Large and medium vessel vasculitis MCQs

In outbreaks of waterborne hepatitis E in India and Asia, the case-fatality rate is 1-2% and up to 10-20% in pregnant women. Reference : Harrison's Principles of internal medicine 21st ed chap 339 pg. 2577

The presence of a swollen optic disc suggests ischaemic optic neuropathy. In elderly people giant cell arteritis is a common presentation of acute monocular visual loss. Optic neuritis is very rare in people over the age of 50. You would expect bilateral swollen optic discs in raised intracranial pressure. In central retinal vein occlusion you would expect diffuse retinal haemorrhages. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 426, Pg: 3343

The urinary tract is the most common source of E. coli bacteremia, accounting for one-half to two-thirds of episodes Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 135, Pg: 1071

Anticholinergic agents decrease large intestinal motility. The other options and cholinergic agents increase large intestinal motility. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch:327, Pg: 2494

Ans. is 'b' i.e.,Medium Chain FA [Ref Harrison's 18thie p. 294] Medium chain fatty acids directly enter the portal vein on absorption,bypassing the lymphatics.Hence,they are used in chyluria

This patient presents with multi system involvement as characterized by the presence of multiple peripheral nerve involvement, arthralgia and fever. His laboratory reports show features of inflammation characterized by anemia, high ESR. He also has renal impairment with hematuria and RBC cast which indicates glomerulonephritis. The entire constellation of symptoms points towards the diagnosis of a vasculitis. PAN is a disease of medium sized vessels and it does not cause glomerulonephritis. Renal impairment and hypertension can be seen in PAN due to involvement of the renal artery or its branches. All the other options are small vessel vasculitis and can cause glomerulonephritis. Reference: Harrison’s Principles of Internal Medicine 21 st edition Ch:363 Pg:2810

In this question, we have a young female with symptoms of upper limb claudication, visual loss, abdominal pain and weak femoral pulses. The history points to the involvement of the branches of Aorta. The retinal hemorrhage could be secondary to hypertension. The involvement of large and medium vessels in a young female points towards the diagnosis of Takayasu Arteritis. PAN typically involves renal and visceral vessels, ie, small and medium sized arteries. It does not produce absent peripheral pulses. Microscopic polyangiitis is a small vessel vasculitis, mainly presenting as glomerulonephritis and pulmonary vasculitis. Thromboangiitis obliterans(Buerger's disease) is an inflammatory occlusive vascular disorder of small and medium sized arteries of the distal upper and lower limb and is seen in men

Ans. is 'b' i.e., Heart Sites of Atherosclerosis Atherosclerotic plaques develop primarily in elastic arteries (e.g., aorta, carotid and iliac arteries), and large & medium sized muscular arteries (e.g., coronary artery and poplitial arteries). In descending order, the vessels most commonly involved are - Abdominal aorta (most common) → Causing aneurysm Coronary arteries (heart) → Causing MI Popliteal arteries → Causing ischemic gangrene of lower limbs. Internal carotid arteries → Causing stroke a Circle of willis Vessels usually spared are Vessels of upper extremities Mesentric and renal vessels, except at their ostia.