Blood vessels worksheet
______________________ means hardening of the arteries.
Arteriosclerosis A fibrous cap will be made by the smooth muscle- now fibroblast secreting collagen
With regards to vascular injury, which of the following is true? A. The causative agents of endothelial damage are purely genetic in nature B. Neutrophils are responsible for synthesizing the biological products that effect on smooth muscle cells of the media C. Endothelial chemical mediators stimulate the proliferation and migration of media smooth muscle cells, which accumulate in the subendothelial space. D. Injured endothelial cells retain their ability to contract and synthesize scar-like accumulations of collagen and elastin
C. Endothelial chemical mediators stimulate smooth muscle A. no environmental and just age B. nutraphils C endothelial cells are metabolically active the they are activated they will synthize biological products that have effect on smooth muscle D the endothelial lining is either stiff and crusted or soft and mealy
Markedly elevated __________ is an independent risk factor for development of atherosclerosis. This is a marker that signals systemic ______________.
CRP Inflammation Increases C reactive protein made by the liver in response to inflammation anywhere in the body its an independent marker- in the absence of all other symptoms id CRP is raised =stroke, MI and arteriosclerosis
what is another drug that's used to lower heart rate
Ca channel blockers Inhibit Ca ions from entering the heart causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension
Lowering total plasma________________ by_________ mg/dL reduces cardiovascular risk by half. Each additional _____________ mg/dL decrease cuts the risk in half again.
Cholesterol 50 50
CABG operation refers to___________ . It is done when opening blocked arteries by cardiac ____________ and _______________ placement is not a good option.
Coronary artery bypass grafting catheterization stent Otherwise you can cardia artery grafting graft veins and arteries past point of obstruction with insertion of a stent to keep it open
renin-angiotensin-aldosterone system the kidneys __________ cells make _________ which coverts to_______________ which stimulated the adrenal cortex to make_________ which leads to __________ absorption and increased _________ _______
-decreased blood pressure causes the juxtaglomerular cells of kidneys to secrete renin - which converts angiotensinogen (inactive) to angiotensin I (active) -which is then converted into angiotensin II by angiotensin-converting enzyme (ACE) -Angiotensin II stimulates - the adrenal cortex to secrete aldosterone - leads to absorption of Na and increased blood pressure -once blood pressure is restored, there is a decreased drive to stimulate renin release
The most common clinical consequence of atherosclerosis is_____________ , followed by __________, aneurysms, and peripheral vascular disease.
1. MI (heart attack, occlusion ) 2. stroke (brain occlusion 3. aortic aneurism (enlargement dilation over time only worrisome if rupture ) 4. peripheral vascular disease :Peripheral Vascular Disease Arterial blockage (including peripheral artery disease or PAD) Aortic aneurysms. Buerger's Disease. Raynaud's Phenomenon.
Desirable fasting ranges for total cholesterol is ___________ mg/dL. ___________ cholesterol is more than 60 mg/dL. LDL cholesterol is ________mg/dL. triglycerides is________ mg/dL.
<200 >60 healthy C <100 looser C <150
Which of the following statements about varicose veins is true? A. The population most commonly affected by varicose veins is women who have had several pregnancies. B. Deep veins are more often affected than superficial ones C. Skin ulcers are a common result of varicose veins D. Varicose veins are found only in the extremities, most commonly the legs.
A B. superficial are affect more than deep C. rare cases ulcers will occure D. they can be in the anus of esophagus
6. Which of the following is a modifiable risk factor in atherosclerosis? A. Inflammation B. High Blood homocysteine C. Hypertension D. Gender
A we all get inflammation B we have homocysteine(amino acid, but like naturally occurring not dietary ) in our blood ??-B12 folate breakdown and high levels can mean CVD and stroke C you can modify w lifetyle D. no
Which one of the following is associated with an increased risk of atherosclerosis? A. HDL cholesterol < 40 mg/dL B. LDL cholesterol <100 mg/dL C. VLDL cholesterol <30mg/dL D. Triglyceride <150 mg/dL
A. HDL or helpful should be higher >60 B it should be <100 or lower mg/dL C. were not given a charted VLDL to look fro D. <150 is where it should be
Which one of the following is the site of the initial arterial injury in atherosclerosis? A. Endothelial cell B. Basement Membrane C. Muscular wall (media D. Adventitia
A. endothelial cell "leaky" they have not been able to prevent mostly cholesterol into the arterial wall -yes there is a basement membrane in veins, remember inflmation and injury- how new arteries are formed or basmsnt membrane will separate with endothelial to allow WBC through t fight inflmmation and injury -muscular wall is third step in changes in atherosclerosis -adventita the outer layer of vessels this would be effected with trauma or hemorrhage
80% of patients with systematic sclerosis and 20% with SLE have primary Raynaud phenomenon
F 80% have primary meaning no disease but test 80 and 20 but they have SECONDARY
True or false? Elevated triglyceride levels have no effect on atherosclerosis.
