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Rheumatology > Vasculotides > Flashcards

Vasculotides Flashcards

1
Q

Define Polyarteritis Nodosa

A

Necrotizing arteritis of medium-sized vessels

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2
Q

What does polyarteritis nodosa commonly involve?

A 
Skin
Peripheral nerves
Mesenteric vessels
Heart
Brain
Can affect any organ
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3
Q

Etiology of PolyArteritis Nodosa

A

Idiopathic
Hep B & C
Hairy cell leukemia

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4
Q

Pathogenesis of Polyarteritis Nodosa

A

Thickening of inflamed vessel wall leads to lumen narrowing
Reduce blood flow & thrombosis
Ischemia to involved organ
Inflammation can also lead to aneurysm formation

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5
Q

Signs & Symptoms of Polyarteritis Nodosa

A 
Fatigue
Weight loss
Weakness 
Fever
Arthralgias
Skin lesions
HTN
Renal insufficiency
Neurologic dysfunction
Abdominal pain
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6
Q

Skin Manifestations of Polyarteritis Nodosa

A 
Tender erythematous nodules
Purpura
Livedo reticularis
Ulcers
Bullous or vesicular eruption
Focal or diffuse & usually on lower extremities
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7
Q

Renal Manifestations of Polyarteritis Nodosa

A 
Most commonly involved
Renal insufficiency & HTN
Perirenal hematoma
Glomerular ischemia but not inflammation or necrosis
UA: minimal protein, moderate hematuria
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8
Q

Neurologic Manifestations of Polyarteritis Nodosa

A

Moto & sensory deficits
Asymmetric neuropathy
CNS involvement

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9
Q

GI Manifestations of Polyarteritis Nodosa

A 
Abdominal pain: post prandial pain, weight loss, bowel infarction with perforation
N/V
Melena
Diarrhea
GI bleeding
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10
Q

Cardiovascular Manifestations of Polyarteritis Nodosa

A

CAD
HF: vasculitis of coronary arteries or uncontrolled HTN due to renal disease
MI uncommon

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11
Q

Musculoskeletal Manifestations of Polyarteritis Nodosa

A

Myalgias

Muscular weakness

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12
Q

Other Manifestations of Polyarteritis Nodosa

A

Orchitis
Breast/uterine pain
Ischemic retinopathy
Retinal detachment

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13
Q

Diagnosis of Polyarteritis Nodosa

A

H&P
Confirm with biopsy or angiography
Labs: CMP, CPK, HBV, HCV, UA, ESR

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14
Q

Treatment of Polyarteritis Nodosa

A

High dose steroids
Cyclophosphamide
Azathiprine
Methotrexate

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15
Q

Epidemiology of Kawasaki Disease

A

3-5 year old Asian or Pacific Islander males

Increased in summer & winter

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16
Q

Pathophysiology of Kawasaki Disease

A

Vasculitis due to the infiltration of vessel walls with mononuclear cells & later IgA secreting plasma cells
Can result in destruction of tunica media & aneurysm formation

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17
Q

Diagnostic Criteria for Kawasaki Disease

A 
Fever >5 days without explanation
Bilateral bulbar conjunctival injection
Oral mucous membrane changes
Peripheral extremity changes
Polymorphous rash
Cervical lymphadenopathy
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18
Q

Define Incomplete Kawasaki Disease

A

Only 2 of the criteria are met

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19
Q

Classic Presentation of Kawasaki Disease

A 
Irritability or lethargy
Vomiting alone
Anorexia
Cough or rhinorrhea
Diarrhea, vomiting, or abdominal pain
20
Q

Fever in Kawasaki Disease

A

Minimally responsive to antipyretics
May be intermittent
>5 days

21
Q

Conjunctivitis in Kawasaki Disease

A

Bulbar injection
May spare limbus
Photophobia & anterior uveitis

22
Q

Mucositis in Kawasaki Disease

A

Cracked red lips
Strawberry tongue
Mild or not occur at all

23
Q

Extremity Changes in Kawasaki Disease

A

Early: erythema of hands & feet
Late: desquamation of hands & feet

24
Q

Polymorphous Rash in Kawasaki Disease

A

First days of illness
Perineal erythema & desquamation followed by macular, morbilliform or targeted skin lesion of the trunk & extremities

