Repeated USMLE Questions Step 1- 173

A 24-year-old woman visits her physician for evaluation of recurrent low grade fevers for 6 months. She has noted arthralgias and muscle fatigue and has lost about 10 pounds. She has no major health problems and she does not take any prescribed medications. She does not smoke, drink alcohol or take any recreational drugs. On examination, her temperature is 97.8 F, her pulse is 84 on her left arm and 64 on her right arm and her blood pressure is 120/70 on left arm and 106/60 on the right arm. Her laboratory tests show mild normocytic normochromic anemia, negative antineutrophil cytoplasmic autoantibody (ANCA), and slightly high erythrocyte sedimentation rate (ESR) and normal chemistry panel. Urine analysis shows normal values.

What is the most likely diagnosis?

A- Buerger disease

B- Polymyalgia rheumatica

C- Takayasu arteritis

D- Temporal arteritis

E- Systemic lupus erythematosus

Answer: 






The patient's age, low-grade fevers, weight loss, arthralgia, muscle fatigue and aortic arch involvement suggests the diagnosis of Takayasu arteritis. Buerger disease occurs mostly in smokers. Polymyalgia rheumatica and temporal arteritis occur in old age and have other criteria than Takayasu arteritis. Systemic lupus erythematosus shows different results on both serum and urine investigations.

The correct answer is C