F high triglycerides alone do not produce vascular disease but they can amplify high LDL of low HDL
True or false? Atherosclerosis begins around age 30.
F from the crib!
True or false? Most aneurysms occur in the thoracic aorta and are a result of atherosclerosis.
F. they are usually causes from atherosclerosis but in the abdominal aorta
Matching: Benign, small, red, blood-filled lesions composed of capillary-size blood vessels
Hemangioma non cancerous growth that appears like birth mark on the skin often in infants
Normal endothelial cells are responsible for __________. They regulate vessel _________, ____________ and ________
Hemostasis, diamater flow pressure
Waxy degenerative changes in the walls of arterioles is called _____
Hyaline arteriolosclerosis -The fingerprint of hypertension, hyaline degenerative changes to small arteriole walls in kidney -especially in nephrosclerosis -Hyaline is pale and glassy serum protein , also what makes casts in kidney disease -diabetes, -elderly
A condition caused by prolonged exposure to cortisol(as in Cushings ) excessive steroid production from adrenal cortex is called __________ and is a common case of _______________
Hypercortisolism secondary hypertension
____________________ vasculitis can often be traced back to a drug. This condition is also known as microscopic polyangiitis.
Hypersensitivity (Microscopic Polyangitis ) Affects mostly lungs and kidneys capillaries and arterioles so small vessels Hypersensitivity to a drug is usually main culprit (penicillin )
Hyperplastic arteriolosclerosis is the microscopic hallmark of severe chronic ___________________________.
Hypertension Onion skin walls in sever hypertensions in renal arterioles concentric layers of hyper plastic cells that are proliferations of smooth muscle
__________ mostly affects kidneys , viscera and skin but can be others this virus __________ may be apart of pathogenesis
Polyarteritis nodosa Hep B Systemic, mostly young adults
"Red, white and blue" discoloration of the hands in response to cold temperature or stress is called the______________ . It can happen in the absence of any disease or it can be a feature of _____________ diseases like SLE or vasculitis.
Raynaud phenomenon autoimmune like SLE, sclerosis (secondary) Its a vasculitis primary when no other disease is present
The _________nervous system regulates arterial blood pressure (ABP) by functionally influencing the vasculature, kidney, and heart.
Sympathetic herat rate, contractility and vasoconstriction -The PSNS causes relaxation of blood vessels, decreasing total peripheral resistance. It also decreases heart rate. As a result, the blood pressure comes back to the normal level. -The SNS is activated when baroreceptors, specialised stretch receptors located within thin areas of blood vessels and heart chambers, sense changes in pressure [20]. When arterial pressure drops, the SNS is immediately activated resulting in increased cardiac output and vasoconstriction of peripheral vessels
True or false? Halving vessel diameter increases resistance sixteenfold.
T 2^4 Vessel resistance (R) is directly proportional to the length (L) of the vessel and the viscosity (η) of the blood, and inversely proportional to the radius to the fourth power (r4) or diameter to the fourth power (D4) -very small changes in vessel diameter produce large changes in resistance. Vessel length does not change significantly and blood viscosity normally stays within a narrow range unless hematocrit changes
As total cross sectional area increases the speed of blood flow falls therefore the speed of blood flow in capillaries is significant lower than in that of the aorta
T although they are as small as a blood cell they're amount is so large the vessel diameter decreases but the number of vessels increases so that the cross sectional area increases rapidly -so their collective cross sectional area is vastly larger than the aorta and blood slowed allowing exchange pf material
The vast majority of sodium passes from globular filtrate back to plasma, as the renal tubes reabsorb it
T in excess of 99% goes from plasma to globular filtrate and back to plasma as renal tubes reabsorb it.
