🔍 Key clinical features to identify:
📋 Clinical scenario (examiner prompt)
A 12‑year‑old girl is brought to the clinic because of headaches and dizziness. On examination, her blood pressure in the right arm is 155/95 mm Hg, while in the left arm it is 130/80 mm Hg. The left radial pulse is weak and the right radial pulse is bounding. There is a bruit over the left carotid artery. The child has had fever, night sweats, and weight loss over the past 3 months. She is otherwise healthy with no history of cardiac disease.
1. Identify the diagnosis from the clinical context.
2. Describe the clinical features (hypertension, blood pressure asymmetry, absent pulses, bruits, constitutional symptoms).
3. Explain the underlying condition (Takayasu arteritis – large vessel vasculitis).
4. Discuss diagnosis and management (MRA/CTA, glucocorticoids, tocilizumab/TNF inhibitors).
🎯 Expected answers (for examiners)
⚡ Quick FCPS‑style MCQ
A 12-year-old girl with hypertension, a 25 mm Hg blood pressure difference between arms, a weak left radial pulse, and a carotid bruit. The most likely diagnosis is:
A. Coarctation of aorta B. Takayasu arteritis C. Fibromuscular dysplasia D. Kawasaki disease| Feature | Takayasu Arteritis |
|---|---|
| Definition | Chronic granulomatous large vessel vasculitis involving aorta and its major branches |
| Epidemiology | Female predominance (2-4:1), most common in Asian descent, onset 10-40 years |
| Presenting features | Hypertension (renal artery stenosis), blood pressure asymmetry (>10 mm Hg), absent/diminished pulses (pulseless disease), vascular bruits, claudication, constitutional symptoms (fever, weight loss) |
| Diagnosis | EULAR/PRES criteria: angiographic abnormalities + ≥1 of: decreased pulses, BP difference >10 mm Hg, bruits, hypertension, elevated ESR/CRP |
| Imaging | MRA with STIR (vessel wall edema), CTA, PET-CT (inflammation), conventional angiography (luminal stenosis) |
| First-line treatment | Glucocorticoids (prednisone 1-2 mg/kg/day) |
| Biologic therapy | Tocilizumab (IL-6 inhibitor) or TNF inhibitors (adalimumab, infliximab) for refractory/steroid-dependent disease |
| Hypertension management | ACE inhibitors (first-line), calcium channel blockers, beta-blockers; aggressive BP control |
| Surgical intervention | For critical ischemia or refractory hypertension after inflammation controlled; avoid active inflammation |
| Prognosis | 5-year survival 80-90%; causes of death: stroke, heart failure, renal failure, aneurysm rupture |