Vasculitis

Question 1

What is vasculitis?

Answer 1

Inflammation of blood vessels

Clinical features arise from damage to blood vessel walls

Question 2

What can cause vasculitis?

Answer 2

Idiopathic
Infection 
Inflammatory disease
Drug induced
Neoplastic

Question 3

What are symptoms of vasculitis?

Answer 3

Fever 
Malaise 
Weight loss 
Arthraligia 
Hameopytsis 
Epistaxis
GI bleeding 
Haematuria 
Visual changes

Question 4

What investigations are done for suspected vasculitis?

Answer 4

Urine dip

Bloods

• FBC
• U+Es
• CRP
• LFTs
• Coag
• ANA
• ANCA
• Anti-GBM

CXR

Question 5

How is vascilitis classified?

Answer 5

Small vessel
Medium vessel
Large vessel

Question 6

What are small vessel vasculitides?

Answer 6

Henoch-schonlein purpura 
Collagen vascular disease
Microscopic polyangitis 
Wegener's 
Churg-strauss

Question 7

What are medium vessel vasculitides?

Answer 7

Polyarteritis nodosa

Kawaski disease

Question 8

What are large vessel vasculitides?

Answer 8

Takayasu arteritis

Giant cell arteritis

Question 9

What is Henoch-schonlein purpura?

Answer 9

IgA vasculitis

Question 10

How does Henoch-schonlein purpura present?

Answer 10

Purpura ( purple marks that don’t disappear when pressed) over legs and buttocks

Question 11

What are collagen vascular disease?

Answer 11

RA
Sjogren’s syndrome
SLE

Question 12

What is microscopic polyangitis?

Answer 12

ANCA associated vasculitis

Question 13

What is Wegener’s?

Answer 13

Granulomatosis with polyangitis

Question 14

What are the symptoms of Wegener’s?

Answer 14

ELK classification

ENT
- sinusitis

Lungs

• dyspnoea
• haemopytisis
• wheeze

Kidneys

• haematuria
• proteinuria

Question 15

What proteins are associated with Wegeners?

Answer 15

PR3

C-ANCA

Question 16

How do you induce remission in Wegener’s?

Answer 16

Cyclophoshamide OR rituximab
+
Prednisolone

Question 17

How do you maintain remission in Wegener’s?

Answer 17

Azathioprine/methotrexate

Question 18

What is Churg-Strauss?

Answer 18

Eosinophilic granulomatosis with polyangitis

Question 19

What are the 6 criteria of Churg-Strauss?

Answer 19

Asthma 
Eosinophilia
Paranasal sinusitis
Pulmonary infiltrates
Histological confirmation 
Mononeuritis/polyneuropathy

Question 20

How many of the Churg-Strauss criteria do you need to make a diagnosis?

Answer 20

4

Question 21

What proteins are associated with Churg-Strauss?

Answer 21

MPO

P-ANCA

Question 22

How do you induce remission in Churg-Strauss?

Answer 22

Cyclophosamide OR rituximab
+
prednisolone

Question 23

How do you maintain remission in Churg-Strauss?

Answer 23

Azathioprine/methotrexate

Question 24

What is polyarteritis nodosa?

Answer 24

Necrotising vasculitis that causes aneurysms and thrombosis

Question 25

What are the symptoms of polyarteritis nodosa?

Answer 25

``` Weight loss Livedo reticularis Testicular pain/tenderness Myalgias Mononeuropathy Polyneuropathy Hypotension <90 ```

Question 26

What are the diagnostic criteria for polyarteritis nodosa?

Answer 26

``` Weight loss >4kg Livedo reticularis Testicular pain/tenderness Myalgias Mononeuropathy or polyneuropathy Hypotension <90 Elevated kidney blood tests (urea >14.3) Evidence of hep B Presence of granulocyte or mixed leukocyte infiltrate in arterial wall biopsy ```

Question 27

How many diagnostic criteria do you need for polyarteritis nodosa?

Answer 27

3

Question 28

What infection is associated with polyarteritis nodosa?

Answer 28

Hepatitis B

Question 29

How do you investigate suspected polyarteritis nodosa?

Answer 29

Hep B antigen ESR FBC - neutrophilia Biopsy arteries

Question 30

How is polyarteritis managed?

Answer 30

Steroid + cyclophoshamide to induce remission Azathioprine for maintenance

Question 31

What is Kawasaki disease?

Answer 31

Autoimmune vasculitis affecting children

Question 32

What are the symptoms of Kawasaki disease?

Answer 32

Fever Swollen neck glands Chest rash Red peeling skin on palms and soles

Question 33

How is Kawasaki disease managed?

Answer 33

Gamma globulin | Aspirin

Question 34

What is Takayasu arteritis?

Answer 34

Systemic vasculitis affecting aorta and its branches

Question 35

What are the symptoms of Takayasu arteritis?

Answer 35

Depend on arteries involved Aortic arch - dizziness - visual changes - weak arm pulses Raised BP Fever Malaise

Question 36

What are complications of Takayasu arteritis?

Answer 36

Aortic regurg Aortic aneurysm Aortic dissection Ischaemic stroke

Question 37

How is Takayasu arteritis managed?

Answer 37

Prednisolone