Pulseless disease or____________ is a local vasculitis that mainly effects___________
Takayasu arteritis the aorta
Give 2 examples of local vasculitis. Describe the signs and symptoms of each one. Give 2 examples of systemic vasculitis. Compare the signs and symptoms of the systemic and local vasculitides.
Temporal arteritis, although local is still the most common form vasculitis. - temporal and cranial arteries. Patients would describe symptoms of headache, scalp tenderness, trouble chewing and vision issues owing to the inflammation of the carotid and ophthalmic arteries. -Signs would be neurological, ophthalmological with fever and labs showing high ESR, CRP accompanied by biopsy with lymphocyte infiltration of vessel tissue. - Berger disease or Thromboangiitis obliterates. Here the digits of toes and fingers supplied by small and medium inflamed vessels with compromised blood supply will be cyanotic (discolored )and the patient may report paresthesia and pain. If smoking continues ulcers, gangrene and complete occlusion can follow. Systematic vasculitis, while also presenting with local pain and issues will be noticeable by its constitutional symptoms of muscle and joint aches and pains, fever and general malaise. ---Sometimes clearly visible in nodules and livedo reticularis of the skin Polyarteritis nodosas ischemic complications are most often in the kidneys and GI tract. The essential nature of renal and GI systems means symptoms and signs are systematic, weight loss, abdominal pain and weakness are common. Kawasakis disease another systematic vasculitis can also show up with skin rashes on the palms and soles of hands and feet. Skin, again is a good marker of a systematic autoimmune attack as the inflammation from attack on the vessels makes them narrow or become occluded. Other signs can be inflammation of the eyes, oral ulcers fever and lymphadenopathy. In addition Kawasaki disease can endanger the heart because it also likes to affect the coronary arteries. Local vasculitis will have more specific signs and symptoms related to the area, organ and tissue involved in the compromised vessel inflammation. Systematic vasculitis can be in small, medium or large vessels and may be present in multiple organs resulting is less specific signs and symptoms representative of multiple disfunction.
54 AA male with past history of hypertension and elevated cholesterol Despite changing meds he still has elevated BP. tests show elevated renin, normal cortisol , epinephrine and norepinephrine What of the following secondary causes of hypertension could explain his failure to respond to medication a. Renal artery stenosis b. Cushing disease c.pheochromocytoma d.none of the above
a. Renal artery stenosis- renal issues can secrete renin from kidneys -stenosis is a narrowing or the renal artery due to atherosclerosis b. Cushing disease-you would see elevated cortisol usually from strips treatment they increase sodium and water retention c.pheochromocytoma-tumor of the medulla it would be secreting Catecholamines epinephrine and norepinephrine. d.none of the above
35 year old male with Marfan syndrome has sever tearing chest and back pain . Blood pressure in arms is markedly different. What is the likely cause of his pain a. vascular dissection b.abdominal aneurysm c. angina d. vasculitis
a. vascular dissection dissecting hematoma a longitudinal tear within in artery the vessel wall is defective usually from an atheroma in older men in young men its usually due to genetic condition like Marfan or Ehlers b.abdominal aneurysm aneurism is weakening of the vessel wall leading to dilation on here chamber or artery c. angina-reduced blood flow to heart coronary heart disease is most common cause d. vasculitis - would have more general symptoms
ACE inhibitors work on ____________________ blocking its release and keeping vessels ________________. ________________ receptor blockers do the same through a different mechanism
angiotensin dilated angiotensin angiotensin converting enzyme inhibitors prevents enzyme from releasing angiotensin II which would narrow the blood vessels so it keeps them opened and dilated -blockers work on receptors
The basic lesion of atherosclerosis is called an____________ , a fatty plaque in the_____________ .
atheroma sub-endothelial space
An autopsy of a 68 yr old female with outstanding hypertension demonstrated nephrosclerosis which is caused by accumulation of which of the following lesions a. hyperpastic arteriolosclerosis b. hayline arteriolosclerosis c. diabetic neuropathy d. glomerulonephritis
b. hayline arteriolosclerosis- is the cause of nephrosclerosis a- hyperplastic is also a complication of sever hypertension but opinion skin not lesions c. diabetics micopangiopathys would be in multiple organs
What is the earliest stage for which drug treatment of hypertension should be imitated a. stage 1 b. stage 2 c. stage 3 d. stage 4
b. stage 2
___________________ block epinephrine(adrenaline ) hormone and neurotransmitter released by adrenal medulla. Which _______ heart rate
beta blockers lower medications used to treat hypertension and angina pectoris by lowering heart rate
Which vasculitides are associated with hep B a. Takayasu arteritis b. Temporal arteritis c. Plyarteritis nudosa d.n microscopic polyangitis
c. Plyarteritis nudosa
All systemic vasculitides share _________________________ symptoms that include myalgia, arthralgia, fever and malaise.
