Vasculitides - discuss

[Cliff Huxtable]

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Please help me, and potentially others, by talking about the vasculitides like the other threads about breast cancer and pulmonary infections.

Thanks.

 

[quietude]

Okay, I'll bite. Here's one I always used to miss (until I made myself memorize it):

A young child with peeling palms and strawberry tongue PLUS swollen cervical lymph node(s) and red eyes doesn't have scarlet fever, he has Kawasaki disease. Usually I figure this out when they ask the most likely complication and coronary artery aneurysm is listed. Any question I've seen so far is about the aneurysm.

Takayasu (can you guess why this came to mind next?) is by far one of the easiest because it'll be a young Asian woman without pulses.

The temporal arteritis question doesn't always mention the ESR, but it's usually an older man with segmental inflammation or granulomas on biopsy. The question here is almost always what should be done first or what's the worst complication: prednisone/blindness.

This is only tangentially related, but a question that specifically points out that the patient has weak femoral pulses really wants you to understand that the patient has bad atherosclerosis and that the answer has something to do with a sequelae of it.

As Goljan says, abdominal pain = PAN = Hep B.

If you're having a hard time remembering the difference between Wegener's and Goodpasture's, a necrotizing granuloma in the nasal cavity is Wegener's. Wegener's is also the only thing off the top of my head that causes nasal septum perforation (other than cocaine). I haven't seen a question that asks that, but it'd be a good one.

Also not a vasculitide, but I've never seen a Monckeberg calcification question. Compare that to aortic stenosis from calcification, which appears to be 10% of USMLEWorld.

Rash on buttocks with joint pain in young child: Henoch-Schonlein.

Someone should throw up a sticky about the USMLE: if a disease has a specific, pathognomic description or histology, you need to know how it would be described in plain English, because that's how it's going to be. This goes for EVERYTHING. There ought to be a section in FA just for decoding what on earth the question is trying to describe. Vasculitides aren't too bad, but derm questions are ridiculous sometimes.

 

[Whats_up_doc]

Okay, I'll bite. Here's one I always used to miss (until I made myself memorize it):

A young child with peeling palms and strawberry tongue PLUS swollen cervical lymph node(s) and red eyes doesn't have scarlet fever, he has Kawasaki disease. Usually I figure this out when they ask the most likely complication and coronary artery aneurysm is listed. Any question I've seen so far is about the aneurysm.

Takayasu (can you guess why this came to mind next?) is by far one of the easiest because it'll be a young Asian woman without pulses.

The temporal arteritis question doesn't always mention the ESR, but it's usually an older man with segmental inflammation or granulomas on biopsy. The question here is almost always what should be done first or what's the worst complication: prednisone/blindness.

This is only tangentially related, but a question that specifically points out that the patient has weak femoral pulses really wants you to understand that the patient has bad atherosclerosis and that the answer has something to do with a sequelae of it.

As Goljan says, abdominal pain = PAN = Hep B.

If you're having a hard time remembering the difference between Wegener's and Goodpasture's, a necrotizing granuloma in the nasal cavity is Wegener's. Wegener's is also the only thing off the top of my head that causes nasal septum perforation (other than cocaine). I haven't seen a question that asks that, but it'd be a good one.

Also not a vasculitide, but I've never seen a Monckeberg calcification question. Compare that to aortic stenosis from calcification, which appears to be 10% of USMLEWorld.

Rash on buttocks with joint pain in young child: Henoch-Schonlein.

Someone should throw up a sticky about the USMLE: if a disease has a specific, pathognomic description or histology, you need to know how it would be described in plain English, because that's how it's going to be. This goes for EVERYTHING. There ought to be a section in FA just for decoding what on earth the question is trying to describe. Vasculitides aren't too bad, but derm questions are ridiculous sometimes.

PAN = A for Abdominal Pain, N for MonoNeuritis (Footdrop), I haven't found the P yet..

Histo: Transmural inflammation with fibrinoid necrosis.

