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Vasculitis Flashcards

1
Q

Types of large vessel vasculitis (2)

A
  • Takayasu

- Giant Cell Arteritis

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2
Q

Examples of medium vessel vasculitis (3)

A

1) Kawasaki
2) PAN
3) Isolated CNS vasculitis

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3
Q

Examples of small vessel vasculitis (3)

A

1) Granulomatosis with polyangiitis (GPA -> Wegners)
2) Eosinophilic granulomatosis with polyangiitis (EGPA -> Churg-Strauss)
3) Microscopic polyangiitis

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4
Q

Most common vasculitis in UK is…

A

GPA

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5
Q

Skin features of ANCA+ vasculitis (4)

A

Infarcts, purpura, ulcer, gangrene

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6
Q

Classical ENT symptom for GPA

A

Subglottic stenosis

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7
Q

Treatment outline for localised vasculitis (2)

A
  • Steroids

- Immunosuppresants (methotrexate) if needed

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8
Q

Generalised vasculitis treatment (2)

A

“Stronger” immunosuppresants such as cyclophosphamide + steroids

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9
Q

Refractory vasculitis treatment options (2)

A
  • IV immunoglobulin

- Rituximab (targets CD20 on B-cells)

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10
Q

Untreated small-vessel vasculitis has what % mortality rate after 2 years?

A

90%

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11
Q

Primary vasculitis always has a known cause. True/false?

A

False - often no cause implicated. Compared to SECONDARY vasculitis which is always triggered by a factor (e.g. infection, drug, toxin)

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12
Q

Asthma & eosinophilia vasculitis is most likely….

A

EGPA

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13
Q

Granuloma without asthma or eosinophilia vasculitis most likely…

A

GPA

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14
Q

Which large vessel vasculitis is common in Asian women <40?

A

Takayasu Arteritis

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15
Q

Giant cell arteritis is a type of large/medium vessel vasculitis. Who does it usually affect?

A

Large vessel.

>50 year olds

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16
Q

GCA can cause temporal arteritis, and also inflammation in which other major vessel?

A

Aorta

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17
Q

What’s the common presenting feature to both TA and GCA? (3)

A

Bruits (most commonly in the carotids 80%), blood pressure difference in extremeties, carotodynia.

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18
Q

Temporal arteritis is associated with bilateral/unilateral headache and which other classical symptom?

A

Unilateral headache - classical symptom is jaw claudication

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19
Q

GCA is commonly associated with which other rheumatic condition?

A

PMR (50% of GCA will have PMR and 15% of PMR will develop GCA)

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20
Q

Name a serious complication of GCA?

A

Blindness (due to optic nerve ischaemia)

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21
Q

Management of GCA is with what dosage of what kind of steroid?

A

40-60mg of prednisolone

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22
Q

GCA is usually associated with an occipital, sharp headache. True/false?

A

False (unilateral)

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23
Q

GCA only causes inflammation of temporary arteries. True/false?

A

False (aorta as well)

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24
Q

GCA is commoner in those <50 years old. True/false?

A

False (TA more common in younger <40 year olds, GCA >50 year olds)

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25
Q

Treatment of GCA with steroids is likely to be lifelong. true/false?

A

False - only to settle inflammation

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26
Q

Steroids should only be started once a positive biopsy result has been obtained in GCA. True/false?

A

False

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27
Q

Methotrexate should be started at the same time as steroids in GCA. True/false?

A

False

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28
Q

Medium vessel vasculitis is most commonly seen in adults/children?

29
Q

Medium-vessel vasculitis commonly affects which arteries?

A

Coronary arteries

30
Q

Polyarteritis nodosa is a form of which type of vasculitis?

31
Q

Polyarteritis nodsoa typically affects vessels at which points?

A

Bifurcations

32
Q

Polyarteritis nodosa is associated with which viral infection?

A

Hepatitis B

33
Q

GPA is more common in women or men?

A

Men (especially northern Europeans)

34
Q

GPA typically onsets between which age ranges?

A

35-55 years old

35
Q

What are some ENT symptoms of GPA small-vessel vasculitis (4)

A

1) Sinusitis
2) Saddle nose (due to cartilage ischaemia)
3) Mouth ulcers
4) Hearing loss

36
Q

What are some respiratory symptoms of GPA small-vessel vasculitis? (3)

A

1) Pulmonary infiltrates
2) Haemoptysis
3) Cavitating nodules

37
Q

What are some renal symptoms of GPA small-vessel vasculitis (2)

A

1) Necrotising glomerulonephritis

2) Protein + blood in urine

38
Q

What are some CNS symptoms of GPA small-vessel vasculitis? (2)

A

1) Mononeuritis multiplex (also in EGPA)

2) CN palsy

39
Q

What are some ocular symptoms of GPA small-vessel vasculitis? (3)

A

1) Conjunctivis
2) Uveitis
3) Proptosis

40
Q

What’s the main difference between GPA and EGPA? (2)

A

In EGPA:

1) late onset asthma
2) high eosinophil count

41
Q

Is butterfly rash a common feature of GPA?

A

No, it’s a feature of SLE

42
Q

Is hearing loss a feature of GPA?

43
Q 
Which of the following is NOT a feature of EGPA?
A. nasal cartilage collapse
B. late onset asthma
C. eosinophilia
D. mononeuritis multiplex
E. purpuric rash
A

A. nasal cartilage collapse = this is GPA

44
Q

ANCA antibodies are directed against what?

A

Neutrophil granulocytes

45
Q

cANCA is positive/negative in GPA?

46
Q

pANCA is positive in which type of vasculitis?

47
Q

Which ANCA type is positive in MPA?

48
Q

PR3 positive antibody is suggestive of which type of vasculitis?

49
Q

MPO positive antibody is suggestive of which vasculitis?

A

MPA (also mildly EGPA)

50
Q

Do ANCA/anti-PR3 and MPO vary with disease activity?

51
Q

Is complement consumed during active vasculitis process?

A

Yes - C3 and C4 may fall

52
Q

ANCA is positive in all vasculitis. True/false?

A

False (only some small vessel vasculitis)

53
Q

ANCA is positive in all patients with GPA. True/false?

A

False - only cANCA

54
Q

cANCA and anti-PR3 are associated with EGPA. True/false?

A

False - GPA

55
Q

cANCA and anti-MPO are associated with GPA. True/false?

A

False - MPO is MPA

56
Q

cANCA and anti-PR3 are associated with GPA. True/false?

57
Q

Localised or early systemic vasculitis can be treated how (2)?

A

1) Methotrexate

2) Steroids

58
Q

Generalised or systemic vasculitis is treated how? (2)

A

1) Steroids
2) Cyclophosphamide
OR
1) Rituximab
2) Steroids
Both options with plasma clearing if creatinine >500

59
Q

Refractory vasculitis is treated how? (2)

A

IVIG, rituximab

60
Q

True or false: ANCA-associated vasculitis (AAV) is commoner in women?

A

False (commoner in men)

61
Q

Nasal carriage of S. aureus may be a risk factor for AAV, true or false?

62
Q

EGPA is the new term for Wegner’s, true/false?

A

False - EGPA is new Churg-Strauss

63
Q

Recurrent sinusitis is a common feature of EGPA. True/false?

A

False (EGPA is asthma and eosinophilia)

64
Q

Renal disease is rare in GPA. True or false?

A

False (necrotising glomerulonephritis)

65
Q

Is Henloch-Schlen purpura an ANCA positive vasculitis?

A

No, ANCA-negative

66
Q

HSP is mediated by which immunoglobulin?

67
Q

HSP is mostly preceded by which infection type?

A

URTI (commonly group-A streptococcous)

68
Q

In HSP, which one test is absolutely essential and why?

A

Urinalysis for renal involvement

MSK (21 decks)

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