Week 12: Vasculitis

Question 1

Name the 2 large vessel vasculitis

Which vessels are affected

Answer 1

1. GCA
2. Takayasu’s arteritis

Affected: aorta + major branches

Question 2

Name the 2 medium vessel vasculitis

Which vessels are affected

Answer 2

1. Polyarteritis nodosa
2. Kawasaki’s

Affected: renal, coronary vessels

Question 3

Name the 3 small ANCA-associated vessel vasculitis

Which vessels are affected

Answer 3

1. Granulomatous polyangiitis (wegener’s)
2. Eosinophilic polyangiitis (Churg-Strauss)
3. Microscopic polyangiitis

Affected: small arteries to capillaries

Question 4

What type of hypersensitivity is vasculitis

Answer 4

Type 3 hypersensitivity

T cell mediated, immune complex deposition

Question 5

What colour ulcer is associated with vasculitis

Answer 5

Purply-blue edge

Question 6

Which cranial nerve palsy is associated with GCA?

Features of this CN palsy

Answer 6

CN3 palsy

Eye down and out
Ptosis

Question 7

Serious vascular complication of GCA

Answer 7

Aortic aneurysm/ dissection

Question 8

Pathogmonic sign of GCA

Answer 8

Jaw claudication

Question 9

Visual symptoms of GCA

-painful or painless?

Answer 9

Painless sudden vision loss

Amarousis fugax

CN3 palsy (which causes diplopia)

Question 10

Findings on temporal artery biopsy of GCA

Answer 10

1. Granulmatous = giant multi nucleated cells
2. Hypertrophy and inflammation of intima
3. Breaking up of internal lamina
4. Lymphocytes, plasma cells

Question 11

Why is there raised neutrophils in GCA

Answer 11

Steroids make vessel wall less sticky

So WBC less likely to be stuck to vessel wall, more likely to be in lumen

More WBC be picked up in centre of lumen

Question 12

What imaging is done for polyarteritis nodosa?

Findings on this imaging

Answer 12

Angiogram

Microaneurysms in hepatic/ intestinal/ renal vessels

Question 13

What group of people is polyarteritis nodosa more common in (different to other autoimmune diseases)

Answer 13

Middle aged men

Question 14

Many of the arteritis involve the lungs. Which one does NOT involve lungs

Answer 14

Polyarteritis nodosa

Question 15

Which arteritis can lead to MI/ pericarditis/ heart failure

Answer 15

Polyarteritis nodosa

Question 16

c-ANCA is otherwise known as anti-what

Answer 16

Anti proteinase 3

Question 17

p-ANCA is otherwise known as anti-what

Answer 17

Anti MPO

Question 18

Which arteritis commonly presents with recurrent haemoptysis

Answer 18

Microscopic polyangiitis

Question 19

Which arteritis cause crescentic glomerulonephritis

Answer 19

1. Granulomatous polyangiitis

2. Microscopic polyangiitis

Question 20

Which arteritis is linked to silicosis exposure

Answer 20

Wegner’s (Granulomatous polyangiitis)

Question 21

Which arteritis is linked to Hep B

Answer 21

Polyarteritis Nodosum

Question 22

Which arteritis is linked to Staph Aureus infection

Answer 22

Wegner’s (Granulomatous polyangiitis)

Question 23

Dose of steroids to give pt with GCA

• with visual symptoms
• without visual symptoms

Answer 23

Visual symptoms: 60mg prednisolone

No visual symptoms: 40mg prednisolone

Question 24

Which HLA is associated with Takayasu’s arteritis

Answer 24

HLA-B52

Question 25

Halo sign/ Loffler syndrome on CXR is associated with what arteritis

Answer 25

Churg Strauss (Eosinophilic polyangiitis)

Question 26

Serious complication of Kawasaki’s

Answer 26

Coronary artery aneurysm

Question 27

Diagnosis of Kawasaki’s

Answer 27

Clinical diagnosis

high temperature that lasts for 5 days or more + CRASH

1. Conjunctuvitis (bilateral)
2. Rash
3. Adenopathy (lymph)
4. Strawberry tongue
5. Hands and feet peel

Question 28

What kind of rash do you get in polyarteritis nodosum

Answer 28

Livedo

Question 29

What kind of rash do you get in takayasu arteritis

Answer 29

Erythema multiforme

Question 30

What investigations must be done in Kawasaki’s

Answer 30

ECHO and coronary angiogram

to check for coronary artery aneurysm

Question 31

Describe mononeuritis multiplex

• nerves involved
• symptoms

Answer 31

Pain + weakness + sensory deficit

> 2 nerves involved

Question 32

What can be seen on an angiogram in Takayasu’s arteritis

Answer 32

Homogenous thickening of the aorta

Macaroni sign