Section 4: Vasculitis Flashcards
List the features common to all forms of vasculitis
- Fatigue, malaise, weight loss
- Fever: May present as a fever of unknown origin (FUO)
- Skin lesions: Palpable purpura, rash
- Joint pain
- Neuropathy: Mononeuritis multiplex
Common laboratory features
- Normocytic anemia
- Elevated ESR
- Thrombocytosis
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4595-4621). . Kindle Edition.
Vasculitis:
Most accurate test
Best initial therapy
What are the alternate or additional therapy?
Biopsy
Prednisone and glucocorticoids
Alternate therapies
- Cyclophosphamide
- Azathioprine/6-Mercaptopurine
- Methotrexate
Apart from the common features of vasculitis, list the distinct CF of polyarteritis nodosa (PAN)
- Abdominal pain (65 percent)
- Renal involvement (65 percent)
- Testicular involvement (35 percent)
- Pericarditis (35 percent)
- Hypertension (50 percent)
Use mnemonic “H - TRAP”
PAN does not affect the lungs.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4623-4649). . Kindle Edition.
PAN:
- Best initial test
- Most accurate test
- Other tests
- Rx
- Angiography of abdominal vessels
- Biopsy (of skin, muscle, or sural nerve)
- Hepatitis B surface antigen is found in 30 percent of patients with PAN
- Prednisone and cyclophosphamide
CCS Tip: There is no good blood test for PAN
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4623-4649). . Kindle Edition.
Diagnosis:
Upper and lower respiratory findings + c-ANCA
Most accurate test for above condition
Rx of above condition
Wegener’s Granulomatosis
Biopsy
Prednisone and cyclophosphamide
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4623-4649). . Kindle Edition.
Diagnosis:
Vasculitis + Eosinophilia + Asthma
Other positive serological tests
Most accurate test
Rx
Churg-Strauss
p-ANCA and anti-myeloperoxidase
Biopsy
Steroids
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4623-4649). . Kindle Edition.
True or False:
p-ANCA and anti-myeloperoxidase are more uniquely suggestive of Churg Strauss than eosinophilia and asthma
False
Temporal arteritis is a type of giant cell arteritis. Fever, weight loss, malaise, and fatigue can be present, as they are in all forms of vasculitis.
What other rheumatological condition could it be related to?
Most accurate test
PMR
Biopsy
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4646-4675). . Kindle Edition.
A patient presents with headache, jaw claudication, visual disturbance, and tenderness of the scalp. The ESR is elevated.
What is the next best step in management?
Treatment with steroids is more important than getting a specific diagnostic test in temporal arteritis.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4646-4675). . Kindle Edition.
Diagnosis:
Young Asian female + Diminished pulses
Takayasu’s Arteritis
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4646-4675). . Kindle Edition.
True or False:
Half of patients with Takayasu’s arteritis have the usual vasculitis findings present before the loss or decrease of pulse
True. They have:
- Fatigue, malaise, weight loss, arthralgia
- Anemia, increased ESR
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4646-4675). . Kindle Edition.
List the special features of Takayaku’s arteritis
How is Takayaku’s arteritis diagnosed
Rx
TIA and stroke from vascular occlusion
Aortic arteriography or magnetic resonance angiography (MRA)
Steroids as with all vasculitis.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4646-4675). . Kindle Edition.
True or False:
The most accurate test for Takayaku’s arteritis is biopsy
False
Diagnosis:
- CF of vasculitis
- Hepatitis C
- Renal involvement
Rx fo above condition
Cryoglobulinemia
Treat the hepatitis C with interferon and ribavirin. (Note that Step 3 loves this question!)
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4678-4691). . Kindle Edition.
Diagnosis:
- Patients of Middle Eastern or Asian ancestry
- Oral and genital ulcers
- Ocular involvement (uveitis, optic neuritis): Can lead to blindness
- Skin lesions: “Pathergy,” which is hyperreactivity to needle sticks, resulting in sterile skin abscesses
Diagnostic test for above condition
Rx of above condition
Behcet Disease
There is no specific test for Behcet disease
Treatment is with prednisone and colchicines.
Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kindle Locations 4678-4691). . Kindle Edition.
