Vasculitis, Hyperreactivity, Veins and Lymphatics, Vascular Tumors

Question 1

Nonspecific signs of vasculitis

Answer 1

Fever, malaise, joint and muscle aches

Question 2

Noninfectious vasculitis

Answer 2

Via immunologic (complex or autoantibody) injury

Question 3

Infectious vasculitis

Answer 3

Pathogenic organisms invading the vessel wall

Question 4

Treatment for NONINFECTOUS vasculitis

Answer 4

Immunosuppression

Question 5

Large vessel vasculitis possibilities

Answer 5

• Giant cell (temporal) arteritis (>50)

- Takayasu arteritis (

Question 6

Medium vessel vasculitis possibilities

Answer 6

• Polyarteritis nodosa (immune complexes)

- Kawasaki disease (anti-endothelial Ab’s)

Question 7

Small vessel vasculitis possibilities (7)

Answer 7

• Microscopic polyangiitis (no asthma or granulomas)
• Wegener’s granulomatosis (granulomas, no asthma)
• Churg-Strauss (granulomas, asthma, eosinophilia)
• SLE (complex)
• HSP (IgA complex)
• Goodpasture’s (complex)
• Cryoglobulin vasculitis (complex)

Question 8

Anti-proteinase-3

Answer 8

C-ANCA

Question 9

Anti-myeloperoxidase

Answer 9

P-ANCA

Question 10

T or F: ANCA levels correlate w/ disease severity

Answer 10

TRUE

Question 11

MOA of ANCAs

Answer 11

Activate neutrophils that then release ROS

Question 12

Giant cell (temporal) arteritis

Answer 12

• Vision loss and/or headache, non-specific symptoms
• T-cell inflammation of arteries in head (temporal, ophthalmic)
• Granulomatous inflammation w/ multinucleated giant cells
• PATCHY and FOCAL inflammation
• Scarring of media, thickening of intima

Question 13

Takayasu arteritis

Answer 13

• Weak pulse and low BP in upper extremities
• Similar inflammation to temporal arteritis, but involving aortic arch and major branch vessels
• Younger age group (

Question 14

Polyarteritis nodosa

Answer 14

• Young adult (could be any age though)
• Systemic vasculitis via immune complexes
• Renal > coronary > liver > GI tract
• LUNGS ARE SPARED
• Transmural necrotizing inflammation w/ fibrinoid necrosis
• 1/3 have Chronic Hepatitis B (HBsAg-Ab complexes)

Question 15

Kawasaki’s disease

Answer 15

• Infants and small children ( aneurysm, rupture
• RISK OF ACUTE M.I.
• Anti-endothelial antibodies

Question 16

Treatment of Kawasaki’s disease

Answer 16

Aspirin + IVIg (lower risk of coronary artery event)

Question 17

Microscopic polyangiitis

Answer 17

• Necrotizing vasculitis of SMALL vessels
• Fibrinoid necrosis
• Renal glomeruli and lung capillaries
• P-ANCA
• Many apoptotic neutrophils

Question 18

Churg-Strauss syndrome

Answer 18

• Necrotizing vasculitis of SMALL vessels
• ASTHMA, ALLERGIES, EOSINOPHILIA
• GRANULOMAS
• Otherwise similar inflammation to M.P. or PAN

Question 19

Behcet disease

Answer 19

• Vasculitis of small/medium vessels
• ULCERS of ORAL CAVITY
• GENITAL ULCERS
• UVEITIS
• Neutrophilic, nonspecific inflammation
• HLA-B51 association

Question 20

Granulomatosis w/ polyangiitis (Wegener’s)

Answer 20

• Males, 40’s
• Persistent pulmonary, URI, and renal disease
• Necrotizing vasculitis
• Granulomas of upper and lower respiratory tract
• Crescentic glomerulonephritis (RPGN)
• C-ANCA
• Treat w/ corticosteroids and cyclophosphamide

Question 21

Thromboangiitis obliterans (Buerger’s disease)

Answer 21

• THROMBOSING vasculitis of small/medium vessels
• Tibial aa.
• Radial aa.
• Vascular insufficiency of DIGITS/extremities
• SMOKERS, young adults
• Adjacent veins and nerves can get inflammation too
• Chronic ulceration –> GANGRENE

Question 22

Primary vs. Secondary Raynaud’s

Answer 22

Primary = COLD --> symmetric digits (benign)
Secondary = part of arterial disease (SLE, scleroderma, Buerger's disease) (worsens with time)

Question 23

2 causes of myocardial artery vasospasm

Answer 23

• Excess epinephrine (pheochromocytoma)

- Cocaine

Question 24

Varicose veins

Risks?

Answer 24

• Dilation of veins via valvular incompetence

- Stasis, congestion, thrombus, edema, ischemia of skin

Question 25

Portal hypertension can cause what 3 venous dilations?

Answer 25

- Esophageal varices (can fatally rupture) - Hemorrhoids (rectal veins --> pain, bleeding, ulcerate) - Caput medusa (periumbilical veins)

Question 26

- Sitting for long period of time - Venous congestion in deep leg Risk?

Answer 26

DVT Risk = pulmonary embolism

Question 27

Trousseau sign

Answer 27

Migrating thrombophlebitis - Often due to paraneoplastic hypercoaguability - Usually MUCIN-producing ADENOcarcinomas of LUNG, OVARY, PANCREAS

Question 28

Hemangioma Common sites?

Answer 28

Local increased neoplastic blood vessel growth - Skin, mucus membranes, liver

Question 29

3 types of hemangioma (w/ descriptions)

Answer 29

- Capillary hemangioma (thin-walled capillaries tightly packed) - Cavernous hemangioma (irregular, dilated vascular channels making lesion w/o distinct border; deep tissue) - Pyogenic granuloma (LOBULAR capillary hemangioma) (NOT pyogenic, NOT a granuloma) (rapidly growing, oral mucosa)

Question 30

Lymphangioma vs. hemangioma

Answer 30

Lymphangioma = NO RBCs

Question 31

2 types of lymphangioma (w/ descriptions)

Answer 31

- Simple lymphangioma (head/neck and axilla) | - Cavernous lymphangioma (cystic hygroma) (neck or axilla of children, can be large) (TURNER'S SYNDROME)

Question 32

Glomus tumor

Answer 32

Benign tumor via glomus bodies (distal fingers) - PAINFUL - SM origin

Question 33

Bacillary angiomatosis

Answer 33

Vascular proliferation via Gram (-) Bartonella species - IMMUNOCOMPROMISED - Skin, localized, red papules, capillary proliferation - Treat w/ macrolide antibiotics

Question 34

Epithelioid hemangioendothelioma

Answer 34

Neoplastic endothelial cells resembling epithelium (cuboidal, plump)

Question 35

Kaposi sarcoma - associated w/ what?

Answer 35

HHV8

Question 36

4 types of Kaposi's sarcoma (w/ descriptions)

Answer 36

- AIDS-associated KS (spread to LNs and viscera) - Classic KS (no AIDS, older men of mediterranean descent, skin only) - African KS (no AIDS,

Question 37

Angiosarcoma

Answer 37

Malignant endothelial tumor - Commonly in skin, soft tissue, breast, liver - Older people - Locally invasive and metastatic - Relatively deadly - CD31 marker