R/O - Vasculitis and fibromyalgia

Question 1

takayasu arteritis classification

Answer 1

3/6 of:

• age under 40
• claudication of extremities
• decreased brachial artery pulse
• BP difference over 10 mm Hg between arms
• bruit over subclavian or aorta
• arteriogram abnormality: occlusion or narrowing

Question 2

what is the gold standard diagnostic test for takayasu arteritis?

Answer 2

angiogram

Question 3

classic PAN affects what sized vessels?

Answer 3

small and medium

Question 4

wegeners granulomatosis affects what sized vessels?

Answer 4

small and medium

Question 5

churg strauss affects what sized vessels?

Answer 5

small and medium

Question 6

kawasaki syndrome affects what sized vessels?

Answer 6

small and medium

Question 7

takayasu affects what sized vessels?

Answer 7

large

Question 8

HSP affects what sized vessels?

Answer 8

small

Question 9

cryoglobulinemia affects what sized vessels?

Answer 9

small

Question 10

what conditions can mimic systemic vasculitis?

Answer 10

• atheroembolic disease
• cardiac myxoma
• thrombotic disorders (anti phospholipid antibody syndrome, TTP)
• drug induced vascular damage (ergot, cocaine, amph)
• infective endocarditis

Question 11

how is PAN differentiated from polyangiitis?

Answer 11

PAN:

• small and medium muscular artery
• renal vascular nephropathy
• no lung involvement
• ANCA NEGATIVE

POLYANGIITIS:

• small and medium arteries, arterioles, venules, capillaries
• glomerulonephritis
• lungs involved (33%)
• ANCA POSITIVE

Question 12

wrist drop is seen in what vasculitis disorder?

Answer 12

PAN

Question 13

subcutaneous nodules in hand - which vasculitis?

Answer 13

PAN

Question 14

what is cryoglobulinemia?

Answer 14

immunoglobulins that undergo reversible precipitation in the cold

Question 15

what are the clinical features related to immune complex deposition in cryglobulinemia?

Answer 15

• purpura
• arthralgia
• nephritis
• neuropathy

Question 16

wegeners granulomatosis with polyangiitis classification

Answer 16

2/4 of:

• nasal or oral inflammation (ulcers, bloody nasal drainage)
• abnormal chest radiograph (nodules, fixed infiltrates, cavities)
• urinary sediment
• granulomatous inflammation on biopsy (wall of artery or arteriole, perivascular, or extravascular)

Question 17

polymyalgia rheumatica: clinical features

Answer 17

• pelvic and shoulder girdle aching
• morning stiffness
• rapid response to low doses of corticosteroids**
• anemia

Question 18

polymyalgia rheumatica: lab features

Answer 18

• anemia

- elevated ESR and CRP

Question 19

giant cell arteritis: lab features

Answer 19

• elevated ESR
• elevated CRP
• anemia
• elevated alk phos

Question 20

what is the first manifestation of giant cell arteritis?

Answer 20

PMR symptoms

Question 21

definition: fibromyalgia

Answer 21

chronic pain disorder with unknown etiology and unclear pathophysiology

Question 22

what is the (proposed) pathogenesis of fibromyalgia?

Answer 22

• temporal and spatial pain summation
• decreased endogenous pain inhibition
• unique to temporal brain activation of frontal cortex, motor cortex, and cingulate cortex in anticipation of pain
• significant reduction in total gray matter volume suggesting premature aging
• higher levels of glutamine in right posterior insula

Question 23

what are the clinical manifestations of fibromyalgia?

Answer 23

• widespread musculoskeletal pain
• paresthesias
• fatigue
• cognitive and mood disturbances
• depression and/or anxiety
• headache