Vasculitis

Question 1

What is the most common cause of lower limb purpura (leukocytoclastic vasculitis) without haematuria?

Answer 1

frusemide, antibiotics, allopurionol

Question 2

Which malignancy are patients who were treated with cyclophosphamide at risk of?

Answer 2

bladder cancer

Question 3

Which ANCA type is associated with more frequent relapses?

Answer 3

PR3

Question 4

Which non vasculitic diseases can ANCA occur in?

Answer 4

interstitial lung disease, bronchiectasis, cystic fibrosis

Question 5

Which drugs most commonly induce ANCA and vasculitis?

Answer 5

antithyroid drugs

Question 6

What clinical features suggest vasculitis?

Answer 6

palpable purpura, multi organ disease with sustemic features, pulmonary renal disease, mononeuritis multiplex

Question 7

What is the differential diagnosis for vasculitis?

Answer 7

thrombocytopaenia, infective endocarditis, septicaemia, amyloidosis, choleterol emboli, atrial myxoma with emboli, mycotic aneurysm with emboli

Question 8

What investigations should be ordered for suspected vasculitis?

Answer 8

FBE, CRP, ESR
APTT and PT
urinalysis and UEC
LFT
ANA, ANCA, RF, cryoglobulins, AECA, lupus anticoagulation, anticardiolipin antibodies
C3/C4
Hep B, C
CXR
angiography
biopsy

Question 9

What are the small vessel vasculitides?

Answer 9

granulomatous polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatous polyangiitis (EGPA)

Question 10

What are the charateristic features of behcet’s disease?

Answer 10

oral apthous ulcers plus ocular inflammation, genital ulcers, pathergy reaction, skin lesions (pustules or erythema nodosum)

Question 11

What are the features of takayasu arteritis?

Answer 11

age < 40, claudication of extremities, decreased pulsation of one or both brachial arteries, difference in BP between arms, bruit of subclavian artery/abdominal aorta

Question 12

What are the features of GCA?

Answer 12

age > 50, headache, tender or decreased pulse of temporal artery, ESR > 50, biopsy with necrotising arteritis

Question 13

What are the features of polyarteritis nodosa?

Answer 13

organ ischaemia, peripheral neuropathy, no GN/lung haemorrhage, may be associated with hepatitis B, no ANCA

Question 14

What are the features of kawasaki disease?

Answer 14

infants, fever > 5 days, bilateral conjuctival injection, oral mucosal changes, erythema of soles/desquamation, polymorphous rash, cervical lymphadenopathy

Question 15

Which disease is ANCA found in?

Answer 15

MPA, GPA, EGPA, some cases of drug induced vasculitis and some cases of rheumatoid vasculitis

Question 16

Which disease is ANCA not found in?

Answer 16

PAN, kawasaki disease, CNS vasculitis, HSP, cryoglobulinaemic vasculitis, hypersensitivity vasculitis, vasculitis secondary to viral infections