Thursday, February 12, 2015

Study group discussion: Vasculitis

This review question session was held by Sakkan!

Examples of large, medium and small arteries?
Large arteries: Aorta, pulmonary. Also, the major branches of aorta are large arteries - Brachiocephalic, common carotid and subclavian.

Mediucm sized arteries: Brachial and temporal, femoral are medium.

Small sized artery: Digitalis artery.

A patient comes with rhinitis and dyspnea, he also complains of hematuria. Which is the most probable vasculitis?

Wegners granulomatosis. Wegeners is diagnostic of upper and lower respiratory tract involvement and nephritis.

How will you confirm it is Wegeners?

c-ANCA. Also, tissue biopsy for necrotising granulomas.

Next question: Another patient. He has dyspnea and he has hematuria but on biopsy there are no granulomas.. Only vasculitis. Which condition?

Polyangiitis!
The difference is of granuloma. Microscopic polyangitis has no upper airway involvement and no granuloma.

Another patient comes with history of asthma. On general examination you find nodules on his skin. What's your diagnosis?

Churg strauss.

What will you find in his CBC?

Eosinophilia.

Next question! A patient comes with hypertension. On further testing you find renal artery stenosis. On admission, he also develops severe abdominal pain. Diagnosis of mesenteric ischaemia is made. Which vasculitis is this?
Hint - bronchial vessels are involved but not the pulmonary arteries.

Polyarteritis nodosa. PAN has characteristic visceral arteries involved.

Which hepatitis virus is associated with this disease?

Hepatitis B.

44 year old male, bilateral knee swelling, per rectal bleeding, on and off fever and Bells palsy?
Another case of PAN. It has peripheral neuropathy too.. Mononeuritis multiplex. It can present as stroke too!

A 55 year old patient, complains of fever and headache. On further questioning he agrees to having pain in the calf and sometimes he looses his complete sight.
Temporal arteritis aka giant cell arteritis.

Which another lab finding will be diagnostic?

Raised ESR.

How do you confirm the diagnosis?
Biopsy of temporal artery. Treatment is steroid immediately in high doses.

Q: A female comes for regular check up..You can't find her pulse.

Takayasu! The Pulseless disease!

What was the one with the smoker?

The only arterial disease associated with smoking is thromboangitis obliterans.

In which disease all arteries of your body can be involved.. Irrespective of their size?
Hint - it is also the vasculitis which causes coronary artery aneurysm.

Kawasaki!

What is treatment of Kawasaki?
High dose aspirin.

How does kawasaki's disease present? And how is the presentation clinically relevant to the treatment?

Fever with rash. With cervical lymphadenopathy. So it looks like a viral infection in a child and aspirin is contraindicated in children due to Reye's syndrome. So it's one of the rare cases where you give aspirin to a kid.

Review questions by Huzaifa Bhopalwala:

Treatment for Kawasakis disease other than high dose aspirin?

High dose IV immunoglobulin.

What is the current name for Wegners?

Granulomatosis with polyangiitis.

Treatment for Wegners disease? 

Cyclophosphamide.

What are the general clinical features of a patient who comes to your clinic and is later on diagnosed with vasculitis?

Most patients have nonspecific symptoms and signs such as malaise, weakness, arthralgias, anorexia, and weight loss.

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