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QUESTION 4-1. Which of the following statements regarding vasculitis is INCORRECT?

A) Vasculitis is defined by clear-cut vascular damage, with or without a cellular inflammatory process.

B) The standardized nomenclature for the vasculitides is based primarily on the size of the involved vessels.

C) Clinically, medium vessel vasculitis results in ulcers, nodules, or reticulated purplish discoloration of the skin.

D) Clinically, small vessel vasculitis results in palpable purpura and petechiae.

E) The histopathologic criteria for recognizing microvascular injury are somewhat arbitrary, and the minimal criteria for vasculitis remain controversial.

QUESTION 4-2. An otherwise healthy patient presents with erythematous and violaceous purpuric macules and papules involving the distal lower extremities. In addition, necrotic, eroded, and ulcerated lesions are present. The remainder of the skin exam is unremarkable. The patient recently was prescribed a course of antibiotics for a sore throat. Blood cultures are negative for growth of microorganisms. Serum analysis reveals normal complement levels. A biopsy is performed and the findings are illustrated below. Which of the following statements regarding this patient’s condition is INCORRECT?

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A) This is an example of an immune-complex mediated type III hypersensitivity reaction.

B) The presence of numerous eosinophils suggests a drug-based etiology.

C) Similar eruptions may occur in patients ingesting various foods and nondrug chemicals.

D) Similar eruptions may occur in patients with collagen vascular disease and certain malignancies.

E) This is an example of serum sickness.

QUESTION 4-3. An adult male presents with palpable purpura of the buttocks and lower extremities accompanied by abdominal pain, arthralgia, and hematuria. Focal retiform areas are noted. A few hemorrhagic bullae are present on the abdomen. Serum analysis reveals an elevated adenovirus antibody titer. A biopsy is performed and the findings are illustrated below. The dermatopathology report comes back with a diagnosis of pustular leukocytoclastic vasculitis containing large numbers of neutrophils. Direct immunofluorescence reveals granular IgA and C3 deposition within the dermal vessels. Which of the following statements regarding this condition is INCORRECT?

Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB, Thurman RJ. The Atlas of Emergency Medicine. 3rd ed. New York, NY: McGraw-Hill; 2010.

A) This patient has renal vasculitis that will most likely result in severe long-term renal impairment.

B) This condition most ...

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