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Dermatology > 3: Vasculitis - Mahoney (6 Questions) > Flashcards

3: Vasculitis - Mahoney (6 Questions) Flashcards

1
Q

vasculitis and pigmented purpuric lesions both result in…

A

some reddish and/or purplish change in skin color

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2
Q

define vasculitis

A
    • Inflammation and necrosis of blood vessels caused by the precipitation of immune complexes in the vessel walls
    • Seen with collagen vascular disease and cryoglobulinemia, as examples
    • Changes not confined just to skin, but are often a manifestation of systemic disease
    • Joints, GI, heart, lung, kidney, CNS
    • Lesions have predilection for leg
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3
Q

histology of vasculitis

A
    • Inflammatory infiltrate (PML’s)
    • Leukocytoclasis (disintegration of PML’s)
    • Extravasation of RBC’s
    • Necrosis
    • Hyalinization (degenerative process in tissue which results in clumping of acidophilic structures that appear glassy in appearance)
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4
Q

describe vasculitic lesion

A

very painful, bilateral, and symmetrical

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5
Q

progression of vasculitic lesions

A

erythematous maculopapule –> urticarial papule –> palpable/nonpalpable purpura –> hemorrhagic veiscle and bulla –> necrosis and ulceration

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6
Q

the _____ the vessel, the more common ulceration and necrosis becomes

A

common

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7
Q

what is diascopy?

A

If a skin lesion blanches when you apply pressure over it with a glass slide, it is composed of intact vessels that are inflammed

If the lesion persists under pressure, it is a skin pigmentation (e.g. purpura due to extrasavation of blood)

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8
Q 
classification of blood vessels based on size of artery ...
capillary
small artery
medium artery
large artery
A

capillary-leukocytoclastic vasculitis (LCV) and Henoch-Schoenlein purpura

small artery- granulomatous vasculitis, Henoch-Schoenlein purpura

  • Vast majority of vasculitis involves small arteries
  • Along with capillaries, most likely to have palpable purpura

medium artery-PAN (polyarteritis nodosa)

large artery-giant cell arteritis

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9
Q 
most common skin manifestation of vasculitis
Necrosis
Palpable purpura
Macule
Ulceration
Cyst
A

palpable purpura

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10
Q

major etiologies of purpura

A

“The Sleepy Giant’s Hen Cried With Pain”

thrombocytopenia (and coagulopathies - non palpable)
SLE
Giant Cell arteritis
Henoch-Schonlein purpura
Cryoglobulinemia
Wegener granulomatosis
PAN
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11
Q

children and young adults

preceded by pharyngitis

A

Henoch-Schonlein Purpura

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12
Q

aka IgA vasculitis

A

henoch-schonelin purpura

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13
Q

diagnosis henoch-schonlein purpura

A
  • biopsy
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14
Q

association with hepatitis B

A

PAN

- necrotizin inflammatin with common manifestation of nodules

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15
Q

diagnosis of PAN

A

confirmed by arterial aneurysms on aangiography

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16
Q

new onset diastolic blood pressure greater than 90 mm Hg

A

PAN

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17
Q

causes nail fold infarctts and purpura

A

wegener’s granulomatosis

  • primarily affects lungs and kidnyes
  • has both granulomas and vasculitis
18
Q

C ANCA +

A

wegener’s granulomatosis

19
Q

most common type of primary systemic vasculitis

A

giant cell arteritis

20
Q

giant cell arteritis is associated with what disease

A

polymyalgia rheumatica manifested by shoulder and pelvic girdle pain

21
Q
  • age greater than 50
  • localized headache of new onset
  • sed rate greater than 60
  • do biopsy
A

giant cell arteritis / polymyalgia rheumatica

22
Q

– Cold precipitable proteins that migrate with gamma globulins on electrophoresis
— are immune complexes
associated with hepatitis C infection

A

cryoglobulinemia (three Cs on list)

23
Q

only way to diagnose a vasculitis ***

A

must be a deep punch biopsy

24
Q

lab work up cryoglobulinemia

A

Cyroglobulinemia
Hypocomplementemia
Hepatitis screen

25
Q

lab work up SLE

A

antinuclear antibodies

anti-double stranded deoxyribonuclease (anti-dsDNA)

26
Q

lab work up henoch-schonlein purpura

A

ASO titres (anti-strep )
Urinalysis
Serum creatinine

27
Q

lab work up thrombocytopenia or coagulopathy

A

Platelets
PTT
PTT

28
Q

lab work up PAN

A
  • urinalysis
  • creatinine
  • hep screen
29
Q

lab work up Wegener’s granulomatosis

A
  • ANCA

- chest film

30
Q

lab work up Giant cell arteritis

A
  • EST
31
Q

tx vascultiis

A
  • high does steroids

- fyclophopamide

32
Q 
A patient exhibits purpuric lesions that are not palpable.  Your first lab test ordered would be
ESR
Hepatitis
Chest film
platelet count 
ASO
A

platelet

33
Q

variants of schamberg’s dx

A

pigmented purpuric dermatosis

34
Q

descrone pigmented purpuric dermatosis

A

– Look like vasculitis (look purplish), but are not autoimmune diseases
– Many are variants of Schamberg’s Disease
asymptomatic (may itch)
– minute petechial lesions which begin on dorsum of feet, ankles and lower legs
– rarely atrophies
– normal clotting mechanisms and platelet function

35
Q

cayenne pepper disease

A

pigmented purpuric dermatosis

36
Q

tx pigmented purpuric dermatosis

A

Bioflavinoids (rutoside-50 mgs bid) and Vit C (500 mgs bid)

37
Q

Purplish, mottled vascular pattern which is fish net-like

A

livedo reticularis

38
Q

describe livedo reticularis

A 
Purplish, mottled vascular pattern which is fish net-like
May indicate systemic disease
Usually just a local idiopathic reaction
females, 25-40 y/o
worse in winter

Spasm of cutaneous arteries followed by dilatation of subpapillary venous plexus
slowing of blood flow
thrombosis
ischemia outlines the areas between cones as violaceous reticulum
Cone is an areas of skin supplied by an arteriole

39
Q

Idiopathic ivory white plaques stippled with telangiectasias and surrounded by erythema, petechia, or hyperpigmentation usually on legs and ankles of healthy women

A

atrophie blanche

Necrosis of epidermis and superficial dermis
purpura
infarcts heal
white plaques

40
Q

You notice purple circular lesions on the feet and legs of a patient that are not palpable. The patient relates always having cold feet. The diagnosis is:

A

livedo reticularis

41
Q
  • palpable purpura in pts w/ neither thrombocytopenia nore coagulopathy
  • arthritis/arthralgia
  • abdominal pain
  • renal dz w/ biopsy showing IgA nephropathy
A

henoch schonlein purpura

  • tx with steroids
  • most cases resolve spontaneously w/i 1 month
42
Q

definitive diagnosis henoch schonlein purpura

A

skin biopsy

Dermatology (24 decks)

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