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J MSK > Vasculitis > Flashcards

Vasculitis Flashcards

1
Q

definition of vasculitis

A

inflammation of blood vessels (usually arteries)

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2
Q

aetiology of vasculitis

A

secondary inflammation from near by inflammatory site

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3
Q

histology (3)

A

lymphocytes = chronic inflammation
neutrophils = acute inflammation
plasma cells/B cells = chronic inflammation

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4
Q

large vessel vasculitis (2)

A

takayasu arteritis

giant cell arteritis

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5
Q

medium vessel vasculitis (2)

A

polyarteritis nodosa

Kawasaki disease

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6
Q

small vessel vasculitis (4)

A

churg strauss syndrome (eosinophilic granulomatosis with polyangitis (EGPA))
wegners granulomatosis (granulomatosis with polyangitis (GPA))
microscopic polyangitis (MPA)
henoch schnleein purpura (HAP aka IgA vasculitis)
others…

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7
Q

what investigation do you always do if you suspect vasculitis

why

A

urinalysis

for renal involvement

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8
Q

prognosis of vasculitis

A

good if treated, fatal if untreated

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9
Q

who does takayasu arteritis occur in

A

<40 y/o
females
Asians

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10
Q

who does giant cell arteritis present in

A

> 50 y/o

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11
Q

which other MSK condition is giant cell arteritis associated with

A

polymyalgia rheumatica (morning stiffness in shoulders/hips)

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12
Q 
unilateral temporal headache
tender, enlarged, non pulsatile arteries 
fever 
jaw claudication (osteoarthritis in TMJ)
unilateral hypertension
A

giant cell arteritis

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13
Q

patient >50 y/o with sudden onset headache

A

giant cell arteritis

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14
Q

investigations for giant cell arteritis

A

inflammatory markers - ESR, plasma viscosity, CRP raised
temporal artery biopsy
fundoscopy (dont forget!)

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15
Q

what are you looking for on temporal artery biopsy in giant cell arteritis (4)

A

thickening of media
infiltration
multinucleated giant cells
inflammation

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16
Q

who does Kawasaki disease affect

A

<5 y/o

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17
Q

where does Kawasaki disease occur

A

coronary arteries

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18
Q

polyarteritis nodosa occurs at…

A

vessel bifurcations (aneurysms develop)

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19
Q

rosary bead sign

A

polyarteritis nodosa

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20
Q

treatment of giant cell arteritis

A

steroids, reduce over 2 years;
prednisolone 40mg if no visual symptoms
prednisolone 60-80mg if visual symptoms

aspirin long term
PPI long term

21
Q

do you treat giant cell arteritis before or after you get the temporal artery biopsy back

A

before! could be fatal (vision loss)

22
Q

what happens if giant cell arteritis isnt treated

A

vision loss

23
Q

why do you take aspirin long term in giant cell arteritis

A

reduce ischaemia = reduce optic neuropathy risk

24
Q

why do you take a PPI long term in giant cell arteritis

A

you need GI protection bc youre taking aspirin

25
Q

what type of vasculitis is eosinophilic granulomatosis with polyangitis (EGPA)

A

small vessel

26
Q

what is eosinophilic granulomatosis with polyangitis (EGPA) also known as

A

churg strauss syndrome

27
Q 
late onset asthma/rhinitis
mononeuritis multiplex (neuroproblem)  
oral ulcers 
nose bleeds
cough 
deafness 
skin involvement
A

eosinophilic granulomatosis with polyarteritis (EGPA)

28
Q

which type of vasculitis is associated with asthma

A

eosinophilic granulomatosis with polyanteritis (EGPA)

29
Q

investigations for eosinophilic granulomatosis with polyarteritis (EGPA)

A

high eosinophil
pANCA
anti-MPO

(same as MPA)

30
Q

histology of eosinophilic granulomatosis with polyarteritis (EGPA)

A

eosinophils

31
Q

what other name is granulomatosis with polyarteritis (GPA) known as

A

wegners granulomatosis

32
Q

granulomatosis with polyarteritis (GPA) usually occurs in…

A

35-55 y/o males

33
Q

histology of granulomatosis with polyarteritis (GPA) (2)

A

necrotising granulomatous glomerulonephritis

nucleate giant cells

34
Q

presentation of granulomatosis with polyarteritis (GPA)

A

ENT symptoms - oral ulcers, nose bleeds, nasal cartilage collapse (saddle nose), cough, deafness
haemoptysis

35
Q

investigations in granulomatosis with polyarteritis (GPA)

A

cANCA positive

anti-PR3 antibody positive

36
Q

cANCA positive

anti-PR3 positive

A

granulomatosis with polyarteritis (GPA)

37
Q

pANCA positive

anti-MPO positive

A

eosinophilic granulomatosis with polyarteritis (EGPA)
OR
microscopic polyangitis (MPA)

38
Q

which vasculitis presents with ENT symptoms (not asthma)

A

granulomatosis with polyangitis (GPA)

39
Q

which vasculitis present with ENT and asthma

A

eosinophilic granulomatosis with polyangitis (EGPA)

40
Q

histology of microscopic polyangitis (MPA)

A

necrotising glomerulonephritis

41
Q

investigations for microscopic polyangitis (MPA)

A

pANCA positive
anti-MPO positive

(same as EGPA)

42
Q

what is henoch schnlein purpura (HSP) also known as

A

IgA vasculitis

43
Q

which vasculitis is IgA mediated

A

henoch schnlein purpura

44
Q

which group of people get henoch schnlein purpura

A

children aged 2-11 (not infants)

45
Q

which vasculitis presents in kids and follows a URTI (1-3 weeks before)

A

henoch schnlein purpura

46
Q

presentation of henoch schnlein purpura (5)

A

purpuric rash over buttocks and lower limbs
colicky abdo pain
bloody diarrhoea
joint pain
proteinuria/haematuria after recent infection

47
Q

treatment of ALL small vessel vasculitis (EGPA, GPA, MPA, HSP) (3)

if kidney involvement

A

IV steroids
IV cyclophosphamide
long term immunosuppression - methotrexate

if kidney involvement - dialysis

48
Q

what is used to detect ANCAs

A

immunofluorescence

49
Q

often the first sign of small vessel vasculitis

why

A

renal involvement

kidneys v susceptible to damage

J MSK (30 decks)

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