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Want to support the channel? Be a patron at: • / lymed Welcome to LY Med, where I go over everything you need to know for the USMLE STEP 1, with new videos every day. • Follow along with First Aid, or with my notes which can be found here: • https://www.dropbox.com/sh/xisbr5u8re... • Enough about heart pathologies! Let's talk about vessel pathologies! This video will be on vasculitis. They like to divide this into the size of vessels that they effect. We'll start with large vessel vasculitides first. There are only two: • 1) Giant cell arteritis/Temporal arteritis: this effects the temporal artery and causes a tender temple, the maxillary artery leading to jaw pain and the ophthalmic artery leading to vision loss. ESR is raised and a biopsy confirms it but this takes time. You can't wait as this can lead to blindness and treat it with steroids right away. Granulomas would be seen hence the name. Know it's associated with polymyalgia rheumatica. • 2) Takayasu: effects your aorta and causes fibrosis, leading to pulselessness. Treat with steroids and is seen more in young asian females. • Medium sized arteritis: • 1) Polyarteritis nodosa: related to hepatitis B. Immune complex deposition in your vessels leads to fibrinoid necrosis and causes aneurysms and vasospasms. This leads to beading of a vessel, especially your renal arteries. • 2) Kawasaki: seen more in asian kids and leads to fever, adenopathy, conjunctivitis, mucositis, and palm and feet rash. Treat with IVIG and aspirin to avoid a myocardial infarction. • 3) Thromboangiitis obliterans: seen in smokers, smoke damages the vessels leading to thrombosis, gangrene and autoamputation. Treatment is by stopping smoking. • Small vessel: • 1) Granulomatosis with polyangiitis: effects many different parts of the body, including your upper respiratory tract (nasopharynx), lungs (cough and hemoptysis), and kidneys (hematuria and glomerulonephritis). This is associated with C-ANCA. What is C-ANCA? This is antibodies against the cytoplasm against your own neutrophil's cytoplasm, with the most common target being proteinase 3 (PR3). You can also have P-ANCA, which is antibodies against the nucleus of your neutrophils. The most common target is myeloperoxidase (MPO). • 2) Microscopic polyangiitis: no granulomas and nasopharynx involvement. P-Anca positive. • 3) Eosinophilic granulomatosis with polyangiitis: shows eosinophilia and IgE and is P-anca positive. • 4) Henoch schonlein purpura: seen in children after a upper respiratory infection. IgA attack it and complexes can deposit in your skin and causes palpable purpura and renal damage. • Done!

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