Vasculitis

Question 1

What is Type 3 immune mechanism?

Answer 1

Immune complex deposition formed locally or deposited in areas of increased vascular permeability

Question 2

What happens to complement and neutrophils in type 3?

Answer 2

Fixation of complement and infiltration of neutrophils

Question 3

In severe cases what does type 3 cause?

Answer 3

Fibrinoid necrosis

Question 4

Examples of type 3?

Answer 4

SLE
Serum sickness
Cryoglobulinemia
Chronic viruses

Question 5

Cytoplasmic ANCA indicative of what?

Answer 5

Wegener’s granulomatosis

Question 6

Perinuclear ANCA indicative of what?

Answer 6

Micro PAN

Question 7

Are ANCA’s intrinsic part of pathogenesis or correlated phenomenon?

Answer 7

Unclear

Question 8

What do ANCA’s serve as?

Answer 8

Diagnostic clinical marker

Question 9

Granulomas associated with what?

Answer 9

Type 2 or 3 processes

Question 10

Type 4 mechanisms present as?

Answer 10

Herpes and measles with no vasculitis

Question 11

What infiltrate is there in type 2?

Answer 11

Leukocytes with direct cytotoxicity of endothelium

Question 12

Type 3 infiltrates?

Answer 12

Immune complex deposition, complement fixation, and neutrophils

Question 13

Type 4 infiltrate?

Answer 13

Monocytic infiltrate

Question 14

What is associated with collections of eosinophils?

Answer 14

Allergic angiitis/Churg-Strauss syndrome

Question 15

What are leukoclastic lesions?

Answer 15

Fragmentation of neutrophils

Question 16

Where are granulomas in vascular wall?

Answer 16

Within vessel wall or directly adjacent to wall

Question 17

What is fibrinoid necrosis?

Answer 17

Necrosis of cells within the vessel wall + accumulation of fibrin

Question 18

Fibrinoid necrosis accompanies what?

Answer 18

Immune complex deposition and infiltration of leukocytes as in polyarteritis nodosa

Question 19

How does hyalin accumulate?

Answer 19

Secondary to endothelial injury
Leakage of fibrin and synthesis of ECM
Long standing benign hypertension

Question 20

What does hyper plastic lesions cause?

Answer 20

Activation of endothelial cells and proliferation of smooth muscle

Question 21

Where are hyper plastic lesions seen?

Answer 21

Malignant hypertension, due to cytokines as in scleroderma

Question 22

Chronic or repetitive damage to endothelium forms what?

Answer 22

Hyperplastic lesions

Question 23

Polyarteritis Nodosa (Classic) presents where?

Answer 23

Small and medium arteries

Question 24

PAN spares what organ?

Answer 24

Lungs

Question 25

What do lesions of PAN look like?

Answer 25

Sharply segmental, branching points and bifurcations

Question 26

In PAN what type of dilation occurs?

Answer 26

Segmental aneurysmal dilation, palpable nodule in skin

Question 27

What causes the vessel wall weakening in PAN?

Answer 27

Inflammatory involvement

Question 28

In PAN, renal involvement causes many deaths, how does this happen?

Answer 28

Due to renal arterioles, not glomerulonephritis

Question 29

What do you see in acute phase of lesions?

Answer 29

Transmural infiltrates inflammatory cells and fibrinoid necrosis

Question 30

Chronic phase of lesions?

Answer 30

Fibrous thickening of bessel wall/mononuclear infiltrate

Question 31

Symptoms of PAN?

Answer 31

Melena (black tarry stools indicative of blood in feces) | Peripheral neuritis

Question 32

Where does microscopic PAN occur?

Answer 32

Post capillary venules

Question 33

What disorders are involved with Microscopic PAN?

Answer 33

Necrotizing glomerulonephritis (90%) and pulmonary capillary involvement.

Question 34

In microscopic PAN what does cutaneous lesions manifest as?

Answer 34

Palpable purpura

Question 35

What differs between microscopic PAN and normal PAN>

Answer 35

Lesions tend to be of the same age in microscopic

Question 36

Characteristic of microscopic PAN?

Answer 36

Few or no immune deposits

Question 37

P or C ANCA?

Answer 37

P (80%)

Question 38

Giant cell arteritis occurs in who?

Answer 38

Older individuals

Question 39

Where does Giant Cell Arteritis occur?

Answer 39

Temporal, vertebral, ophthalmic arteries. Rarely aortic arch

Question 40

Symptoms of Giant Cell Arteritis?

Answer 40

Blindness, tenderness over involved arteries

Question 41

What does Giant Cell Arteritis respond too?

Answer 41

Corticosteroids

Question 42

Takayasu's Arteritis occurs in who?

Answer 42

Women younger than 40

Question 43

What does Takayasu's Arteritis involve?

Answer 43

Origins of great arteries arising from aortic arch

Question 44

Takayasu has what affect on the mediastinum?

Answer 44

Widening

Question 45

How will Takayasu present?

Answer 45

Lower blood pressure and diminished or asymmetric pulses in upper extremities

Question 46

Classical triad of Wegener's Granulomatosis

Answer 46

Acute necrotizing granulomas Granulomatous vasculitis Renal disease with social/necrotizing glomerulonephritis

Question 47

Wegener's Granulomatosis associated with what?

Answer 47

Associated with epistaxis and hemoptysis and ulcerative lesions of nose, palate, pharynx

Question 48

Good marker of disease activity in Wegener's?

Answer 48

c-ANCA present in 90%

Question 49

How quickly will Wegener's kill you?

Answer 49

1 year

Question 50

Kawasaki disease in who?

Answer 50

Young children

Question 51

What type of lymph node syndrome is Kawasaki?

Answer 51

Mucocutaneous