MRI
3 - X-ray
4 - CT scan
1 - biopsy or ultrasound
How can we treat giant cell arteries?
1 - NSAIDS given immediately
2 - strong dose of steroids given immediately
3 - DMARDs given immediately
4 - biologics given immediately
2 - strong dose of steroids given immediately
Takayasus arteritis is a form of large vessel arteritis. The presentation is very similar to giant cell arteritis, except for which 2 key differences?
1 - affects asian women <40 y/o
2 - affects large vessels of legs only
3 - affects men <40 y/o
4 - affects the blood vessels branching off the aortic arch, specifically the branches
1 - affects asian women <40 y/o
4 - affects the blood vessels branching off the aortic arch, specifically the branches
Takayasus arteritis is a form of large vessel arteritis that typically affects the blood vessels branching off the aortic arch, specifically the branches. What symptoms can this present with?
1 - weak or lack of pulses in upper extremities
2 - visual symptoms
3 - neurological symptoms
4 - all of the above
4 - all of the above
If a biopsy was taken from a patient with suspected takayasus cell vasculitis we would see giant cells. What are these cells though?
1 - megakaryocytes
2 - lymphocytes grouped together
3 - reed-sternberg cells
4 - monocytes packed together
4 - monocytes packed together
- form a granuloma
- found in internal elastic lamina
- this is the same as in giant cell arteritis
In giant cell arteritis, a form of large cell vasculitis, why would we want to do a chest X-ray?
1 - ensure lungs are ok
2 - common carotid artery could be affected
3 - aorta could be inflamed
4 - check on the heart
3 - aorta could be inflamed
How can we treat takayasus cell arteries?
1 - NSAIDS given immediately
2 - strong dose of steroids given immediately
3 - DMARDs given immediately
4 - biologics given immediately
2 - strong dose of steroids given immediately
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 the antigens present for what?
1 - hepatitis B
2 - bacteria
3 - hepatitis C
4 - multiple myeloma
1 - hepatitis B
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
4 - all layers
- has a transmural effect like crohns
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
4 - fibrinosed vessel wall becomes weak and is at risk of aneurysms
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 - all of the above
5 - all of the above
- essentially can cause end organ ischaemia and the symptoms relate to this
How can we treat Polyarteritis nodosa (PAN) arteries?
1 - NSAIDS given immediately
2 - strong dose of steroids given immediately
3 - DMARDs given immediately
4 - biologics given immediately
2 - strong dose of steroids given immediately