questions 4

Large Vessel Vasculitides

Topic updated on 01/31/17 9:05am

  • Includes 
    • Takayasu arteritis
    • giant cell (temporal) arteritis
  • Chart overview of vasculitides  
Takayasu Arteritis
  • Overview
    • characterized by granulomatous thickening of aortic arch and/or proximal great vessels 
  • Epidemiology
    • primarily affects Asian females < 40 years of age
  • Presentation
    • symptoms
      • flu-like symptoms
        • fever, night sweats, and myalgia
      • arthritis symptoms
    • physical exam
      • weak pulses in upper extremities
      • "pulseless disease"
      • skin nodules
      • ocular disturbances
  • Evaluation
    • labs
      • elevated ESR
    • imaging
      • diagnosis generally confirmed by arteriography
      • CT angiography with IV dye injection may be adequate in some cases
  • Treatment
    • pharmacologic
      • high dose steroids
        • indications
          • for patients with symptoms or serologic markers of active disease (increased ESR)
      • cytotoxic agents
        • indications
          • helpful in patients who fail to respond or who relapse on tapering steroids
Giant Cell (Temporal) Arteritis
  • Overview 
    • vasculitis affecting large arteries
      • usually involves superficial temporal and/or ophthalmic arteries
      • characterized histologically by granulomatous inflammation
    • affects adults > 50 years
    • associated with polymyalgia rheumatica
  • Presentation
    • symptoms
      • unilateral temporal headache
      • jaw claudication (pain with chewing)
      • impaired vision
  • Evaluation
    • labs
      • elevated ESR
        • definitive diagnosis with vessel biopsy but due to risk of rapid blindness must use ESR to determine if steroid treatment should be given immediately
  • Treatment
    • pharmacologic 
      • high-dose steroids 
  • Complications
    • monocular blindness
      • as a result of occlusion of ophthalmic artery that may lead to irreversible blindness


Qbank (3 Questions)

(M1.CV.9) A 69-year-old woman presents to her primary care physician complaining of a new-onset, left-sided, throbbing headache that has lasted for several days. She reports that the pain is worsened by eating. Which of the following is a complication of this condition if not treated promptly? Topic Review Topic

1. Skin nodules
2. Intestinal ischemia
3. Monocular blindness
4. Myocardial infarction
5. Ischemic stroke

(M1.CV.63) A 68-year-old Caucasian male complains of severe headache and pain while chewing. Upon examination, he is found to have a left visual field deficit. Laboratory results show elevated erythrocyte sedimentation rate. Which of the following drugs would be the best choice for treatment of this patient?
Topic Review Topic

1. Propranolol
2. Prednisone
3. Sumatriptan
4. Pilocarpine
5. Clopidogrel

(M1.CV.69) A 30-year-old Japanese female presents with flu-like symptoms and weak pulses in her upper extremities. An angiogram reveals granulomatous inflammation of the aortic arch. Which of the following disease processes is most similar to this patient's disease? Topic Review Topic

1. Temporal arteritis
2. Polyarteritis nodosa
3. Kawasaki disease
4. Buerger's disease
5. Infectious vasculitis

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