[10] Vasculitis Flashcards by Brainscape Admin

What are the classification of vasculitis?

Large vessel
Medium vessel
Small vessel

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Give two examples of large vessel vasculitis

Giant Cell Arteritis

Takayasu’s arteritis

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Give two examples of medium vessel vasculitis

Polyarteritis nodosa

Kawasaki disease

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How can small vessel vasculitides be further classified?

pANCA
cANCA
ANCA -ve

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Give two examples of cANCA small vessel vasculitis

Churg-Strauss

Microscopic polyangiits

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Give an example of a cACNA small vessel vasculitis

Wegener’s granulomatosis

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Give 4 examples of a ANCA -ve small vessel vasculitis

Henoch-Schonlein purpura
Goodpasture’s disease
Cryoglobulinaemia
Cutaneous leukocytoclastic vasculitis

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What is giant cell arteritis also known as?

Temporal arteritis

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Who is giant cell arteritis common in?

Elderly

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Who is giant cell arteritis rare in?

<55

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What % of cases of giant cell arteritis are associated with polymyalgia rheumatica?

50%

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What are the features of giant cell arteritis?

Systemic signs
Headache
Temporal artery and scalp tenderness
Jaw claudication
Amaurosis fugax
Prominent temporal arteries, with or without pulsation

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What are the systemic signs of giant cell arteritis?

Fever
Malaise
Fatigue

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What action should be taken if you suspect a patient has giant cell arteritis?

Do an ESR, and start prednisolone 40-60mg/day PO

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What may be found on blood tests in giant cell arteritis?

Greatly increased ESR and CRP
Increased ALP
Decreased Hb
Increased platelets

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What kind of anaemia is present in giant cell arteritis?

Normocytic normochromic

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How quickly should a temporal artery biopsy be done in suspected giant cell arteritis?

Within 3 days

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How should giant cell arteritis be managed after starting steroids?

Taper steroids gradually

Give PPI and alendronate cover

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What should the tapering of steroids be guided by in giant cell arteritis?

Symptoms and ESR

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How long should PPI and alendronate be given in giant cell arteritis?

Usually 2 year course

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When does polymyalgia rheumatica present?

> 50 years old

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How does polymyalgia rheumatica present?

Severe pain and stiffness in shoulders, neck, and hips

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Describe the onset of symptoms in polymyalgia rheumatica?

Sudden/subacute onset

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Are the symptoms of polymyalgia rheumatica symmetrical?

Yes

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When is the pain of polymyalgia rheumatica worse?

In the morning

Is there associated weakness in polymyalgia rheumatica?

What other features may be present in polymyalgia rheumatica?

Mild polyarthritis Tenosynovitis Carpal tunnel syndrome Systemic signs

What systemic signs may be present in polymyalgia rheumatica?

Fatigue Fever Weight loss

What % of patients with polymyalgia rheumatica develop giant cell arteritis?

15%

What is found on investigation in polymyalgia rheumatica?

Increased ESR and CRP Increased plasma viscosity Increased ALP Normal CK

How is polymyalgia rheumatica managed?

Same as giant cell arteritis

Where is Takayasu's arteritis found?

Japan - rare outside of Japan

What gender is more commonly affected wiht Takayasu's arteritis?

Females

What age is Takayasu's arteritis most common in?

20-40 years

What are the features of Takayasu's arteritis?

Weak pulses in upper extremities Visual disturbance Hypertension Constitutional symptoms

What are the constitutional symptoms of Takayasu's arteritis?

Fever Fatigue Weight loss

Is polyarteritis nodosa common in UK?

No, is rare

What it the male to female ratio of polyarteritis nodosa?

M:F = 2:1

What age group is most commonly affected with polyarteritis nodosa?

Young adults

What infection is polyarteritis associated with?

Hepatitis B

What are the features of polyarteritis nodosa?

Rash Hypertension Melaena and abdominal pain Constitutional symptoms

How is polyarteritis nodosa managed?

Prednisolone and cyclophosphamide

What is Kawasaki's disease?

A childhood PAN variant

What are the features of Kawasakis disease?

``` 5-day fever Bilat non-purulent conjunctivitis Oral mucositis Cervical lymphadenopathy Polymorphic rash Extremity changes Coronary artery aneurysms ```

What extremity changes are seen in Kawasaki's disease?

Erythema and desquamation

How is Kawasaki's disease managed?

IVIg and aspirin

What happens in Wegener's granulomatosis?

Necrotising granulomatous inflammation and small vessel vasculitis, which particularly affects the URT, LRT, and kidneys

What are the URT features of Wegener's granulomatosis?

Chronic sinusitis Epistaxis Saddle-nose deformity

What are the LRT features of Wegener's granulomatosis?

Cough Haemoptysis Pleuritis

What are the renal features of Wegener's granulomatosis?

Rapidly progressive glomerulonephritis

What are the skin features of Wegener's granulomatosis?

Palpable purpura

What are the ocular features of Wegener's granulomatosis?

Conjunctivitis Keratitis Uveitis

What investigations are done in Wegener's granulomatosis?

Urine dipstick | CXR

What are the features of Churg-Strauss?

Late-onset asthma Eosinophilia Granulomatous small-vessel vasculitis

What does the granulomatous small-vessel vasculitis lead to in Churg-Strauss?

Rapidly progressive glomerulonephritis Palpable purpura GIT bleeding

What autoantibody is found in Wegener's granulomatosis?

cANCA

What autoantibody is found in Churg-Strauss?

pANCA

What drug might Churg-Strauss be associated with?

Montelukast

What are the features of microscopic polyangiitis?

Rapidly progressive glomerulonephritis Haemoptysis Palpable purpura

What autoantibody is found in microscopic polyangiitis?

pANCA

What is produced in Goodpastures?

Anti-glomerular basement membrane antibodies

What are the features of Goodpastures syndrome?

Rapidly progressive glomerulonephritis | Haemoptysis

What is found on CXR in Goodpastures?

Bilateral lower zone infiltrates (haemorrhage)

How is Goodpastures managed?

Immunosuppression and plasmapheresis

What is produced in simple cryoglobulinaemia?

Monoclonal IgM

What is simple cryoglobulinaemia secondary to?

Myeloma CLL Waldenstroms

What does simple cryoglobulinaemia cause?

Hyperviscosity

What does the hyperviscosity in simple cryoglobulinaemia lead to?

``` Visual disturbance Bleeding from mucous membranes Thrombosis Headaches Seizures ```

What % of cases of cryoglobulinaemia are mixed?

80%

What is produced by mixed cryoglobulinaemia?

Polyclonal IgM

What is mixed cryoglobulinaemia secondary to?

SLE Sjorgens Hep C Mycoplasma

What does mixed cryoglobulinaemia lead to?

Immune complex disease

What does the immune complex disease in mixed cryoglobulinaemia lead to?

Glomerulonephritis Palpable purpura Arthralgia Peripheral neuropathy

[10] Vasculitis Flashcards

(73 cards)