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Pathology 2 - Block 1 - Part 2

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davidwurbel7's version from 2016-05-26 16:18

Vasculitis

Question Answer
Inflammation of the blood vessel wall. May affect arteries, veins and capillariesVasculitis
Responsible for most cases of vasculitisImmunologic Hypersensitivity Reaction Type III
Consequence of Immunologic Hypersensitivity Reaction Type III in the blood vessel because of endothelial damage and vessel wallFibrinoid Necrosis
Consequence of Immunologic Hypersensitivity Reaction Type III in the blood vessel because of endothelial damageThrombosis
Consequence of Immunologic Hypersensitivity Reaction Type III in the blood vessel because of healing by fibrosisVessel Stenosis
Consequence of Immunologic Hypersensitivity Reaction Type III in the blood vessel because of weakened vessel wallAneurysm Formation
Consequence of Immunologic Hypersensitivity Reaction Type III in the blood vessel because of extravasations of bloodPalpable Purpura
Implicated in some types of vasculitis due to presence of granulomas in the vessel wallImmunologic Hypersensitivity Reaction Type IV - CD4 Mediated
An example of the presence of granulomas in the vessel wall (Immunologic Hypersensitivity Reaction Type IV) is this conditionTemporal Arteritis
The gold standard laboratory test for vasculitisBlood Vessel Biopsy
An increase in ESR along with a tender temporal artery is highly suggestive of thisTemporal Arteritis
A positive antibody test result that is suggestive of vasculitisAntineutrophil Cytoplasmic Antibodies (ANCA)
This is generally seen in some types of vasculitis especially small vessel vasculitisAntineutrophil Cytoplasmic Antibodies (ANCA)
Antibody directed against proteinase 3c-ANCA
Cytoplasmic staining pattern seen in immunofluorescencec-ANCA
Antibody directed against myeloperoxidasep-ANCA
Perinuclear staining pattern seen in immunofluorescencep-ANCA
Wegener’s granulomatosis is associated with these antibodiesc-ANCA
Treatment for this condition is cyclophosomideWegener’s Granulomatosis
Churg-Strauss syndrome and microscopic polyangiitis are associated with these antibodiesp-ANCA
Giant cell arteritis (Temporal Arteritis) and Takayasu’s arteritis are classified as this type of vasculitisLarge Vessel Vasculitis
Polyarteritis nodosa (PAN), Kawasaki’s disease, and Thromboangitis obliterans (TAO) are classified as this type of vasculitisMedium Vessel Vasculitis
Hypersensitivity vasculitis, Henoch Schonlein purpura, Churg Strauss syndrome, Wegener granulomatosis and Microscopic polyangiitis are classified as this type of vasculitisSmall Vessel Vasculitis
Patient presents with loss of pulse or stroke in addition to fever, weight loss, malaise, myalgiasLarge Vessel Vasculitis
Patient presents with infarction or aneurysm, ischemia in addition to fever, weight loss, malaise, myalgiasMedium Vessel Vasculitis
Patient presents with palpable purpura in addition to fever, weight loss, malaise, myalgiasSmall Vessel Vasculitis
Patient is woman >50 yo presenting with Temporal headache, painful and enlarged temporal artery, Muscle aches and pains, Temporary / permanent blindnessTemporal Arteritis (Giant Cell Arteritis)
Patient is woman of Asian descent <50 yo presenting with claudication of upper extremity due to ischemia, absent upper extremity pulse, blood pressure discrepancy between extremities, visual disturbance and dizzinessTakayasu’s Arteritis
Common in young to middle aged men. Kidneys: infarction, hypertension, hematuria, albuminuria. GI tract: Bowel infarction, abdominal pain, melena. Skin: Ischemic ulcers and nodules. Coronary arteries: aneurysms, MI. Systemic manifestation: fever, malaise and weight loss. Transmural inflammation (involving all layers). Segmental involvement of vessel lumen, fibrinoid necrosisPolyarteritis nodosa (PAN)
Common in young to middle aged men. Kidneys: infarction, hypertension, hematuria, albuminuria. GI tract: Bowel infarction, abdominal pain, melena. Skin: Ischemic ulcers and nodules. Coronary arteries: aneurysms, MI. Systemic manifestation: fever, malaise and weight loss. Transmural inflammation (involving all layers). Segmental involvement of vessel lumen, fibrinoid necrosis but also presents with a history of atopy, Bronchial asthma, allergic rhinitis and, peripheral blood eosinophiliaChurg-Strauss Syndrome
An acute self limited febrile illness of infants and children (< 5 yrs). Is endemic in Japan, Hawaii. High fever, Erythematous rash of trunk and extremities with desquamation of skin. Mucosal inflammation - cracked lips, oral erythema. Erythema, swelling of hands and feet. Localized lymphadenopathy.Kawasaki Disease
