Arterial.7.Vasospastic Disorders and Arteritis

Question 1

List Vasospastic Disorders

Answer 1

1. Raynaud’s disease
2. Raynaud’s phenomenon
3. Acrocyanosis
4. Erythromelalgia
5. Erythrocyanosis Frigida (Bazin’s disease).
6. Causalgia: Look Neurosurgery
7. Sudeck’s atrophy : Look orthopedics.

Question 2

ETIOLOGY of Raynaud’s disease

Answer 2

Not exactly known, Certain factors are suggested :

1. Sensitivity of the small arteries and arterioles of the hands, and less commonly the feet, to cold.
2. Increased sympathetic tone.
3. Psychological instability.
4. The presence of cold agglutinins in the blood which cause agglutination of RBCs on exposure to a low temperature.

Question 3

DIAGNOSIS of Raynaud’s disease

Answer 3

History:

Examination

Question 4

History in DIAGNOSIS of Raynaud’s disease

Answer 4

1. The disease is bilateral and symmetrical and is much more common in young females, in both hands.
2. The attacks are precipitated by coldness or emotional excitement and are relieved by warmth.
3. The attack is usually accompanied by pain.
4. The attack consists of 3 consecutive phases

Question 5

3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease

Answer 5

• Pallor
• Cyanosis
• Redness

Question 6

Pathogenesis of Pallor in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease

Answer 6

Due to spasm of the digital arterioles.

Question 7

Pathogenesis of Cyanosis in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease

Answer 7

Due to sluggish circulation & extraction of 02 by the tissues.

Question 8

Pathogenesis of Redness in 3 consecutive phases in History in DIAGNOSIS of Raynaud’s disease

Answer 8

As the attack passes off, the arterioles dilate “under the effect of metabolites” and oxygenated blood passes into the dilated
capillaries

Question 9

Examination in DIAGNOSIS of Raynaud’s disease

Answer 9

1. The radial and ulnar pulses are preserved.

2. No major gangrene, only minute patches of ulceration or gangrene may occur.

Question 10

Grades of Raynaud’s disease

Answer 10

1. First grade :
2. Second grade :
3. Third grade :

Question 11

First grade in Grades of Raynaud’s disease

Answer 11

Presents only with Raynaud’s phenomena

Question 12

Second grade in Grades of Raynaud’s disease

Answer 12

Mild trophic changes in the tips of fingers & nails

Question 13

Third grade in Grades of Raynaud’s disease

Answer 13

Presents with gangrene of the tips of fingers.

Question 14

TREATMENT of Raynaud’s disease

Answer 14

1. conservative measures

2. Cervico-dorsal sympathectomy

Question 15

conservative TREATMENT of Raynaud’s disease

Answer 15

• Indications

* Modalities

Question 16

Indications of conservative TREATMENT of Raynaud’s disease

Answer 16

In the early stages of Raynaud’s disease

Question 17

Modalities of conservative TREATMENT of Raynaud’s disease

Answer 17

• The patient is advised to avoid cold weather and to wear woolen gloves in winter time.
• Vasodilator drugs.
• Calcium channel antagonists

Question 18

Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease

Answer 18

• Indication

* Outcomes

Question 19

Indication of Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease

Answer 19

In severe cases of Raynaud’s disease

Question 20

Outcomes of Cervico-dorsal sympathectomy in TREATMENT of Raynaud’s disease

Answer 20

• Its immediate results are good

* but usually the symptoms recur after sometime, but are at least, not severe

Question 21

Definition of Raynaud’s phenomenon

Answer 21

Colour changes similar to those of Raynaud’s disease may accompany a large group of organic diseases.

