Takayasu Arteritis - LARGE CELL

Question 1

Vasculitis is an autoimmune inflammatory condition where immune cells mistake antigens on the endothelium for foreign antigens. What is the called?

1 - immune tolerance
2 - molecular mimicry
3 - cross reactivity
4 - all of the above

Answer 1

2 - molecular mimicry

Question 2

In vasculitis damaged endothelium tries to repair itself. Which of the following does NOT occur during this healing process?

1 - tissue factor and collagen are exposed to coagulation factors
2 - increased risk of coagulation
3 - walls become thinner and weaker, increasing risk of aneurysms
4 - fibrin is deposited into vessel walls
5 - walls become more elastic

Answer 2

5 - walls become more elastic
- walls actually become stiffer due to all the other factors such as fibrin deposits

Question 3

Which of the following is NOT a general symptom of vasculitis?

1 - fever
2 - weight loss
3 - anaemia
4 - fatigue
5 - myalgia/arthralgia

Answer 3

3 - anaemia

Question 4

There are generic symptoms patients with vasculitis can present with, such as fever, weight loss and fatigue. Which of the following specific organs can be affected?

1 - ENT = nasal bridge collapse
2 - Skin = purpura rash (non-blanching), can cause necrosis
3 - Oral = mucus membrane ulcers, necrosis and haemorrhage in gums
4 - Neural = cerebral vasculitis (white matter on T2 scan)
5 - all of the above

Answer 4

5 - all of the above

Question 5

Vasculitis is an autoimmune inflammatiion of the blood vessels. Vasculitis can be classified into 3 categories. Which of the following is NOT one of these categories?

1 - Large Vessel
2 - Medium Vessel
3 - Moderate Vessel
4 - Small Vessel

Answer 5

3 - Moderate Vessel

• Large Vessel = Takayasu’s, Giant Cell arteries
• Medium Vessel = Polyarteritis nodosa, Kawasaki’s
• Small = Henoch Schonlein purpura, EGPA and GPA, MPA

Question 6

Takayasus arteritis is a form of large vessel arteritis. Which ethnicity is most at risk of Takayasus arteritis?

1 - caucasians
2 - europeans
3 - african americans
4 - asians

Answer 6

4 - asians

Question 7

Takayasus arteritis is a form of large vessel arteritis. What age group is Takayasus arteritis most common in?

1 - <20
2 - <30
3 - <40
4 - <50

Answer 7

4 - <50

Question 8

Takayasus arteritis is a form of large vessel arteritis. Are men or women affected more by Takayasus arteritis?

Answer 8

• women

Question 9

All of the following blood vessels can be affected in Takayasus arteritis, but which is the most common to be affected?

1 - aorta and the aortic arch vessels (carotids, subclavian).
2 - pulmonary arteries
3 - renal arteries
4 - coronary arteries

Answer 9

1 - aorta and the aortic arch vessels (carotids, subclavian)

• stenosis is a common finding

Question 10

Takayasus arteritis is a form of large vessel arteritis. The presentation is very similar to giant cell arteritis, except for which 2 key differences?

1 - affects asian women <40 y/o
2 - affects large vessels of legs only
3 - affects men <40 y/o
4 - affects the blood vessels branching off the aortic arch, specifically the branches

Answer 10

1 - affects asian women <40 y/o

4 - affects the blood vessels branching off the aortic arch

Question 11

Takayasus arteritis is a form of large vessel arteritis that typically affects the blood vessels branching off the aortic arch, specifically the branches. What symptoms can this present with?

1 - weak or lack of pulses in upper extremities
2 - visual symptoms
3 - neurological symptoms
4 - all of the above

Answer 11

4 - all of the above

Question 12

If a biopsy was taken from a patient with suspected takayasus cell vasculitis we would see giant cells. What are these cells though?

1 - megakaryocytes
2 - lymphocytes grouped together
3 - reed-sternberg cells
4 - monocytes packed together

Answer 12

4 - monocytes packed together
- form a granuloma
- found in internal elastic lamina

• this is the same as in giant cell arteritis

Question 13

How can we treat takayasus cell arteries?

1 - NSAIDS given immediately
2 - strong dose of steroids given immediately
3 - DMARDs given immediately
4 - biologics given immediately

Answer 13

2 - strong dose of steroids given immediately
- typically glucocorticoids is 1st line

Question 14

How can we treat giant cell arteries?

1 - NSAIDS given immediately
2 - strong dose of steroids given immediately
3 - DMARDs given immediately
4 - biologics given immediately

Answer 14

2 - strong dose of steroids given immediately

• prednisolone 40mg-60mg/day

If steroids fail, use:
- Methotrexate
- Leflunomide
- Tociluzumab