A 26-year-old woman presents with claudication of both upper limbs, absent radial pulses bilaterally, a carotid bruit, and discrepant arm blood pressures. ESR is 70 mm/hr. What is the most likely diagnosis?

• A Thromboangiitis obliterans
• B Takayasu arteritis ✓
• C Giant cell arteritis
• D Polyarteritis nodosa

Explanation

Takayasu arteritis is a granulomatous large-vessel arteritis of the aorta and its major branches, classically affecting young Asian women and producing limb claudication, absent pulses ('pulseless disease'), vessel bruits, and blood pressure discrepancy from subclavian stenosis. Giant cell arteritis kills the unwary student but occurs almost exclusively above age 50, which excludes it here. Thromboangiitis obliterans affects distal limb vessels in heavy smokers.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.