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90 Cards in this Set

  • Front
  • Back
2 most common mechanisms for vasculitis
Direct invasion by pathogens (infectious)

Immune mediated
c- ANCA found in _
Wegners granulomatosis
p- ANCA found in _
Microscopic polyangitis

Churg Strauss syndrome

Most common form of systemic vasculitis in adults
Temporal arteritis
What type of vessels are affected in temporal arteritis
Large and medium size vessels
What type of inflammation in temporal arteritis
Which arteries are affected in temporal arteritis
Arteries in head (mainly temporal)

Why is temporal arteritis considered to be an emergency
Pathology behind temporal arteritis
Granulomatous inflammation (T cell mediated and antigen driven)causes thickening of vascular wall and narrowing of the lumen with subsequent thrombosis
Treatment for temporal arteritis
Anti inflammatory (steroids)
Patient presents with complain of headache, flu like symptoms, palpable temporal artery and episodes of diplopia - what is the diagnosis and treatment
Temporal arteritis - emergent treatment with steroids
Good test screening for temporal arteritis
ESR levels
Which vessels are involved in Takayasu syndrome
Large vessels to medium sized
What type of inflammation in Takayasu disease
Name vasculitides with granulomatous inflammation


Temporal arteritis
Characteristic features of Takayasu disease
Ocular involvement

Weakening of pulses in upper extremities

Fibrous thickening of aorta (arch and branches)
Another name for Takayasu disease
Pulseless disease
Who usually gets Takayasu disease
Young Asian females
34 year old Asian female presents with complain of coldness in fingers, HTN, intermittant claudication and pulmonary HTN - diagnosis
Takayasu disease
Chest X ray show thickening of aortic wall without narrowing of major branches - diagnosis
Takayasu disease
Is there pulmonary involvement in PAN
What type of vessels affected in PAN
Medium size arteries (no arterioles, capillaries, venules)
30 year old male with long standing history of drug abuse, HIV/AIDS and hepatitis B presents to ER with palpable purpura
Main cause of death in people with PAN
Renal involvement
PAN is associated with what other disease (30%)
Hepatitis B
Polyarteritis nodosa - C anca or P anca
P anca
Treatment for PAN
Corticosteroids and cyclophosphamide
Patient presents with tender erythematous nodules with "punched out" ulcerations - diagnosis?
_ one of the most severe manifestations of PAN and usually presenting complain
What type of inflammation in PAN
Segmental necrotizing
Which vessels are affected in microscopic polyangitis
SMALL - arterioles, venules and capillaries
Major difference between PAN and microscopic polyangitis
Patient presents with hemoptysis, hematuria and proteinuria and complain of abdominal pain, arthralgias and muscle pain/weakness. Physical exam shows palpable purpura
Microscopic polyangitis
Microscopic polyangitis - p ANCA or c ANCA
Common precipitating cause for microscopic polyangitis
Immunologic reaction to antigen (drugs, bacterial infections)
5 most common clinical manifestations of microscopic polyangitis
Kidney inflammation

Weight loss

Skin lesions

Nerve damage

What would you see on UA in patient with microscopic polyangiitis
RBC casts
Splinter hemorrhages on nails are seen in which vasculitis
Microscopic polyangitis
In which vasculitis vascular necrosis IS associated with a granulomas with eosinophilic necrosis
Churg Strauss disease
Patient presents with palpable purpura - history is positive for long standing allergic rhinitis, eosinophilia (IGE) and bronchial asthma
Churg Strauss syndrome
Churg Strauss syndrome - c ANCA or P anca
This vasculitis occurs almost exclusively in patients with asthma
Churg Strauss syndrome
What type of inflammation in Churg Strauss
Systemic vasculitis involving both systemic and pulmonary circulation
Childhood vasculitis
Kawasaki disease
Kawasaki disease targets which vessels
Coronary arteries
Child presents with high fever, conjunctival and oral lesions, rash and lymphadenitis. Work up reveals presence of coronary aneurysm
Kawasaki disease
Necrotizing vasculitis of respiratory tract and kidneys
Wegener granulomatosis
Patient presents with

