Master the board step 3

Master the Boards: USMLE Step 3
Presentations include the following:
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Renal
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Myalgias
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GI bleeding and abdominal pain
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Purpuric skin lesion
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Stroke
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Uveitis
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Neuropathy
The very nonspecific findings of fever, weight loss, and fatigue will also be present.
Multiple motor and sensory neuropathy with pain are key to diagnosis.
Diagnostic Testing
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Best initial test: ESR and markers of inflammation
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Most accurate test: Biopsy of sural nerve or the kidney
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Test for hepatitis B and C, which can be associated with 30 percent of PAN.
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Angiography showing “beading” can spare the need for biopsy.
Treatment
The best initial therapy is cyclophosphamide and steroids.
IgA Nephropathy (Berger’s Disease)
This condition presents with painless recurrent hematuria, particularly in an
Asian patient after a very recent viral respiratory tract infection. Proteinuria
and red cells and red cell casts can be present in all forms of glomerular disease.
There is no specific physical finding that clearly defines the disease.
Diagnostic Testing
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Best initial test: There is no specific blood test. IgA levels are sometimes
elevated.
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Most accurate test: Renal biopsy is essential, because there is no blood
test or specific physical findings to use in diagnosis. Complement levels are
normal.
Treatment
There is no proven effective therapy to reverse IgA nephropathy.
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Steroids are used in boluses when there is a sudden worsening of proteinuria.
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ACE inhibitors are used as they are for all patients with proteinuria.
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Fish oil may have some effect in delaying progression.
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