MCC of an acute MI in childrenKawasaki Disease
This condition is usually seen in young male smoker from Asia and the Middle East presents with Pain in the foot which is severe and present even at rest. On examination - Presence of ulcers and blackish areas over the fingers and toes. Some missing digits. Claudication in feet or hands, gangrene of digits often requiring amputationThromboangitis Obliterans (Buerger's Disease)
A patient with PAN is mostly associated with a pre-existing infection of thisHepatitis B
In thromboangitis Obliterans (Buerger's Disease) not only does the artery become inflamed but also this becomes inflamedNeurovascular Bundle
Refers to a group of immune complex mediated vasculitides characterized by acute inflammation of small blood vessels manifesting as palpable purpuraHypersensitivity (Leukocytoclastic) Vasculitis
This condition may be precipitated by Exogenous antigens - Drugs, Infectious organisms, Foods and chronic diseases such as SLE and RAHypersensitivity (Leukocytoclastic) Vasculitis
The reason for palpable purpura seen in Hypersensitivity (Leukocytoclastic) Vasculitis is due thisSkin Deposition of Immune Complex
Hypersensitivity (Leukocytoclastic) Vasculitis is diagnosed by this testSkin Biopsy
The Lungs - hemoptysis, GIT - abdominal pain, Kidneys - hematuria and Musculoskeletal system - arthralgia can be affected by thisHypersensitivity (Leukocytoclastic) Vasculitis
Most common vasculitis in childrenHenoch Schonlein purpura (HSP)
Condition seen in children, usually occurs following an upper respiratory infection and is caused by deposition of IgA-C3 immune complexes in vessel wall. Clinically presents as palpable purpura over extensor aspects of arms and legs commonly limited to lower extremities/buttocksHenoch Schonlein purpura (HSP)
Immune complex deposition only within the renal tubule causing hematuria and RBC casts following an upper respiratory infectionIg-A Nephropathy
The treatment for Henoch Schonlein purpura (HSP)Steroids
Condition characterized by necrotizing granulomatous inflammation of upper respiratory and lower respiratory tract and granulomatous vasculitis of the same areas plus kidneysWegener Granulomatosis (WG)
Patient presents with lesions of the nose, sinuses and lungs (upper & lower respiratory tract) and Kidneys. Investigions reveal granulomatous inflammation in the upper respiratory tract and lower respiratory tract and in the blood vessels of the upper respiratory tract and lower respiratory tract. In the kidneys granulomatous inflammation of the blood vessels especially within the glomerulus. Labs show c-ANCAWegener Granulomatosis (WG)
Wegener’s granulomatosis is associated with these antibodiesc-ANCA
Treatment for this condition is cyclophosomideWegener’s Granulomatosis
Cyclophosomide treatment can lead to this complicationTransitional Cell Carcinoma
This condition can form a cavatory lesion of the lung that resembles TB and Wegener's GranulomatosisSmall-Cell Carcinoma of the Lung
This condition of the bridge of the nose can be destroyed due to necrosis of the nasal septum called saddle nose deformityWegener’s Granulomatosis
Wegener’s Granulomatosis affecting the nasal septum causing thisSaddle Nose Deformity
Clinical features include middle aged 40-50 yrs (Peak incidence). Male> females. In the upper respiratory tract - Chronic Sinusitis, ulcers of nasopharyngeal mucosa. Saddle nose deformity. In the lower respiratory tract - recurrent pneumonia with nodular lesions which undergo cavitation Kidney: hematuria due to rapidly progressive glomerulonephritis can cause renal failure. Lab - c-ANCA positive. Chest radiograph - bilateral nodular infiltrates or cavitary lesions. Treatment - CyclophosphamideWegener Granulomatosis (WG)
Necrotizing vasculitis involving multiple organs, especially lung and kidney. Nasopharyngeal involvement and granulomas are absent. Serum p-ANCA. Treatment is corticosteroids and cyclophosphamideMicroscopic Polyangiitis
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Question Answer
Treatment for Temporal Arteritis (Giant Cell Arteritis) isCorticosteroids
Treatment for Takayasu’s Arteritis isCorticosteroids
Treatment for Polyarteritis nodosa (PAN) isImmunosuppressive Therapy
Treatment for Churg-Strauss Syndrome is
Treatment for Kawasaki Disease isAspirin
Treatment for Thromboangitis ObliteransCession of Smoking
This drug is contraindicted in Kawasaki DiseaseCorticosteroids
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Raynaud's Disease

