Mtb: Rheumatology 11, Vasculitis

Front 1

cause of vasculitis

Back 1

unknown

but there are co-morbid disease associations to be aware of

Front 2

4 symptoms that are seen in all vasculitides

Back 2

fever

malaise

weight loss

joint and muscle pain

Front 3

-associated wtih HBV and HVC infection

affects small to medium sized vessels but spares the lungs

Back 3

polyarteritis nodosa (PAN)

Front 4

is there any distinguishing feature of PAN?

Back 4

no it's very hard to dx apart from its association with hepattiis

Front 5

what GI complaint is common in PAN patients?

Back 5

pain worsened with eating due to mesenteric vasculitis, similar to ischemic bowel disease

Front 6

what is the classic skin finding with PAN?

Back 6

livedo reticularis

Front 7

you also see on the skin:

Back 7

purpura

nodules

gangrene

lower extremity ulcers

Front 8

what are some neurological manifestations of PAN?

Back 8

can give symptoms of peripheral neuropathy like foot drop

foot drop is the most common

the other thing that can happen is a stroke in a young person

Front 9

what is mononeuritis multiplex?

Back 9

it's a feature of PAN in which multiple nerves large enough to have a name (e.g. ulnar, radial, common peroneal etc.

Front 10

most accurate test for PAN?

Back 10

biopsy of an affected vessel, site

Front 11

what does angiography show in a case of PAN?

Back 11

shows beading (aka abnormal dilatations along the vessels)

Front 12

What is the big antibody associated with PAN?

Back 12

p-ANCA, but it's only seen in about 20% of cases

Front 13

what effect on the kidney does PAN have?

Back 13

causes a general nephritic syndrome but doesn't really give any specific signs or findigns on U/A or anything

Front 14

2 drugs used in mgmt of PAN

Back 14

prednisone

cyclophosphamide

treat the underlying hepatitis as well

Front 15

what is the quintessential lab finding associated with PMR?

Back 15

really high ESR

Front 16

what is the hx like for PMR?

Back 16

hair/chair/stair weakness that is associated wth MUSCLE PAIN as well

Front 17

What do CPK and aldolase show in a case of PMR?

Back 17

they are normal

Front 18

treatment of PMR

Back 18

it's extremely responsive to steroids

Front 19

disease that tends to be on a spectrum with PMR

Back 19

giant cell arteritis

Front 20

how does GCA present?

Back 20

visual symptoms, scalp tenderness, unilateral headache

Front 21

what can you see in the arms and near the clavicles in giant cell arteritis?

Back 21

you can see decreased arm pulses, bruits near the clavicles, aortic regurg etc.

Front 22

a lab test that is obviously useful in GCA

Back 22

really high ESR

Front 23

but the most accurate test for GCA is

Back 23

temporal artery biopsy

Front 24

treatment of GCA

Back 24

high dose prednisone

Front 25

what do you do first? steroids or biopsy?

Back 25

steroids to prevent blindness

Front 26

what is the classic jaw-related symptom in GCA>

Back 26

jaw claudication with chewing

Front 27

upper respiratory tract findings along with renal insufficiency and granulomas

Back 27

Wegener's granulomatosis

Front 28

what are some ways for upper respiratory tract to be involved in Wegener's?

Back 28

sinusitis, mastoiditis, otitis media

nasal septal perforation

oral and gingival involvement even

Front 29

best initial test for Wegener's granulomatosis

Back 29

antineutrophil cytoplasmic antibody (c ANCA)

Front 30

what is the difference between cANCA and p ANCA?

Back 30

directed at different things:

c-ANCA is against proteinase-3

p ANCA is against myeloperoxidase

Front 31

what type of biopsy is best to dx Wegener's definitively?

Back 31

lung biopsy

Front 32

tx of Wegener's

Back 32

prednisone and cyclophosphamide just like PAN

Front 33

classic way for USMLE to ask Wegner's

Back 33

a pneumonia that is not resolving with antibiotics

Front 34

another pulmonary renal syndrome but this vasculitis shows an association with asthma and eosinophilia

Back 34

Churg Strauss

Front 35

most accurate test for churg strauss

Back 35

biopsy of affected areas

Front 36

tx for Churg strauss

Back 36

prednisone and cyclophosphamide

Front 37

kid with abdominal pain and bleeding, palpable purpura, joint pains, hematuria after a recent hx of URTI

Back 37

Henoch Schonlein purpura (HSP)

Front 38

dx of HSP

Back 38

mostly clinical

you can get a biopsy to be most accurate, but you should probabyl just treat it when it presents

Front 39

what is the mgmt for HSP

Back 39

this should resolve on its own but STEROIDS are used to reduce severe abdominal pain as well as decrease renal progression

Front 40

Is serum IgA useful for dx of HSP?>

Back 40

no

Front 41

another vasculitis that is associated with HCV

also connected to endocarditis and Sjogren syndrome as a comorbidity

Back 41

cryoglobulinemia

Front 42

what is the difference between cryoglobulinemia and cold agglutinins?

Back 42

they're both IgM antibodies, cold agglutinins are associated with EBV and Mycoplasma pneumonia. they are more characterized by HEMOLYSIS

Front 43

so cold agglutinins hemolyze. What does cryoglobulinemia result in?

Back 43

it's a much more systemic disease characterized by joint pain, purpuric skin lesions, neuropathy, nephritis etc.

Front 44

What is the tx for cryoglobulinemia?

Back 44

interferon

ribavirin

telepravir

so in other words treat their Hep C

Front 45

as opposed to cold agglutinins treatment which is

Back 45

stay warm

give rituximab, cyclophosphamide and cyclosporine

Front 46

Asian or Middle Eastern person with painful oral and genital ulcers and erytema nodosum-like lesions on the skni

Back 46

Behcet syndrome

Front 47

what is the eye manifestation of Behcet

Back 47

gives ocular lesions and anterior uveitis

BLINDNESS eventually

Front 48

What CNS disease can Behcet mimic?

Back 48

MS