Question 22

Causes of Raynaud’s phenomenon

Answer 22

1. Thoracic outlet syndrome.
2. Buerger’s disease.
3. Collagen diseases as rheumatoid arthritis, scleroderma, SLE.
4. Cryogloubulinaemia.
5. Drugs as chronic administration of ergot-containing drugs for migraine.
6. Certain occupations as typists, pianists & laborers using vibrating tools.
7. Atrophic disorders of limbs, e.g. after poliomyelitis

Question 23

Treatment of Raynaud’s phenomenon

Answer 23

• Treatment of the cause

* Vasodilators and B-blockers are prescribed

Question 24

Difference between acrocyanosis and Raynaud’s disease

Answer 24

1. Not paroxysmal.
2. It affects hands, nose, ears & L.L.
3. Initial stage of pallor is absent.

4- The attack is painless & pain occurs after the attack.

5. Accompanied by paraesthesia.
6. In between the attacks the hands are colder than normal & there is excessive sweating of the palms.

Question 25

Treatment of acrocyanosis

Answer 25

Sympathectomy is less effective than in Raynaud's disease.

Question 26

Erythromelalgia

Answer 26

Precipitated by warmth rather than cold. It affects mainly the feet.

Question 27

Main complain of Erythromelalgia

Answer 27

* Burning pain. * Redness. * The patient often immerses his feet in cold water during the attack

Question 28

a vasospastic condition in which The patient often immerses his feet in cold water during the attack

Answer 28

Erythromelalgia

Question 29

Alternative name for Erythrocyanosis Frigida

Answer 29

Bazin's disease

Question 30

Erythrocyanosis Frigida

Answer 30

* Body parts affected * Pathogenesis * Morphology * Prognosis

Question 31

Body parts affected in Erythrocyanosis Frigida

Answer 31

L.L of obese females in winter.

Question 32

Pathogenesis of Erythrocyanosis Frigida

Answer 32

It is due to ischemic fat necrosis.

Question 33

Morphology of Erythrocyanosis Frigida

Answer 33

There are dusky red indurated areas in the calves & ankles.

Question 34

Prognosis of Erythrocyanosis Frigida

Answer 34

After repeated attacks, indolent ulcers will result.

Question 35

vasospastic condition affecting L.L of obese females in winter.

Answer 35

Erythrocyanosis Frigida

Question 36

vasospastic condition in which There are dusky red indurated areas in the calves & ankles.

Answer 36

Erythrocyanosis Frigida

Question 37

vasospastic condition Precipitated by warmth rather than cold.

Answer 37

Erythromelalgia

Question 38

vasospastic condition affects hands, nose, ears & L.L

Answer 38

acrocyanosis

Question 39

vasospastic condition in which The attack is painless & pain occurs after the attack

Answer 39

acrocyanosis

Question 40

vasospastic condition Accompanied by paraesthesia

Answer 40

acrocyanosis

Question 41

vasospastic condition in which In between the attacks the hands are colder than normal & there is excessive sweating of the palms.

Answer 41

acrocyanosis

Question 42

Vasospastic condition in which The attacks are precipitated by coldness or emotional excitement and are relived by warmth.

Answer 42

Raynaud's disease

Question 43

Vasospastic condition in which The attack is usually accompanied by pain

Answer 43

Raynaud's disease

Question 44

Types of Arteritis

Answer 44

1. Buerger's diseases. 2. Takayasu's diseases 3. Arteritis of collagen origin 4. Cranial arteritis (temporal & occipital). 5. Erythema nodosum

Question 45

Takayasu's diseases in Types of Arteritis

Answer 45

* Autoimmune disease * Affecting thoracic & abdominal aorta & their branches. * Treated by cortisone.

Question 46

Arteritis of collagen origin in Types of Arteritis

Answer 46

* Polyarteritis nodosa. * Scleroderrna * Rheumatoid * SLE

Question 47

Erythema nodosum in Types of Arteritis

Answer 47

Allergic vasculitis due to bacterial toxins

Question 48

Autoimmune disease Affecting thoracic & abdominal aorta & their branches.

Answer 48

Takayasu's diseases

Question 49

Allergic vasculitis due to bacterial toxins

Answer 49

Erythema nodosum