what do you think this pt has?

[purplelife]

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[ATStillisWatching]

Fibrinoid necrosis- polyarteritis nodosa?

 

[dyspareunia]

C, henoch schonlein?

 

[ATStillisWatching]

C, henoch schonlein?

HSP is usually in kids. I'm more inclined to go with polyarteritis nodosa due to the history of HBV

 

[oingoboingo]

C - I believe this is PAN

 

[EazyE1907]

Fibrinoid necrosis- polyarteritis nodosa?

yup, hypertension with elevated ESR and CRP point to some sort of vasculitis. Increased risk of Hep B infection is pinpoints polyarteritis

 

[GadRads]

Before looking at other responses, I thought about small vessel vasculitis and PAN also came to mind. And I totally forgot HBV is found in 30% of PAN cases.

 

[EazyE1907]

they set the pt up like he had either TB infection or sarcoidosis. but by looking at the elevated crp and esr you can't get rid of a d and e since they are all pretty much associated with the same disease process. eosinophiles is an easy one to eliminate as well.

 

[EazyE1907]

oh and f would be due hyperplastic arteriolosclerosis which is due malignant htn which i see how they try to trick you there with the increase bp. but again the cCRP and ESR give it away.

 

[Freddie Mercury]

sickle cell

 

[dyspareunia]

Purpura associated with PAN though? That's what made me think HS

 

[purplelife]

Answer is C. Fibrinoid necrosis, polyarteritis nodosa

Thanks guys

 

[EazyE1907]

Purpura associated with PAN though? That's what made me think HS

Right. But that's usually in younger children usually following an upper respiratory infection.

 

[Slack3r]

Purpura associated with PAN though? That's what made me think HS

Ya the purpura, arthralgias and abd pain seems to point to HS as the "classic triad", but Wikipedia says purpura/livedo can occur in some PAN pts, so who knows.

 

[EazyE1907]

Guys. that HS is due to a CHILDHOOD vasculitis 2ndary to IgA complex deposition following a Upper respiratory tract infection. Had this patient been a CHILD. with the symptoms aforementioned (purpura, ab pain and arthralgias). then yes it would have been Henoch-Schonlein Purpura. You also need to look at the lab values given as well. CRP and ESR are not at all related to HS. it's very simple.

 

[Slack3r]

Guys. that HS is due to a CHILDHOOD vasculitis 2ndary to IgA complex deposition following a Upper respiratory tract infection. Had this patient been a CHILD. with the symptoms aforementioned (purpura, ab pain and arthralgias). then yes it would have been Henoch-Schonlein Purpura. You also need to look at the lab values given as well. CRP and ESR are not at all related to HS. it's very simple.

You are aware HS occurs in adults too, right? Although, yes ESR/CRP suggest PAN, as does the HBV hx.

 

[EazyE1907]

indeed. but how many qbank questions have you came across with the same classic presentation in an adult and it was HS. i never came across it. it's not as common as it is in children. not trying to argue just saying.