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90 Cards in this Set
- Front
- Back
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2 most common mechanisms for vasculitis
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Direct invasion by pathogens (infectious)
Immune mediated |
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c- ANCA found in _
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Wegners granulomatosis
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p- ANCA found in _
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Microscopic polyangitis
Churg Strauss syndrome PAN |
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Most common form of systemic vasculitis in adults
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Temporal arteritis
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What type of vessels are affected in temporal arteritis
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Large and medium size vessels
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What type of inflammation in temporal arteritis
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Granulomatous
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Which arteries are affected in temporal arteritis
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Arteries in head (mainly temporal)
Ophthalmic |
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Why is temporal arteritis considered to be an emergency
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CAN CAUSE BLINDNESS
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Pathology behind temporal arteritis
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Granulomatous inflammation (T cell mediated and antigen driven)causes thickening of vascular wall and narrowing of the lumen with subsequent thrombosis
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Treatment for temporal arteritis
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Anti inflammatory (steroids)
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Patient presents with complain of headache, flu like symptoms, palpable temporal artery and episodes of diplopia - what is the diagnosis and treatment
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Temporal arteritis - emergent treatment with steroids
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Good test screening for temporal arteritis
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ESR levels
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Which vessels are involved in Takayasu syndrome
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Large vessels to medium sized
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What type of inflammation in Takayasu disease
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Granulomatous
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Name vasculitides with granulomatous inflammation
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Takayasu
Wegners Temporal arteritis |
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Characteristic features of Takayasu disease
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Ocular involvement
Weakening of pulses in upper extremities Fibrous thickening of aorta (arch and branches) |
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Another name for Takayasu disease
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Pulseless disease
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Who usually gets Takayasu disease
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Young Asian females
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34 year old Asian female presents with complain of coldness in fingers, HTN, intermittant claudication and pulmonary HTN - diagnosis
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Takayasu disease
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Chest X ray show thickening of aortic wall without narrowing of major branches - diagnosis
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Takayasu disease
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Is there pulmonary involvement in PAN
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NO
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What type of vessels affected in PAN
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Medium size arteries (no arterioles, capillaries, venules)
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30 year old male with long standing history of drug abuse, HIV/AIDS and hepatitis B presents to ER with palpable purpura
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PAN
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Main cause of death in people with PAN
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Renal involvement
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PAN is associated with what other disease (30%)
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Hepatitis B
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Polyarteritis nodosa - C anca or P anca
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P anca
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Treatment for PAN
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Corticosteroids and cyclophosphamide
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Patient presents with tender erythematous nodules with "punched out" ulcerations - diagnosis?
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PAN
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_ one of the most severe manifestations of PAN and usually presenting complain
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GI
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What type of inflammation in PAN
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Segmental necrotizing
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Which vessels are affected in microscopic polyangitis
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SMALL - arterioles, venules and capillaries
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Major difference between PAN and microscopic polyangitis
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LUNG INVOLVEMENT
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Patient presents with hemoptysis, hematuria and proteinuria and complain of abdominal pain, arthralgias and muscle pain/weakness. Physical exam shows palpable purpura
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Microscopic polyangitis
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Microscopic polyangitis - p ANCA or c ANCA
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p ANCA
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Common precipitating cause for microscopic polyangitis
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Immunologic reaction to antigen (drugs, bacterial infections)
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5 most common clinical manifestations of microscopic polyangitis
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Kidney inflammation
Weight loss Skin lesions Nerve damage Fevers |
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What would you see on UA in patient with microscopic polyangiitis
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RBC casts
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Splinter hemorrhages on nails are seen in which vasculitis
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Microscopic polyangitis
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In which vasculitis vascular necrosis IS associated with a granulomas with eosinophilic necrosis
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Churg Strauss disease
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Patient presents with palpable purpura - history is positive for long standing allergic rhinitis, eosinophilia (IGE) and bronchial asthma
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Churg Strauss syndrome
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Churg Strauss syndrome - c ANCA or P anca
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P ANCA
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This vasculitis occurs almost exclusively in patients with asthma
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Churg Strauss syndrome
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What type of inflammation in Churg Strauss
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Systemic vasculitis involving both systemic and pulmonary circulation
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Childhood vasculitis
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Kawasaki disease
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Kawasaki disease targets which vessels
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Coronary arteries
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Child presents with high fever, conjunctival and oral lesions, rash and lymphadenitis. Work up reveals presence of coronary aneurysm
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Kawasaki disease
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Necrotizing vasculitis of respiratory tract and kidneys
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Wegener granulomatosis
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Patient presents with
-sinusitis - pneumonitis with nodular infiltrates w/ cavitations similar to TB |
WG
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You see nodules on chest x ray - which vasculitis?
