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71 Cards in this Set
- Front
- Back
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What are Vasculitides?
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Inflammatory and necrotizing vascular lesions associated with immune complex deposition
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What are 3 antigens that are FREQUENTLY found in vasculitis immune complexes?
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-DNA
-Hep B surface antigen -Hep C RNA |
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What size vessels are involved in Polyarteritis nodosa? What are 2 classic findings in this?
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Small and Med sized
-Necrotizing immune complex inflammation -Aneurysmal nodules |
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What type of HSN is Polyarteritis nodosa?
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Type III
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What virus is implicated in 30% of Polyarteritis nodosa cases?
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Hepatitis B!
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What are the clinical findings in PAN?
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Fever/weightloss/malaise
Headache/Myalgias/Hypertension |
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What is the most frequent cause of death in PAN?
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Vasculitis in renal arterioles and glomeruli leading to hypertension
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What does PAN cause when lesions are in the heart?
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Ischemic heart disease
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What do PAN lesions in the muscles and bones lead to?
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-Myalgias
-Arthralgia -Arthritis |
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How does PAN in the GI system manifest?
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-Nausea/vomiting
-Abdominal pain |
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What is the HALLMARK CLASSIC FINDING in PAN?
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Anti-neutrophilic myeloperoxidase
P-ANCA positive! |
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What is a necrotizing vasculitis some consider a variant of PAN?
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Churg-Strauss Syndrome
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What is Churg-Strauss also called?
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Allergic granulomatous angiitis
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What are the 3 hallmark features of Churg-Strauss syndrome?
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-Pulmonary vessel necrosis
-Marked periph eosinophilia -Asthma symptoms |
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What is Leukocytoclastic vasculitis?
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A group of Hypersensitivity reaction induced vasculitides
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What size vessels are particularly affected in Hypersensitivity vasculitis?
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SMALL - arterioles/caps/venules
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How do the lesions in Leukocytoclasic vasculitis compare to those in PAN?
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Leukocytocl: all same age
PAN: differing ages due to ongoing process |
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What is the prominent clinical finding when Leukocytoclastic Hypersensitivity Vasculitis involves the skin?
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PALPABLE PURPURA
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What can cause Hypersensitivity Vasculitis?
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Anything
-Exogenous antigens -Systemic diseases (CT dis) |
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What are 2 syndromes that are Hypersensitivity vasculitidies?
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-Henoch Schonlein purpura
-Serum sickness |
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In what age group is Henoch Schonlein typically seen? What is the prominent symptom?
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-Children after viral infections, foods, drugs
-Hemorrhagic urticaria on arms, legs, butt |
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What commonly precedes Henoch Schonlein attacks?
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Strep Upper resp infections
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What is Serum sickness?
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Horse serum induced type III HSN
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What disease is characterized by NECROTIZING Granulomatous Vasculitis in small-med vessels?
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Wegener's Granulomatosis
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What are the predominant tissues where the necrotizing granulomatous vasculitis is seen? What manifests as a result?
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-UPPER RESP TRACT - sinusitis
-Glomeruli - nephrotic syndrome |
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What is the hallmark lab test associated with Wegner?
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C-ANCA - cytoplasmic staining pattern
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What are the 2 giant cell arteritides? Which is most common?
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-Temporal Arteritis - more common
-Takayasu arteritis |
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What is the most frequently occuring vasculitis? In what age?
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Temporal arteritis! Elderly
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What vessels are typically affected in Temporal arteritis?
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The temporal artery... branches of Carotid
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What are the clinical symptoms of Temporal arteritis?
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-Headache
-Tenderness -Palpable nodules along course of involved artery -Visual impairment -Polymyalgia rheumatica |
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What is Polymyalgia rheumatica?
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-Early morning stiffnes
-Periarticular pain -Proximal muscle weakness |
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What lab finding can be seen in Temporal Arteritis?
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Markedly elevated ESR
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Will there be a pulse in the artery affected in Temporal arteritis?
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no
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Will there be a pulse in Takayasu Arteritis? Why?
