Master the board step 3

Master the Boards: USMLE Step 3
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?
Answer: Treatment with steroids is more important than getting a specific diagnostic
test in temporal arteritis.
Takayasu’s Arteritis
• Young Asian female +
Diminished pulses =
Takayasu’s arteritis
Half of patients with Takayasu’s arteritis have the usual vasculitis findings
present before the loss or decrease of pulse:
··
Fatigue, malaise, weight loss, arthralgia
··
Anemia, increased ESR
The special features of this vasculitis are TIA and stroke from vascular occlusion.
The most accurate test for
Takayasu’s is not a biopsy.
Takayasu’s is also distinctive in that it is diagnosed with aortic arteriography
or magnetic resonance angiography (MRA).
Takayasu’s is treated with steroids like all vasculitis.
Cryoglobulinemia
Cryoglobulinemia has all the usual features of vasculitis, such as fatigue,
malaise, skin lesions, and joint pain. There is an association with hepatitis C
and renal involvement. Sryoglobulins and rheumatoid factor are very similar.
Treat the hepatitis C with interferon and ribavirin. (Note that Step 3 loves
this question!)
Behcet Disease
This condition presents in patients of Middle Eastern or Asian ancestry.
Features are the following:
··
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
There is no specific test for Behcet disease. Use the features described above.
Treatment is with prednisone and colchicines.
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