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WG
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Wegeners granulomatosis is c ANCA or p ANCA
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c ANCA
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Good marker during treatment of WG
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c ANCA
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Patient presents with hematuria, proteinuria and granulomas in the eye and rash - diagnosis
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WG
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Peripheral vascular disease in smokers
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Buergers disease
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_ can result in remission of Buergers disease
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Stop smoking
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Pathophysiology of Buergers disease
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Neutrophillic infiltration leads to thrombosis and obliteration of lumen which leads to gangrene
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Patient presents with intermittant claudication and ulcers on the digits - what should you suspect
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Buerger disease
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Intermittent, bilateral attacks of ischemic vasospasm in the skin
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Raynaud phenomenon
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Sequence of colors in Raynauds
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White --> blue --> red
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Pathophysiology of why Raynaud phenomenon occurs with cold
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Cold induces IgM --> Aggregation of IgM in blood leads to increased viscosity --> Decrease of blood flow
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Acute inflammation within few weeks following group A streptococcal pharyngitis
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Rheumatic fever
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Pathophys of RF
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Cross reaction of antibodies directed at M components of strep with proteins in heart, joints, brain etc
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Consequence of acute RF on the heart
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Valvular deformities
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Most common murmur of RF
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Mitral regurgitation
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Focal inflammatory lesions of RF
swollen eosinophilic collagen - found is any layer of the heart (“pancarditis” ) - in pericardium fibrinous or serofibrinous exudate |
Aschoff bodies
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Focal inflammatory lesions of RF
-swollen macrophages and/or plasma cells |
Anitshkow cells
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"buttonhole” or “fishmouth” stenoses
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Mitral stenosis
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Do you see Achoff bodies in rheumatic heart disease
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No, replaced by fibrous scar
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Most common heart problem with rheumatic heart disease
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Mitral stenosis
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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
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Major cause of mitral stenosis
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Rheumatic heart disease
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Jones criteria for rheumatic fever
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Migratory polyarthritis (large joints)
Carditis Subcutaneous nodules Erythema marginatum Sydenham chorea |
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Chest x ray shows large shadow over L atrium
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Rheumatic heart disease - mitral stenosis
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This type of pericarditis is result of viral disease
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Acute serofibrinous pericarditis
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This type of pericarditis is the result of bacterial infection (except for infection by Mycobacterium tuberculosis)
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Acute purulent pericarditis
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This type of pericarditis is the result of infection by M. tuberculosis or fungi
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Chronic pericarditis
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Pathophys of acute serofibrinous pericarditis
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- Direct cellular damage by the virus
- Destruction of viral infected cells by sensitized T lymphocytes Antibody dependent cell mediated toxicity |
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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
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Hemorrhagic pericarditis
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Rare type but most frequent cause of chronic constrictive pericarditis
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Caseous pericarditis
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Most frequent cause of aortic stenosis
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Calcification of congenitally deformed valve
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Most frequent cause of aortic insufficiency
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Dilation of ascending aorta (HTN and aging)
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Most common cause of mitral stenosis
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Rheumatic heart disease
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Most common cause of mitral insufficiency
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Mitral valve prolapse (myxomatous degeneration)
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Most common of all valvular abnormalities
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Calcific aortic stenosis
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Pathophys of aortic stenosis
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LV outflow is obstructed --> compensates by hypertrophy (concentric, pressure overload) --> ischemic myocardium --> chest pain, syncope, etc
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Critical factors in management and outcome in treatment of aortic stenosis
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Symptoms - if asymptomatic excellent prognosis, if symptomatic 50% mortality in 5 years with angina and in 2 years with CHF
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In which valvular disease you hear midsystolic click
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Mitral valve prolapse
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Most common causative organism of infective endocarditis
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Strep viridans
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Causative organism for endocarditis (10-20%)
-found on skin - increased virulence -attack normal or damaged valves - i.v. drug users |
Staph Aureus
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Which valves are involved in iv drug abusers
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Right sided valves
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Heart disease associated with SLE
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Libman Sacks endocarditis
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