constitutional
Kidney dysfunction would raise the level of blood urea nitrogen (BUN) and ________
creatinine both will rise with decreased clearance from the kidney as GFR drops with small vessel damage in the kidneys
Which of the following is associated with DVT a. pregnancy+prolonged immobilization b.heart failure c. obesity and parnioplastic syndrome d. all of the above
d
The most common cause of vascular___________ in young people is ______________disorders such as Marfan syndrome and Ehlers-Danlos syndrome.
dissection connective tissue disorders -artery, most often the aorta. A defect in the artery wall allows blood to seep into the wall and tear open a space in its different layers -it widens and ruptures the vessel-massive bleeding and almost always fatal
A pulmonary _____________ will make its way from the ___________ through to the __________ until its moved by the ____________ ventricle to the pulmonary arteries
embolism distal veins heart right -its returning from venous flow if its a large arty in lungs its fatal if its small thrombotic drugs and anti coagulants can treat it
Development of atheromas begins with a subtle injury to the __________________ cells that may be caused by high blood pressure, smoking and diabetes among other causes.
endothelial Atheroma is the lesion of atherosclerosis Once the tight junctions are compromised they become leaky and cholesterol can leak behind the endothelial cells. -drawing macrophages, neutrophils platelets foam cells from marcos -smooth muscle proliferation evolve into collagen producing fibroblasts
A seven-year-old Hispanic male presents to his pediatrician's office with five days of unexplained fever. On physical exam, conjunctivitis, oral ulcers, and desquamation of the palms and soles of his feet are noted. He also has bilateral lymphadenopathy of his cervical lymph nodes. From what vasculitis does he suffer? A. Microscopic polyangiitis B. Takayasu arteritis C. Temporal arteritris D. Kawasaki disease
feet and lymph symptoms D.Kawasaki disease( mucocutanous lymph fevers -systemic but lymph symptoms are biggest clue Microscopic polyangitis -renal , affects veins and arteries Takayasu arteritis-is local and rare granulomous inflammation or aorta in women under 40 Temporal arteritis- also local and rare temporal or cranial arteries women 70 jaw and vision issues
When macrophages engulf fatty substances in the sub-intimal area of blood vessels, they are called ______________. This is followed by migration of ___________ cells from ___________ into the sub-intimal area.
foam cells smooth muscles tunica media -Macrophages ingulf fats and gets distinctive foam cell appearance release paracrin (cytocikne to nearby cells )to attract smooth muscle inner to outer of a vessel: tunica intima(internai), media, externa (adventitia) autocrine (intracell ) endocrin( through blood)
4 things that can cause an aneurysm
hypertension arteriosclerosis trauma-stretching or blunt congenital disease -connective tissue disorders
Most cases of essential hypertension feature _________________________ total peripheral resistance (TPR).
increased Essential has no secondary cause 95% of cases Its primary hypertension with no underlying disease
A 70-year-old Caucasian woman presents to your office complaining of headaches, vision changes, and pain in her jaw muscles during chewing. Her labs reveal an elevatedESR and CRP, and a biopsy reveals lymphocytes infiltrating the affected blood vessel wall. What is your diagnosis? A. Polyarteritis nodosa B. Takayasu Arteritis C. Temporal arteritis D. Kawasaki disease
jaw and vision =temporal C . Temporal arteritis local
25. A 35-year-old African American male presents to your office complaining of headaches. This is his fourth visit in three months. You note that despite aggressive lifestyle modification his blood pressure has continued to increase. What must you consider prior to prescribing antihypertensive agents?
look for renal disease-renin levels or adrenal disease- noephinerne or epinephrine
A vasculitis that causes hemoptysis and hematuria points to the involvement of the arteries in the_____________ and ___________, respectively.
