vasculitis geriatrics

Question 1

what is polyarteritis nodosa

Answer 1

systemic vasculitis primarily of medium sized arteries and muscular arterioles (necrotizing)

Question 2

what is polyarteritis nodosa associated with

Answer 2

chronic hepatitis B

Question 3

sx polyarteritis nodosa

Answer 3

arthralgia, arthritis, myalgias
renin-mediated HTN
postprandial abdominal pain
mononeuritis multiplex and peripheral neuropathy

Question 4

dx polyarteritis nodosa

Answer 4

increased ESR and proteinuria
ANCA negative
renal or mesenteric angiography - micro aneurysms with abrupt cut-off of small arteries (beading)
bx (definitive) - necrotizing medium-vessel vasculitis and NO GRANULOMAS

Question 5

granulomatosis with polyangitis is also called

Answer 5

wegener’s

Question 6

what is granulomatosis with polyangitis

Answer 6

small vessel vasculitis (granulomatous inflammation) and necrosis affecting nose, lungs, kidney

Question 7

sx granulomatosis with polyangitis

Answer 7

triad - upper respiratory tract, lower respiratory tract + glomerulonephritis

upper respiratory tract - nasal - congestion, saddle nose deformity

lower respiratory tract - lungs - cough, dyspnea, wheezing

glomerulonephritis - crescentic glomerulonephritis seen on bx

cutaneous involvement - Purpura on LE, may have neurologic involvement

Question 8

dx granulomatosis with polyangitis

Answer 8

CXR - may have nodules
C-ANCA positive - best initial
bx - necrotizing granulomas

Question 9

tx granulomatosis with polyangitis

Answer 9

steroids plus rituximab or cyclophosphamide

Question 10

what is microscopic polyangiitis

Answer 10

small and medium vessel vasculitis, necrotizing vasculitis with few or no immune deposits, and tropism (turning) for the kidneys and lungs

Question 11

is microscopic polyangiitis associated with granulomas

Answer 11

NO - no granulomatous inflammation

Question 12

sx microscopic polyangiitis

Answer 12

constitutional - fever, weight loss
lung - hemoptysis
cutaneous - palpable purpura on LE
neurologic - mononeuritis multiplex - sensory or motor sx
renal - usually crescentic (rapidly progressive) glomerulonephritis

Question 13

dx microscopic polyangiitis

Answer 13

PANCA positive
CXR - nonspecific findings
bx - non-granulomatous inflammation

Question 14

tx microscopic polyangiitis

Answer 14

steroids + rituximab or cyclophosphamide

Question 15

what is another name for anti-GBM antibody disease

Answer 15

goodpasture’s

Question 16

what is anti-GBM antibody disease

Answer 16

type 2 hypersensitivity rxn - IgG antibodies against type 4 collagen of the alveoli and glomerular basement membrane of the kidney

Question 17

sx anti-GBM antibody disease

Answer 17

lung - hemoptysis
kidney - hematuria

Question 18

dx anti-GBM antibody disease

Answer 18

glomerulonephritis - increased BUN/creatinine, UA - hematuria, Proteinuria, RBC casts

positive anti-glomerular basement membrane antibodies - best initial after UA

CXR - nonspecific

bx - linear IgG deposits; crescentic (rapidly progressive) glomerulonephritis

Question 19

tx anti-GBM antibody disease

Answer 19

steroids + cyclophosphamide + plasmapheresis