MSK- vasculitis

Question 1

two major categories of large vessel vasculitis

Answer 1

temporal (giant cell) arteritis and Takayasu arteritis (TA)

Question 2

Takayasu arteritis aetiology

Answer 2

<40 years
females
Asian

Question 3

CF Takayasu arteritis

Answer 3

systemic- weight loss, night sweats, fever, malaise
claudication in upper and lower limbs

Question 4

CF Takaysu arteritis- if left untreated

Answer 4

vascular stenosis and aneurysms- carotid bruit, reduced pulses, bp differences extremities

Question 5

giant cell arteritis age range

Answer 5

> 50, most commonly late 60s

Question 6

giant cell arteritis associated with

Answer 6

polymyalgia rheumatica

Question 7

GCA typical presentation

Answer 7

new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate (ESR), CRP or plasma viscosity

Question 8

GCA symptoms

Answer 8

unilateral acute temporal headache with focal tenderness on direct palpation
jaw claudication on chewing firm foods or speaking
visual disturbances
visual loss
constitutional manifestations

Question 9

GCA signs

Answer 9

Tender enlarged non-pulsatile temporal arteries

Question 10

first line investigation in GCA

Answer 10

temporal artery USS

Question 11

gold standard investigation in GCA

Answer 11

temporal artery biopsy

Question 12

management of large vessel vasculitis

Answer 12

Start at prednisolone 40-60mg daily

Question 13

TA specific management

Answer 13

more long term, use steroid sparing agents if needed e.g. leflunamide, methotraxate

Question 14

GCA specific management

Answer 14

gradual reduction in steroid dose over 18 months to 2 years

Question 15

GCA treatment with visual loss

Answer 15

IV methylprednisolone 500mg

Question 16

GCA treatment for bone protection

Answer 16

bisphophonate
vitamin d
calcium

Question 17

polyarteritis nodosa most commonly affects which sex and age group

Answer 17

men
aged 40-60

Question 18

polyarteritis nodosa associated with

Answer 18

hepatitis b

Question 19

skin symptoms of polyarteritis nodosa

Answer 19

livedo reticularis, nodules, ulcers, palpable purpura

Question 19

polyaeteritis nodosa affects which organ systems

Answer 19

skin
nerves
kidneys
MSK
GI
CNS
cardiac

Question 20

polyarteritis nodosa lab results

Answer 20

Haematuria/proteinuria when renal involvement present
elevated CRP/ESR
anaemia, thrombocytosis
low albumin
hep b surface antigen

Question 21

polyarteritis nodosa mild-moderate disease management

Answer 21

oral corticosteroids

Question 22

polyarteritis nodosa life threatening disease management

Answer 22

high-dose pulsed IV corticosteroids

Question 23

polyateritis nodosa additional therapy

Answer 23

Additionalimmunosuppressive therapyis usually required (e.g. azathioprine, methotrexate, cyclophosphamide or rituximab)

Question 24

polyarteritis nodosa complication

Answer 24

aneurysm formation- lead to haemorrhage

Question 25

Granulomatosis with polyangiitis (GPA) affects:

Answer 25

upper and lower respiratory tract, eyes and/or kidneys

Question 26

typical age of GPA

Answer 26

35-50

Question 27

ENT symptoms of GPA

Answer 27

sinusitis nasal crushing mouth ulcers epistaxis (nose bleed) sensourineal deafness otitis media 'saddle nose'

Question 28

respiratory symptoms of GPA

Answer 28

cough haemoptysis pulmonary infiltrates diffuse alveolar haemorrhage cavitating nodules on CXR

Question 29

occular symptoms of GPA

Answer 29

conjunctivitis, episcleritis, uveitis, optic nerve vasculitis, retinal artery occlusion, proptosis

Question 30

cutaneous symptoms of GPA

Answer 30

palpable purpura, cutanous ulcers

Question 31

Renal symptoms of GPA

Answer 31

necrotising glomerulonephritis

Question 32

difference between GPA and EPGA

Answer 32

late onset asthma, high eosinophil count and ANCA specificity in EPGA

Question 33

Microscopic polyangiitis very common clinical feature

Answer 33

Necrotising glomerulonephritis very common - occurs in up to 90% of patients

Question 34

ANCA in GPA

Answer 34

cANCA

Question 35

ANCA in EPGA and MPA

Answer 35

pANCA

Question 36

most cases management of ANCA-associated small vessel vasculitis

Answer 36

IV steroids and cyclophosphamide

Question 37

localised and systemic ANCA associated small vessel vasculitis management usually

Answer 37

methotrexate and steroids

Question 38

generalised and systemic ANCA associated small vessel vasculitis management usually

Answer 38

Cyclophosphamide and steroids

Question 39

renal biopsy of ANCA associated small vessel vasculitis

Answer 39

crescent formation pauci-immune

Question 40

HSP most common age range

Answer 40

children 2-11

Question 41

HSP potential triggers

Answer 41

infection medications vaccines insect bites

Question 42

HSP symptoms

Answer 42

purpuric rash over buttocks and lower limbs colicky abdominal pain bloody diarrhoea arthralgia/arthritis (knee and ankles predominantly)

Question 43

HSP signs

Answer 43

fever renal involvement history of recent upper respiratory tract infection

Question 44

HSP is a clinical diagnosis, what investigation is used for a definitive diagnosis in uncertain cases

Answer 44

tissue biopsy

Question 45

Behçet's disease most common in people from where

Answer 45

Turkey Mediterranean Japan

Question 46

Behçet's disease affects people with what HLA positivity

Answer 46

HLA-B51

Question 47

Behçet's disease symptoms

Answer 47

recurrent oral ulcers recurrent genital ulceration uveitis erythema nodosum

Question 48

test for Behect;s disease

Answer 48

the pathergy test- inflammatory papule or pustule, after mild skin trauma

Question 49

polymyalgia rheumatica affects which age group

Answer 49

>50 years

Question 50

polymyalgia reumatica associated with

Answer 50

giant cell arteritis

Question 51

polymyalgia reumatica symtoms

Answer 51

proximal myalgia of hip and shoulder girdles with morning stiffness lasting >45mins- usually symmetrical, occurs relatively quickly, pain worse with movement systemic symptoms

Question 52

polymyalgia reumatica signs

Answer 52

reduced movement of shoulders, neck, and hips muscle strength normal upper arm tenderness carpel tunnel syndrome pitting oedema

Question 53

polymyalgia rheumatica management

Answer 53

rapid and dramatic response to low dose steroids- start at prednisolone 15mg daily

Question 54

which ig mediates HSP

Answer 54

IgA

Question 55

what is the most common vasculitis in children

Answer 55

HSP