5 Written questions
5 Matching questions
- How do you tx Giant Cell Arteritis?
- What is a vasculitis that presents in pts over 50 with a warning headache, visual symptoms, jaw claudication, throat pain, dry cough, and a fever? It affects medium and large arteries. There is an asymmetry of pulses in arms, murmur of aortic regurgitation and bruits near the clavicle.
- What is a group of vascular dz's that cause inflammatory injury and necrosis of the blood vessels? They are classified as small, medium or large.
- For ITP you are asymptomatic till you start bleeding at...? What is your prognosis?
- What is the tx for ITP?
- a nose, soft palate, petechiae, gums, GI and CNS; good
- b PISD = initial tx: Prednisone 1-2 mg/kg/day; high dose IV Ig of 1 g/kg for 1-2 days for platelet counts < 5000; Splenectomy is definitive tx; Danazol 600 mg/day if all of above fail
- c Systemic Vasculitis
- d Giant Cell Arteritis (blindness if untreated)
- e urgently with prednisone 60 mg/d immediately -> bx to confirm/ then low dose ASA 81 mg/d/ continue prednisone 1 month before tapering
5 Multiple choice questions
- idiopathic thrombocytopenia purpura (ITP); chief complaint - mucosal or skin bleeding
- Giant Cell Arteritis
- lateral and ap x-rays of the chest and CT scans to demonstrate a co-existing thymoma; dx can be confirmed by response to a short-acting anticholinesterase (Phone Eddie)/ Edrophonium IV 10 mg will improve muscle strength, EMG, assay of serum for elevated levels of circulating acetylcholine receptor antibodies (ANA increased but lower titers than SLE)
- Wegener's Granulomatosis (fatal if not treated)
- Takayasu's Arteritis
5 True/False questions
What are the different types of systemic vasculitis? → hematologic malignancies, aplastic anemia
What is tx for Churg-Strauss Syndrome? → P M & M: Prednisone 1 mg/kg/d tapered to < 20 in 8-20 wks with maintenance at 10 mg; Methotrexate 25 mg/wk and mycophenolate mofetil 1500 mg bid for those who are refractory
How do you tx Wegener's Granulomatosis? → crucial to prevent end-organ damage/ tightly control htn
CAP: Cyclophosphamide and prednisone, ASA 325 mg for TIAs/ AM: Azathioprine 2 mg/kg/d for remission and methotrexate 20 mg/wk if not sign/renal dysfunction
In myasthenia gravis what do you see with the thymus gland? → NAP: (since it improves with rest)/ otherwise CT
Anticholinesterase drugs give symptomatic relief
i.e. Neostigmine 15 mg qid and Pyridostigmine 60 mg qid; thymectomy; failure of above - corticosteroids
How do you treat polyarteritis nodosa? → urgently with prednisone 60 mg/d immediately -> bx to confirm/ then low dose ASA 81 mg/d/ continue prednisone 1 month before tapering