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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{AJL}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology
|MainCategory=Pathology
Line 21: Line 21:
|SubCategory=Vascular
|SubCategory=Vascular
|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?
|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?
|Explanation=[[giant cell arthritis|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]].   
|Explanation=Giant cell (temporal) arteritis (GCA), a [[large-vessel vasculitis]] that frequently affects the elderly, is characterized by [[fever]], unilateral [[headache]], [[jaw claudication]], and scalp tenderness.  GCA, often associated with [[polymyalgia rheumatica]], usually manifests with an elevated [[ESR]]. [[Temporal artery biopsy]] usually demonstrates discontinuous areas of [[granulomatous]] inflammation, or skip lesions, that penetrate all layers of the artery wall 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]].
A complication of GCA is [[blindness]], best prevented by initiation of high-dose [[steroids]].


Educational Objective:
|EducationalObjectives= Giant cell (temporal) arteritis (GCA), a [[large-vessel vasculitis]] that frequently affects the elderly, is characterized by [[fever]], unilateral [[headache]], [[jaw claudication]], and scalp tenderness.   GCA is associated with polymyalgia rheumatica and a common complication of GCA is blindness.
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.
|References= Desmet GD, Knockaert DC, Bobbaers J. Temporal arteritis: the silent presentation and delay in diagnosis.  Journal of Internal Medicine. 2009;227(4):237-240
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
 


|AnswerA=Hearing loss
|AnswerA=Hearing loss
|AnswerAExp=Hearing loss is not associated with GCA.
|AnswerAExp=Hearing loss is not frequently associated with GCA.
|AnswerB=Auto-amputation of digits
|AnswerB=Auto-amputation of digits
 
|AnswerBExp=Auto-amputation of digits is frequently a complication of [[thromboangiitis obliterans]].
 
|AnswerBExp=Auto-amputation of digits is a complication of thromboangiitis obliterans.
|AnswerC=Blindness
|AnswerC=Blindness
 
|AnswerCExp=Blindness is a complication of GCA.
|AnswerCExp=Blindness is the most feared complication of GCA.
|AnswerD=Glomerulonephritis
|AnswerD=Glomerulonephritis
 
|AnswerDExp=[[Glomerulonephritis]] frequently occurs secondary to granulomatosis with polyangiitis ([[Wegener granulomatosis]]) or [[Goodpasture syndrome]].
|AnswerDExp=Glomerulonephritis occurs secondary to granulomatosis with polyangiitis (Wegener granulomatosis) or Goodpasture’s syndrome.
|AnswerE=Coronary aneurysm
|AnswerE=Coronary aneurysm
|AnswerEExp=Coronary aneurysm is a complication of Kawasaki disease, a medium-vessel vasculitis.
|AnswerEExp=Coronary aneurysms are frequently complications of [[Kawasaki disease]], a medium-vessel vasculitis.
|RightAnswer=C
|RightAnswer=C
|WBRKeyword=Temporal, arteritis, giant, cell, blindness, polymyalgia, rheumatica, vasculitis, esr
|WBRKeyword=Temporal, arteritis, giant cell, blindness, polymyalgia rheumatica, vasculitis, ESR, steroids, artery, complications, prevention
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:28, 21 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1], Alison Leibowitz [2] (Reviewed by Alison Leibowitz)]]
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 frequently associated with GCA.
Answer B AnswerB::Auto-amputation of digits
Answer B Explanation [[AnswerBExp::Auto-amputation of digits is frequently a complication of thromboangiitis obliterans.]]
Answer C AnswerC::Blindness
Answer C Explanation AnswerCExp::Blindness is a complication of GCA.
Answer D AnswerD::Glomerulonephritis
Answer D Explanation [[AnswerDExp::Glomerulonephritis frequently occurs secondary to granulomatosis with polyangiitis (Wegener granulomatosis) or Goodpasture syndrome.]]
Answer E AnswerE::Coronary aneurysm
Answer E Explanation [[AnswerEExp::Coronary aneurysms are frequently complications 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, jaw claudication, and scalp tenderness. GCA, often associated with polymyalgia rheumatica, usually manifests with an elevated ESR. Temporal artery biopsy usually demonstrates discontinuous areas of granulomatous inflammation, or skip lesions, that penetrate all layers of the artery wall and stain positive for inflammatory markers, such as leucocyte common antigen (LCA) and CD15.

A complication of GCA is blindness, best prevented by initiation of high-dose steroids.
Educational Objective: Giant cell (temporal) arteritis (GCA), a large-vessel vasculitis that frequently affects the elderly, is characterized by fever, unilateral headache, jaw claudication, and scalp tenderness. GCA is associated with polymyalgia rheumatica and a common complication of GCA is blindness.
References: Desmet GD, Knockaert DC, Bobbaers J. Temporal arteritis: the silent presentation and delay in diagnosis. Journal of Internal Medicine. 2009;227(4):237-240]]

Approved Approved::Yes
Keyword WBRKeyword::Temporal, WBRKeyword::arteritis, WBRKeyword::giant cell, WBRKeyword::blindness, WBRKeyword::polymyalgia rheumatica, WBRKeyword::vasculitis, WBRKeyword::ESR, WBRKeyword::steroids, WBRKeyword::artery, WBRKeyword::complications, WBRKeyword::prevention
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