Vasculitis: Clinical

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Vasculitis: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 70-year-old woman comes to the emergency department because of painless vision loss in the right eye. She reports a 2-month history of difficulty dressing due to shoulder stiffness. She has also experienced right-sided headaches and jaw tightness when eating. Past medical history is significant for carotid atherosclerosis, diabetes mellitus, and hypertension. Vitals are within normal limits. Physical examination shows tenderness to palpation on the right side of the head. Visual acuity in her right eye is 20/200, and a right afferent pupillary defect is noted. Laboratory studies show an erythrocyte sedimentation rate of 65 mm/h. Which of the following is the most appropriate treatment for this patient’s current condition? 


Vasculitides are a group of disorders that cause vasculitis, which is inflammation in the walls of the blood vessels.

Since blood vessels pass through organs - vasculitis damages those organs, and mimics a variety of diseases.

There are usually systemic symptoms like fever, fatigue, joint pain, and weight loss; as well as organ-specific symptoms that may literally involve any organ.

Whenever vasculitis is suspected, there’s inflammation, which is often reflected by an increased ESR, CRP, and increased white blood cell count, and sometimes requires a biopsy of whichever organ or tissue is involved.

The vasculitides are divided into groups based on the size of the arteries that are mainly involved.

There’s large vessel, medium vessel, and small vessel vasculitis which affects small arteries and capillaries.

Starting with large vessel vasculitis, the first condition is Giant cell arteritis, also called temporal arteritis.

This is the most common vasculitis in individuals over the age of 50.

The most frequently affected arteries are the external carotid, ophthalmic, and temporal arteries.

Symptoms include a headache and vision loss, and a worrisome complication is that there’s a high risk for a stroke.

Often, the temporal artery can become tender and rigid.

In addition, individuals can get jaw claudication, which is when there’s temporal artery insufficiency causing ischemia of the masticatory muscles, leading to pain while chewing.

Diagnosis of giant cell arteritis is done with temporal artery biopsy, looking for giant cells in the tissue.

The next large vessel vasculitis is Takayasu arteritis.



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