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 patient with a history of polymyalgia rheumatica presents to the physician’s office for right-sided headache and fever of 2 weeks duration. Upon further questioning, the patient explains that she has scalp tenderness and jaw claudication. Vital signs of the patient show a temperature of 38.2 degrees C (100.7 degrees F), heart rate of 104 beats per minute, and blood pressure measuring 120/80 mmHg. Work-up reveals elevated erythrocyte sedimentation rate (ESR). Initiation of steroids is important to prevent which complication in this patient?]] |
| 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) is a large-vessel vasculitis the affects the elderly and 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 |
| Approved | Approved::No |
| Keyword | WBRKeyword::Temporal, WBRKeyword::arteritis, WBRKeyword::giant, WBRKeyword::cell, WBRKeyword::blindness, WBRKeyword::polymyalgia, WBRKeyword::rheumatica, WBRKeyword::vasculitis, WBRKeyword::esr |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |