WBR0429
| 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. |
| 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 |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |