Vasculitides - MedEd

Question 1

Name the classifications of vasculitides

Answer 1

Small vessel
Medium vessel
Large vessel

Question 2

Two types of large vessel vasculitis

Answer 2

Temporal arteritis

Takayasu’s arteritis

Question 3

Symptoms of temporal arteritis/GCA

Answer 3

Unilateral headache
Jaw claudication (pain on chewing, maxillary artery affected)
Visual disturbances
Scalp tenderness

PMR symptoms
FLAWS

Question 4

Define GCA

Answer 4

Granulomatous inflammation of large arteries affecting the external carotid artery, most commonly the temporal artery

Question 5

Investigations for GCA

Answer 5

High ESR

Temporal artery biopsy - NOT SENSITIVE due to skip lesions

Question 6

Diagnostic criteria + Management of GCA

Answer 6

Age of onset over 50 years,
new headache
high ESR

Oral pred

Question 7

MOST APPROPRIATE step for presentation of GCA

Answer 7

Oral pred

Question 8

What is PMR + symptoms

Answer 8

Inflammatory rheumatological condition of unknown cause, causing:

Bilateral hip and shoulder pain
Morning stiffness

Question 9

Investigations for PMR + what is normal

Management of PMR

Answer 9

High ESR, CRP
NORMAL CK

Corticosteroids

Question 10

Takasu’s arteritis + epidemiology

Answer 10

Occlusion and inflammation of AORTA and its main branches

Under 40
Asian
Females

Question 11

Presentation of Takayasu’s arteritis depending on vessel affected

Answer 11

Subclavian artery affected: 
Limb claudication - fatigue on exertion
Absent pulses
Bruits
Unequal BP

Carotid artery affected:
Headache, TIA, STROKE

Right coronary artery affected:
Angina

If abdominal arteries affected, mesenteric ischemia

Question 12

Investigations for Takayasu’s arteritis

Answer 12

High ESR/CRP

CTA/MRA

Question 13

Two types of medium vessel vasculitides

Answer 13

Polyarteritis nodosa

Kawasaki disease

Question 14

Where does polyarteritis nodosa affect?

Answer 14

Arterioles, capillaries, venules in:

Kidneys
Abdomen
Skin
Nerves

Question 15

Risk factors

Answer 15

Hep B infection

Idiopathic

Question 16

Presentation of polyarteritis nodosa

Answer 16

Renal - hypertension, renal failure, haematuria
Abdo - abdo pain, PR bleeding (mesenteric ischemia, vomiting)
Skin - livedo reticularis (mottled appearance)
Nerves - peripheral neuropathy
Arthraliga
FLAWS

Question 17

Investigations for polyarteritis nodosa and key signs

Answer 17

CTangiography
MRangiography
ROSARY sign/beaded appearance due to micro aneurysms of the blood vessels

Question 18

Classification of small vessel vasculitis

Answer 18

ANCA positive and ANCA negative

Question 19

Types of ANCA positive vasculitides

Answer 19

Churg-Strauss
Wegener
MPA

Question 20

Types of ANCA negative vasculitides

Answer 20

HPA

Goodpastures

Question 21

Another name for Wegener’s disease

Answer 21

Granulomatosis polyangiitis

Question 22

Define granulomatosis with polyangiitis

Answer 22

An autoimmune necrotising granulomatous vasculitis characterised by a triad of organ involvement, including URT, LRT and kidneys.

Question 23

Presentation of granulomatosis with polyangiitis

Answer 23

URT - rhinitis, epistaxis
LRT - SOB, haemoptysis
Kidney - haematuria. dysuria

Question 24

Distinct features of GPA on genetic screening/investigations

Answer 24

cANCA
Saddle shaped nose
RBC casts
Cavitating lesions on CXR

Question 25

Another name for Churg-Strauss syndrome

Answer 25

Eosinophilic granulomatosis with polyangiitis

Question 26

Define eosinophilic granulomatosis with polyangiitis

Answer 26

A systemic autoimmune vasculitis causing blood vessel inflammation, characterised by asthma and eosinophilia

Question 27

Presentation of eosinophilic granulomatosis with polyangiitis

Answer 27

Triphasic presentation: Allergic phase - asthma and rhinitis Eosinophilic phase - tissue damage in lungs and GIT Vasculitic phase - widespread organ damage

Question 28

Investigations for eosinophilic granulomatosis with polyangiitis

Answer 28

high pANCA | Eosinophilia

Question 29

Microscopic polyangiitis (MPA) presentation

Answer 29

Similar to granulomatosis with polyangiitis but no URT involvement, therefore: LRT - Haemoptysis, SOB Kidneys - Haematuria, proteinuria Also: FLAWS Mononeuritis multiplex

Question 30

Investigations for microscopic polyangiitis

Answer 30

pANCA U&Es Raised CRP Urinalysis - Haematuria and proteinuria CXR - cavitating lesions Renal biopsy - glomerulonephritis

Question 31

What is the name of the condition that affects all three vessel sizes?

Answer 31

Behcet's syndrome - a multisystem disorder causing vasculitis of small, medium and large sized vessels

Question 32

Presentation of Behcet's disease

Answer 32

Can't see - anterior uveitis Can't pee - genital ulcers Can't eat spicy - oral ulcers Can't climb a tree - Thrombophlebitis, DVT, arthritis, erythema nodosum

Question 33

Rosary sign, hep B infection

Answer 33

Polyarteritis nodosa

Question 34

Uveitis, oral and genital ulcers

Answer 34

Behcet's syndrome

Question 35

pANCA, eosinophilia and asthma

Answer 35

Churg-Strauss/eosinophilic granulomatosis with polyangiitis

Question 36

Commonly affecting asian females

Answer 36

Takayasu's arteritis

Question 37

pANCA and glomerulonephritis

Answer 37

Microscopic polyangitis

Question 38

cANCA, URT, LRT, glomerulonephritis

Answer 38

Wegener's/granulomatosis with polyangiitis