Vasculitis Usmle 1 MS PDF

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1. A 57-year-old woman with unilateral headache, vision loss and "morning joint stiffness" has a biopsy of her temporal artery done in your office. What are the histologic findings you would expect to see in the biopsy? a. Large vessel giant cell vasculitis with fragmentation of elastic lamina b. Small vessel eosinophilic vasculitis c. Medium vessel vasculitis with fibrinoid necrosis d. Large vessel granulomatous vasculitis with massive intimal fibrosis e. Medium vessel transmural vasculitis 2. Histologic examination of a renal biopsy reveals necrotic changes of glomerular capillaries and proliferation of the epithelium of the Bowman capsule. Which of the following diseases does the patient most likely have? a. Polyarteritis nodosa b. Henoch Shonlein purpura c. Microscopic polyangiitis d. Churg-Strauss syndrome 3. A 56-year-old Hispanic male presents to the outpatient clinic with reddishblue lesions on his lower extremities, fever, muscle pain, and weight loss. He reports a history of acute viral hepatitis B three months ago. Physical examination reveals multiple red-purple nodules on the skin of the both legs. Laboratory results for P- and C-ANCA are negative. Urinalysis reveals hematuria and proteinuria. Abdominal ultrasound reveals few 1 – 2 cm fluid-filled cavities in the both kidneys. Which of the following is the most likely diagnosis? a. Polyarteritis nodosa b. Microscopic polyangiitis c. Chrurg-Strauss syndrome d. Henoch-Schonlein purpura

4. A 64-year-old Caucasian male is admitted to the hospital with fatigue, cough, hemoptysis and difficulties with nasal breathing. At admission his vital signs are as follow: temperature of 38.1 C, pulse of 114 bpm, BP of 145/95 mm Hg and RR of 22 breaths/min. Physical examination reveals moderate puffiness of the face, and dullness on percussion and reduced breathing over the left lung. Chest x-ray examination reveals several cavitating opacities in the left lung. Urinalysis detects hematuria and mild proteinuria. PPD test reading in 72 hours reveals 5-mm erythema; sputum microscopy for AFB is negative. Two images below represent gross and microscopic appearance of the patient's lung. Which of the following laboratory tests is most likely to be positive in this patient?

a. b. c. d.

Anti-HIV antibodies C-ANCA Blood and urine Histoplasma antigen Anti-glomerular basement membrane antibodies

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5a. A 47-year-old Caucasian male seeks medical care because of transient hematuria and hemoptysis of one week duration. He had an acute bacterial pneumonia five weeks ago and from that time he has not felt well. Two weeks ago the patient noticed some bloody nasal discharge. He also complains that his left knee has been hurting and that red spots have appeared on his arms and legs. Physical examination reveals lower leg pitting edema, and many small, red, raised lesions on the skin of his extremities that are painless. BP is 150/95 mm Hg. Lab Findings: Moderate leukocytosis with ordinary WBC differential count UA: hematuria and proteinuria Elevated serum P-ANCA level Normal serum IgA level What is the most likely diagnosis? a. b. c. d.

Polyarteritis nodosa Microscopic polyangiitis Rheumatic fever Subacute bacterial endocarditis

5b. What histological changes are most likely seen within the wall of affected vessels? a. Transmural inflammation with fibrinoid necrosis b. Necrotizing granuloma c. Eosinophilic granuloma d. Granuloma with intimal proliferation and elastic fiber destruction 6. A 34-year old Caucasian female presents with malaise, fever, arm pain, loss of appetite, and blurred vision. Physical examination reveals a diminished pulsation and low BP on the upper extremities; pulses and BP pressure on the lower extremities are WNL. Which of the following are the most likely morphologic changes within the affected arteries? a. b. c. d. e. f.

Segmental necrotizing inflammation Necrotizing inflammation with thrombosis and abscess formation Necrotizing inflammation with eosinophilia Granulomatous inflammation and AFBs Granulomatous inflammation and treponemas Granulomatous inflammation...