25
Q

Lymphadenopathy in Kawasaki Disease

A

Anterior cervical nodes

May be able to palpate a single large node

26
Q

Cardiovascular Complications of Kawasaki Disease

A 
Coronary artery aneurysms
CHF & decreased EF
MI
Arrythmias
Peripheral arterial occlusion
27
Q

Evaluation of Kawasaki Disease

A

Labs: CBC, CMP, ESR, CRP
Echocardiogram
CXR: pulmonary edema

28
Q

Treatment of Kawasaki Disease

A 
IVIG
Aspirin (QID dosing)
29
Q

Result of IVIG in Kawasaki Disease

A 
Can reduce incidence of coronary aneurysm
Anti-inflammatory effect
Reduce acute phase reactants, cytokines
Augments T cell suppressor activity
Resolves fever
30
Q

Function of Aspirin in Kawasaki Disease

A

Antipyretic
Anti-inflammatory
Anti-platelet effects

31
Q

Second Line Therapies for Kawasaki Disease

A

Methylprenisolone

TNF inhibitors

32
Q

Another Name for Wegener’s Granulomatosis

A

Granulomatosis with polyangitis

33
Q

Triad of Wegener’s Granulomatosis

A

Necrotizing granulomas of upper respiratory tract
Necrotizing granulomas of lower respiratory tract
Necrotizing glomerulonephritis & thrombosis of capillary loops

34
Q

What arteries does Wegener’s Granulomatosis affect?

A

Small arteries

35
Q

Presentation of Wegener’s Granulomatosis

A 
Nasal congestion
Sinusitis
Otitis media
Mastoiditis
Inflammation of the gums
Stridor
Cough
Dyspnea
Hemoptysis
Fever
Malaise
Weight loss
36
Q

Other Symptoms of Wegener’s Granulomatosis

A 
Arthritis of large joints
Purpura
Dysthesia
Renal insufficiency
Unilateral proptosis
Red eye
Eye inflammation
Rashes/skin sores
Kidney inflammation
37
Q

Lab Results of Wegener’s Granulomatosis

A 
Mild anemia & leukocytosis
Elevated ESR
Hematuria
Blood cell casts
Elevated C-ANCA
38
Q

Chest CT Results in Wegener’s Granulomatosis

A

Infiltrates
Nodules
Masses
Cavities

39
Q

Treatment of Wegener’s Granulomatosis

A

Corticosteroids
Cyclophosphamide
Rituximab

40
Q

Henoch-Schonlein Purpura

A

Palpable purpura
Abdominal pain: GI bleed
Arthritis of lower extremities
Hematuria or proteinuria: glomerulonephritis

41
Q

Commonly Affected Organs in Henoch-Schonlein Purpura

A

Skin
Joints
GI tract
Kidneys

42
Q

Skin Manifestations of Henoch-Schonlein Purpura

A

Erythematous macular wheals
Ecchymosis
Petechiae
Palpable purpura

43
Q

Joint Manifestations of Henoch-Schonlein Purpura

A

Transient or migratory arthritis in large joints

44
Q

GI Manifestations of Henoch-Schonlein Purpura

A 
N/V
Abdominal pain
Ileus
GI bleed
Bowel ischemia
Perforation
Intussusception
45
Q

Kidney Manifestations of Henoch-Schonlein Purpura

A 
Hematuria
\+ protein
Nephritis syndrome
Renal insufficiency
nephrotic syndrome
46
Q

Follow Up of Henoch-Schonlein Purpura

A

UA & BP weekly x 2 months

UA & BP every 1-2 months for 1 year

Rheumatology (8 decks)

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