- pneumonitis with nodular infiltrates w/ cavitations similar to TB
You see nodules on chest x ray - which vasculitis?
Wegeners granulomatosis is c ANCA or p ANCA
Good marker during treatment of WG
Patient presents with hematuria, proteinuria and granulomas in the eye and rash - diagnosis
Peripheral vascular disease in smokers
Buergers disease
_ can result in remission of Buergers disease
Stop smoking
Pathophysiology of Buergers disease
Neutrophillic infiltration leads to thrombosis and obliteration of lumen which leads to gangrene
Patient presents with intermittant claudication and ulcers on the digits - what should you suspect
Buerger disease
Intermittent, bilateral attacks of ischemic vasospasm in the skin
Raynaud phenomenon
Sequence of colors in Raynauds
White --> blue --> red
Pathophysiology of why Raynaud phenomenon occurs with cold
Cold induces IgM --> Aggregation of IgM in blood leads to increased viscosity --> Decrease of blood flow
Acute inflammation within few weeks following group A streptococcal pharyngitis
Rheumatic fever
Pathophys of RF
Cross reaction of antibodies directed at M components of strep with proteins in heart, joints, brain etc
Consequence of acute RF on the heart
Valvular deformities
Most common murmur of RF
Mitral regurgitation
Focal inflammatory lesions of RF
swollen eosinophilic collagen
- found is any layer of the heart (“pancarditis” )
- in pericardium fibrinous or serofibrinous exudate
Aschoff bodies
Focal inflammatory lesions of RF

-swollen macrophages and/or plasma cells
Anitshkow cells
"buttonhole” or “fishmouth” stenoses
Mitral stenosis
Do you see Achoff bodies in rheumatic heart disease
No, replaced by fibrous scar
Most common heart problem with rheumatic heart disease
Mitral stenosis
Autopsy shows thickening
distorted cusps,adherent
commissures with calcification and
thrombus deposition, and thickening, fusion and shortening of chordae tendinae.
Growths are sterile
Mitral stenosis
Major cause of mitral stenosis
Rheumatic heart disease
Jones criteria for rheumatic fever
Migratory polyarthritis (large joints)


Subcutaneous nodules

Erythema marginatum

Sydenham chorea
Chest x ray shows large shadow over L atrium
Rheumatic heart disease - mitral stenosis
This type of pericarditis is result of viral disease
Acute serofibrinous pericarditis
This type of pericarditis is the result of bacterial infection (except for infection by Mycobacterium tuberculosis)
Acute purulent pericarditis
This type of pericarditis is the result of infection by M. tuberculosis or fungi
Chronic pericarditis
Pathophys of acute serofibrinous pericarditis
- Direct cellular damage by the virus

- Destruction of viral infected cells by sensitized T lymphocytes

Antibody dependent cell mediated toxicity
This type of pericarditis is most common in people with malignant neoplasm involving pericardial sac, bacterial infections in people with bleeding disorders and TB and following cardiac surgery
Hemorrhagic pericarditis
Rare type but most frequent cause of chronic constrictive pericarditis
Caseous pericarditis
Most frequent cause of aortic stenosis
Calcification of congenitally deformed valve
Most frequent cause of aortic insufficiency
Dilation of ascending aorta (HTN and aging)
Most common cause of mitral stenosis
Rheumatic heart disease
Most common cause of mitral insufficiency
Mitral valve prolapse (myxomatous degeneration)
Most common of all valvular abnormalities
Calcific aortic stenosis
Pathophys of aortic stenosis
LV outflow is obstructed --> compensates by hypertrophy (concentric, pressure overload) --> ischemic myocardium --> chest pain, syncope, etc
Critical factors in management and outcome in treatment of aortic stenosis
Symptoms - if asymptomatic excellent prognosis, if symptomatic 50% mortality in 5 years with angina and in 2 years with CHF
In which valvular disease you hear midsystolic click
Mitral valve prolapse
Most common causative organism of infective endocarditis
Strep viridans
Causative organism for endocarditis (10-20%)
-found on skin
- increased virulence
-attack normal or damaged valves
- i.v. drug users
Staph Aureus
Which valves are involved in iv drug abusers
Right sided valves
Heart disease associated with SLE
Libman Sacks endocarditis