Week 12: Vasculitis Flashcards
Name the 2 large vessel vasculitis
Which vessels are affected
- GCA
- Takayasu’s arteritis
Affected: aorta + major branches
Name the 2 medium vessel vasculitis
Which vessels are affected
- Polyarteritis nodosa
- Kawasaki’s
Affected: renal, coronary vessels
Name the 3 small ANCA-associated vessel vasculitis
Which vessels are affected
- Granulomatous polyangiitis (wegener’s)
- Eosinophilic polyangiitis (Churg-Strauss)
- Microscopic polyangiitis
Affected: small arteries to capillaries
What type of hypersensitivity is vasculitis
Type 3 hypersensitivity
T cell mediated, immune complex deposition
What colour ulcer is associated with vasculitis
Purply-blue edge
Which cranial nerve palsy is associated with GCA?
Features of this CN palsy
CN3 palsy
Eye down and out
Ptosis
Serious vascular complication of GCA
Aortic aneurysm/ dissection
Pathogmonic sign of GCA
Jaw claudication
Visual symptoms of GCA
-painful or painless?
Painless sudden vision loss
Amarousis fugax
CN3 palsy (which causes diplopia)
Findings on temporal artery biopsy of GCA
- Granulmatous = giant multi nucleated cells
- Hypertrophy and inflammation of intima
- Breaking up of internal lamina
- Lymphocytes, plasma cells
Why is there raised neutrophils in GCA
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
What imaging is done for polyarteritis nodosa?
Findings on this imaging
Angiogram
Microaneurysms in hepatic/ intestinal/ renal vessels
What group of people is polyarteritis nodosa more common in (different to other autoimmune diseases)
Middle aged men
Many of the arteritis involve the lungs. Which one does NOT involve lungs
Polyarteritis nodosa
Which arteritis can lead to MI/ pericarditis/ heart failure
Polyarteritis nodosa
c-ANCA is otherwise known as anti-what
Anti proteinase 3
p-ANCA is otherwise known as anti-what
Anti MPO
Which arteritis commonly presents with recurrent haemoptysis
Microscopic polyangiitis
Which arteritis cause crescentic glomerulonephritis
- Granulomatous polyangiitis
2. Microscopic polyangiitis
Which arteritis is linked to silicosis exposure
Wegner’s (Granulomatous polyangiitis)
Which arteritis is linked to Hep B
Polyarteritis Nodosum
Which arteritis is linked to Staph Aureus infection
Wegner’s (Granulomatous polyangiitis)
Dose of steroids to give pt with GCA
- with visual symptoms
- without visual symptoms
Visual symptoms: 60mg prednisolone
No visual symptoms: 40mg prednisolone
Which HLA is associated with Takayasu’s arteritis
HLA-B52
Halo sign/ Loffler syndrome on CXR is associated with what arteritis
Churg Strauss (Eosinophilic polyangiitis)
Serious complication of Kawasaki’s
Coronary artery aneurysm
Diagnosis of Kawasaki’s
Clinical diagnosis
high temperature that lasts for 5 days or more + CRASH
- Conjunctuvitis (bilateral)
- Rash
- Adenopathy (lymph)
- Strawberry tongue
- Hands and feet peel
What kind of rash do you get in polyarteritis nodosum
Livedo
What kind of rash do you get in takayasu arteritis
Erythema multiforme
What investigations must be done in Kawasaki’s
ECHO and coronary angiogram
to check for coronary artery aneurysm
Describe mononeuritis multiplex
- nerves involved
- symptoms
Pain + weakness + sensory deficit
> 2 nerves involved
What can be seen on an angiogram in Takayasu’s arteritis
Homogenous thickening of the aorta
Macaroni sign