Question Answer
Intermittent attacks of ischemia in the fingers or toes that manifests as pallor > cyanosis > redness. Triggered by cold exposure or emotional stressRaunaud's Disease
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(Insert 1-8)
Question Answer
Clinically presents with cold temperatures and stress are stimuli that may trigger the color changes of the fingers from white to blue to red. Ears and nose cyanotic. Often relived by warmth. Vessel changes - Normal initially. Later – show thickening of intima and hypertrophy of tunica mediaSecondary Raynaud’s Phenomenon
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(Insert locations in the adrenal gland for secretions of various substances (GFR layers of the adrenal gland))

Hypertension

Question Answer
Risk factors for this include African American ancestry, obesity (especially abdominal), stress, lack of physical activity and high salt dietPrimary Hypertension
The most common cause of secondary hypertension is thisRenal Vascular Stenosis
Elderly men: atherosclerotic plaque partially blocks blood flow at the renal artery orificeRenovascular Hypertension
Young to middle aged women: fibromuscular dysplasia or hyperplasia of renal arteryRenovascular Hypertension
Renovascular hypertension occurring in elderly men is due to thisRenal Artery Atherosclerosis at the Orifice
Renovascular hypertension occurring in young to middle age women is due to thisRenal Artery Fibromuscular Dysplasia/Hyperplasia
Severe uncontrollable hypertension due to elevated plasma renin activity. Involved kidney has increased plasma renin activity in renal vein. Presence of abdominal bruit due to turbulence of blood flow through the narrow renal artery. Involved kidney has diminished sizeRenovascular hypertension
Most common cardiovascular complication of hypertension is thisConcentric Left Ventricular Hypertrophy
Most common neurovascular complication of hypertension is thisIntracerebral Hematoma
The renal complication of hypertension is thisBenign Nephrosclerosis
Benign Nephrosclerosis is due thisHyaline Arteriolosclerosis
The opthalmatic complication of hypertension is thisHypertensive Retinopathy
Hemorrhages of retinal vessels, Exudates (increased vessel permeability) and PapilledemaHypertensive Retinopathy
Retinal hemorrhage, papilledema, mental status changes. Renal vessels show - Rupture, fibrinoid necrosis and hyperplastic arteriolosclerosis at different parts of the kidney leading to acute renal failure is a complication of thisMalignant Hypertension
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