WBR0429

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Vascular
Prompt	[[Prompt::A 78-year-old female, with a history of polymyalgia rheumatica, presents to the physician’s office with a right-sided headache and fever of 2 weeks duration. Upon further questioning, the patient explains that she is experiencing scalp tenderness and jaw claudication. Vital signs of illustrate a temperature of 38.2 °C, heart rate of 104 beats per minute, and blood pressure measuring 120/80 mmHg. Work-up reveals an elevated erythrocyte sedimentation rate (ESR). The administration of steroids is most essential to prevent which of the following complications?]]
Answer A	AnswerA::Hearing loss
Answer A Explanation	AnswerAExp::Hearing loss is not associated with GCA.
Answer B	AnswerB::Auto-amputation of digits
Answer B Explanation	AnswerBExp::Auto-amputation of digits is a complication of thromboangiitis obliterans.
Answer C	AnswerC::Blindness
Answer C Explanation	AnswerCExp::Blindness is the most feared complication of GCA.
Answer D	AnswerD::Glomerulonephritis
Answer D Explanation	AnswerDExp::Glomerulonephritis occurs secondary to granulomatosis with polyangiitis (Wegener granulomatosis) or Goodpasture’s syndrome.
Answer E	AnswerE::Coronary aneurysm
Answer E Explanation	AnswerEExp::Coronary aneurysm is a complication of Kawasaki disease, a medium-vessel vasculitis.
Right Answer	RightAnswer::C
Explanation	[[Explanation::Giant cell temporal arteritis (GCA), a large-vessel vasculitis that frequently affects the elderly, is characterized by fever, unilateral headache, and jaw claudication with scalp tenderness. GCA is associated with polymyalgia rheumatica. Work-up usually reveals elevated ESR; temporal artery biopsy reveals discontinuous areas of granulomatous inflammation or skip lesions that penetrate all the layers of the wall in the artery and stain positive for inflammatory markers, such as leucocyte common antigen (LCA) and CD15. The most feared complication of GCA is blindness. Prevention of blindness is best prevented by initiation of high-dose steroids. Educational Objective: Giant cell (temporal) arteritis (GCA) is a large-vessel vasculitis the affects the elderly and is characterized by unilateral headache and jaw claudication with scalp tenderness. GCA is associated with polymyalgia rheumatica. The most feared complication of GCA is blindness. Reference: Desmet GD, Knockaert DC, Bobbaers J. Temporal arteritis: the silent presentation and delay in diagnosis. Journal of Internal Medicine. 2009;227(4):237-240 Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::Temporal, WBRKeyword::arteritis, WBRKeyword::giant, WBRKeyword::cell, WBRKeyword::blindness, WBRKeyword::polymyalgia, WBRKeyword::rheumatica, WBRKeyword::vasculitis, WBRKeyword::esr
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