Tx for Kawasaki --> Aspirin and Gamma globulins

Syphilytic aneurysm IS a Vasculitis : Endarteritis Obliterans

Histo: Plasma Cell infiltrate in Vasa Vasorum

Gross: "Tree bark appearance"

Organism: T.Pallidum FTA-ABS, Dark Field examination

Cardio : Aortic Regurgitation


Another interesting thing for Henoch Scholein is PALPABLE PURPURA in lower extremities.

Also --> IgA immune complexes. Also called Berger Disease.

Not to confuse with Buerger's disease ( Thromboangiitis obliterans)

Patient will present with claudication (pain on calfs when walking). He or she will be at highest risk for gangrene and amputation of that limb.



That's all I wanted to add, quietude was right on the money.👍

 

[Whats_up_doc]

I have to add that Berger's Disease is called when Henoch Scholein has renal manifestations (IgA nephropathy).

For thromboangiitis obliterans add there has to be a history of SMOKING.

 

[Cliff Huxtable]

T h a n k y o u !

 

[future_dr_house]

One of my favorite mnemonics for Takayasu's - I can't TAKA YA pulse

 

[quietude]

PAN = A for Abdominal Pain, N for MonoNeuritis (Footdrop), I haven't found the P yet..

Histo: Transmural inflammation with fibrinoid necrosis.

Tx for Kawasaki --> Aspirin and Gamma globulins

Thanks, had never heard of the gamma globulins before.

Not to confuse with Buerger's disease ( Thromboangiitis obliterans)

Patient will present with claudication (pain on calfs when walking). He or she will be at highest risk for gangrene and amputation of that limb.

That's all I wanted to add, quietude was right on the money.👍

Because I just did a question on it...Buerger's is the vasculitide with smoking/claudication, but claudication can also occur with atherosclerosis of the femoral artery. So if the question is about diabetics and foot pulses, it seems to lean more towards some sort of ischemia question (I've seen it used for mesenteric ischemia, MI risk, etc). If the patient smokes and/or has black fingertips, Buerger's.

 

[Cliff Huxtable]

In class we learned young, male, smoker, think Buerger's.

Also, what questions are you doing and how do you have such a good grasp on the types of questions typically seen?

 

[rahulb]

Also not a vasculitide, but I've never seen a Monckeberg calcification question. Compare that to aortic stenosis from calcification, which appears to be 10% of USMLEWorld.

i've seen exactly one question on monkeberg's sclerosis in over 9000

they described a histological picture of medial calcification and asked what the most likely sequelae was. answer was asymptomatic bc its typically a benign condition. if they didn't use the 'buzzword' medial calcification i wouldn't have picked up on it.

i seriously laughed out loud when i saw the Q because i've read that stupid bullet point in FA/RR path at least 100 times and have been waiting for a single question. i probably would have killed myself if i got it wrong.

 

[ZagDoc]

If you're having a hard time remembering the difference between Wegener's and Goodpasture's, a necrotizing granuloma in the nasal cavity is Wegener's. Wegener's is also the only thing off the top of my head that causes nasal septum perforation (other than cocaine). I haven't seen a question that asks that, but it'd be a good one.

Didn't have a question about a perforated septum, but did have a Wegener's question with a nasal ulcer that did not heal.

 

[quietude]

In class we learned young, male, smoker, think Buerger's.

Also, what questions are you doing and how do you have such a good grasp on the types of questions typically seen?

I'm taking the exam Friday. So I hope I have a pretty good grasp at this point.

But what I've done: all of Kaplan and USMLEWorld Qbanks, the USMLEWorld Assessment 1, NBMEs 3-6, the Goljan RR questions, WikiTestPrep (though I wouldn't recommend it), and various Pre-Test, Kaplan Qbooks, BRS questions. The PreTest/BRS stuff is not what I've been referencing when I reply to threads, as I've found it fairly low-yield.

I have a good knack for remembering something if I see it written down. So I can't tell you if that's how the USMLE will be, but I can tell you if I've seen it in the last three weeks of prep questions. What I try to mention is what tripped me up -- not minor details you can easily memorize, but how the question is put together.