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REALLY NO - it involves the AORTIC ARCH so there are absent pulses in CAROTID/RADIAL/ULNAR arteries!!!
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What is the involvement of the Aortic Arch in Takayasu's called?
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Aortic arch syndrome
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What is Mucocutaneous LN syndrome? What age group? Progression?
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Kawasaki disease
-Children -Acute -Self limiting |
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What are the main symptoms of Kawasaki disease?
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Fever
Hemorrhagic edema of conjunctiva lips and oral mucosa Cervical lymphadenopathy |
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What population is Thromboangiitis obliterans associated with?
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-Jewish
-Younger Men |
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What is another name for Thromboangiitis obliterans?
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Buerger's disease
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What are the 2 hallmark findings in Buerger disease?
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-Painful ischemic disease
-Exacerbated by SMOKING! |
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What are 2 cell types commonly seen in Lymphomatoid Granulomatosis?
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-Atypical lymphocytoid cells
-Plasmacytoid cells |
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What can Lymphomatoid Granulomatosis progress to?
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T-cell non-hodgkin lymphoma!
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What are the 2 FUNCTIONAL vascular diseases?
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-Raynaud disease
-Raynaud PHENOMENON |
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What is the difference?
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Raynaud disease - primary
Phenomenon - 2ndary to underlying disorder |
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How is Raynaud disease manifested?
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Recurrent vasospasms of small vessels - pallor/cyanosis
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In what patients is raynaud's disease most common?
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Young healthy women
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What are 2 hallmark conditions that Raynaud's disease develops secondarily to?
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-SLE
-PSS (scleroderma) |
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What are 3 major types of hypertension?
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1. Primary/Essential
2. Secondary to known cause 3. Malignant - Accelerated |
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What are the majority of htn cases?
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Primary - unknown cause
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What is seen in 3/4 cases of HTN?
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Family history
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In what race is HTN more common and mores severe?
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African americans!
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What does untreated essential HTN predispose you to?
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Ischemic heart disease/stroke
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What is by far the most common cause of 2ndary HTN?
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-Renal disease!
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2 types of causes of renal disease leading to HTN:
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-Parenchymal disorders
-Unilateral renal artery stenosis |
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What causes renal artery stenosis?
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-Atherosclerosis
-Unilateral fibromuscular dysplasia |
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What happens to the affected kidney in renal artery stenosis?
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It ATROPHIES
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What must be done in renal artery stenosis?
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Surgical correction
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What is the MECHANISM of renal hypertension?
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RAAS stimulation
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What makes the RAAS kick in?
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Decreased vasc tone / RPP sensed by JG cells; so they secrete RENIN
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What are 6 Endocrine disorders that can cause 2ndary hyperension?
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-Conn's primary aldosteronism
-Acromegaly -Cushings syndrome/disease -Pheochromocytoma -Hyperthyroidism -Diabetes mellitus w/ Glomneph |
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What is Conn syndrome usually associated with?
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An adrenal adenoma secreting aldosterone, or bilateral adrenal hyperplasia (21-OHase deficiency)
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What are the 3 lab findings in Conn syndrome?
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-Hypertension
-Hypokalemia -Hypernatremia |
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What can cause hypertension LIMITED TO THE UPPER BODY?
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Coarctition of the aorta
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What % of patients with high bp get malignant hypertension? Which ones?
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<5%
-Young African american MALES |
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What type of course of either primary or secondary htn will be followed with malignant htn?
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Accelerated
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What are 4 characteristic features seen in Malignant hypertension?
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-LV hypertrophy and failure
-Markedly increased Diastolic blood pressure -Focal Retinal hemorrhages -Papilledema |
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What is papilledema?
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Swelling of the optic disc due to increased IOP
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In what 3 ways can Malignant hypertension lead to early death?
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-Congestive heart failure
-CVA -Renal failure |
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What does Malignant Hypertension do to the kidneys?
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Malignant Nephrosclerosis
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Hallmark finding in Malignant nephrosclerosis:
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Flea-bitten kidney - multiple pinpoint petechiae on the surfaces
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What happens to the SIZE of the kidneys in malignant nephrosclerosis?
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They become large and swollen
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