lungs kidney hemoptysis- coughing up blood its effecting arteries of upper and lower respiratory system hematuria- blood in the urine shows the kidneys are involved
A young soft atheroma is _________________ dangerous than an old, calcified atheroma.
more More susceptible to bleeding if so it can cause complete occlusion
A child with a fever, rash, lymphadenopathy, conjunctivitis and oral ulcers has developed heart abnormalities. He has Kawasaki disease also knows as _____
mucocutaneous lymph node syndrome lymphadenopathy / oral in children / arteritis systemic autoimmune can affect coronary arteries and heart attack later on so squired heart disease
Hypertensive patients with renal disease may have ___________ and/or _____________ in their urine.
protein blood This is more effective then looking at blood renin esp if there's no signs and symptoms as the globular filtration barriers of endothelial cell in small arterioles become compromised -high blood pressure damages the intima
Diuretics help rid your body of_________________ in management of ________
salt by the kidneys hypertension
Research shows that a diet low in _______________ and salt helps lower blood pressure. If such life style changes are not effective in lowering BP, then drug treatment should be initiated.
saturated fat Diuretics Beta-blockers (epinephrine) ACE inhibitors (angiotensin) Angiotensin II receptor blockers (cause dilation) Calcium channel blockers (slow hr) Vasodilators(dilation)
The effects of hypertension are ________________ and ______________. which makes them deadly
silent and irreversible
The collagen fibers that are deposited in a young atheroma are produced by ____________ cells that have evolved into_____________ .
smooth muscle fibroblasts the intima becomes thickened
An expandable mesh tube called ________________ can be used to enlarge the narrowed area of the artery in atherosclerosis and keep it open.
stent 70% occlusion is the criteria for surgical insertion of a stent
if hemoptysis with a fever occurs its most likely _____________ As in _____________
systematic vasculitis Wegener's granulomatosis -arteries in upper and lower respiratory and renal system nose throat and sinuses lungs -hemoptysis-coughing up of blood and hematuria will be present -most commonly in middle aged men
Classify each of the following blood pressure readings as prehypertension stage1, stage2, stage 3 A. 135/90 B. 135/80 C.150/105 D. 160/105 E. 140/95
systol and distol is only for normal all others are OR A. 135 is pre 90 is stage 1 so its STAGE I B. PRE they're both w/in 120-139/80-89 C.105 even w 150 105 makes it stage 2. >160/>100 GREATER than only one like this except for normal which os less than D. >160/>100 -is stage 2STAGE 3 E.stage 1 140-159/90-99
According to the 7th report of the joint national committee (JNC) for prevention, detection, evaluation and treatment of hypertension, prehypertension is defined as having systolic blood pressure of___________ to_____ or a diastolic blood pressure of ______ to __________ mm Hg.
systolic: 120-139 diastolic: 80-89
True or false? Blood pressure is the result of cardiac output and vascular resistance.
t BP=COx PVR
Permanent blindness and stroke are possible serious consequences of __________________, making it a medical emergency.
temporal arteritis (Giant cell arteritis) local vasculitis carotid, temporal, cranial and ophthalmic vessels chronic granulomatous (immune cell clumping ) inflammation
The most common LOCAL vasculitis
temporal arteritis>70 yr neurological and head issues fever similar in symptoms to Takayasu arteritis another local -arota blockage causes blood flow to head and arms but women <40 systematic are still more common but this is most common amon local
A local vasculitis that is associated with young heavy smokers is ___________
thromboangiitis obliterans (Buerger disease ) Toes fingers painful red discoloration, no constitutional symptoms -hypersensitivity reaction, ischemia infarction even gangrene
Matching: Malignant tumor often found in AIDS patients, caused by HHV8
KP Malignant vascular tumor
The systemic vasculitis that often affects the coronary arteries and increases the risk of a heart attack is ____________________.
Kawasaki disease muccutaneous lymph node syndrome effects CORONARY arteries -systemic that's treated w aspirin
______________ disease plays a major role in development of hypertension
Kidney -The kidney plays a major role in blood pressure regulation renin system -fluid and electrolyte balance and cleaning
____________ refers to a group of factors that are associated with and contribute to the development of cardiovascular disease. These include hyperglycemia, hyperlipidemia, ________________, a low blood _____________ and___________ obesity.
Metabolic syndrome hypertension HDL abdominal linked to insulin resistance
Vasculitis vs arteriosclerosis is in their _____________
Pathogenesis of injury, autoimmune is mostly vasculitis where the inflammation that occurs with arteriosclerosis happen to everyone overtime w cholesterol deposits. Arteriosclerosis will have more erratic formation with inflammation is more concentric in vasculitis
________________ is an adrenal medullary tumor that over secretes _________________ and and _______________ is one of the causes of hypertensions.
Pheochromocytoma epinephrine norepinephrine secondary A tumor of the adrenal medulla -both neurotransmitters and hormones in the body. Their release into the bloodstream causes increases in vasoconstriction, blood pressure, heart rate, and blood sugar levels
A weakened artery wall is prone to dilation and formation of_____________ . The most common causes of this are ______________ and atherosclerosis
Aneurysm hypertension Aneurysm is localized dilation of an artery or heart chamber , congenital or acquired
_________________ refers to vasculitis that involves small blood vessels, although the two terms are often used interchangeably.
Angiitis When large vessels are involved its arteritis Most are autoimmune in origin
Downstream ischemia in coronary artery disease (CAD) produces chest pain called _____
Angina CAD is the main risk of coronary atherosclerosis infarction happens downstream from the lesion , if its in the heart you will get chest pain
Which one of the following explains most aneurysms? A. Cystic medial necrosis of the wall of the aorta B. Atherosclerotic weakening of the vascular wall C. Anatomic weakness in the wall of arteries at a branching point D. Vasculitis of large arteries
B. Atherosclerotic weakening of the vascular wall A. B. the wall weakens bc of atherosclerosis or hypertension C. artery or heart chamber D.vasculitisis is inflammation from autoimmune disease
Prolonged bed rest may cause stasis of blood in deep veins of the legs. This can predispose the person to develop_________________ . A piece of the thrombus that breaks off and circulates in the blood vessel is called a/n________________ , which can travel to the lungs and cause_______________ . This can be quickly fatal or can be treatable depending on the __________ of the _________that gets blocked off.
DVT emboli Pulmonary embolism size artery From impaired venous return usually from immobilization endothelial injury hypercoaguability avascular venous valves=hypoxia on endothelium and molecule adhesion attracting WBC and tissue factor=COAGULATION cascade
The most common form of thrombophlebitis is _________________. And the genetic condition that is associated with hypercoaguability _______________
DVT deep vein thrombosis Factor V Leden acquired disease -Antipholpholipid syndrome
_________________ drugs lower cholesterol by blocking its hepatic synthesis.
Statin Statins are competitive inhibitors of HMG-CoA reductase, the rate-limiting enzyme of cholesterol biosynthesis. Statins are widely and successfully used for lowering plasma cholesterol levels
Ischemia in the brain due to atherosclerosis may produce TIA, _______________
Transient ischemic attack Shorter than a stroke (transient) so not as long lasting
True or false? Autoimmunity is the most common basic mechanism of vasculitis.
True or false? Autoimmunity is the most common basic mechanism of vasculitis.
In the presence of Raynaud phenomenon and normal proximal pulses, the absence of distal pulses on the hands and feet may point to the diagnosis of ___________
Vasculitis or Angiitis vasospasm in response to stress/cold in distal extremities absence of distal pulses
A weak dorsalis pedis pulse would point to ___________
Vasculitistis in distal extremities Thromboangiitis obliterans diabetes obesity hypertension hypercholsterolism
1. Which of the following regarding cholesterol is true? A. Decreasing total cholesterol by 50 mg/dL cuts cardiovascular risk by half B. For every 5 mg/dL LDL is increased, coronary risk declines by 2-3%. C. Smoking raises HDL-C D. Exercise and consumption of moderate amounts of alcohol raise LDL-C.
a LDL is bad cholesterol any increase would increase risk smoking would not raise good H cholesterol Exercise would also not raise bad Loser cholesterol
A 6 year old causation female has an unexplained fever . On examination she has bilateral lymphadenopathy, conjunctivitis ,oral ulcers and desquaminations on palms of hands and feet . What treatment should she receive a. Aspirin b. Intravenous immunoglobulin c. both a and b d. steroids
a. Aspirin b. Intravenous immunoglobulin c. both a and b- this is Kawasakis vasculitis only one d. steroids -are for all other vasculitisis
