Phys Vivas · respiratory
Diffuse Alveolar Haemorrhage — Viva Defence
Structured DCE viva for diffuse alveolar haemorrhage: long-case defence of granulomatosis with polyangiitis presenting with alveolar haemorrhage and dialysis-dependent renal disease — induction, plasma exchange reasoning, maintenance and relapse monitoring.
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Opening statement (SASPOP, delivered aloud)
"Ms Nguyen is a 46-year-old schoolteacher with new PR3-ANCA granulomatosis with polyangiitis, presenting as a pulmonary-renal syndrome: diffuse alveolar haemorrhage confirmed on serial bronchoalveolar lavage, and dialysis-dependent pauci-immune crescentic glomerulonephritis. Her main problems are: life-threatening but currently controlled alveolar haemorrhage on induction immunosuppression; severe renal failure of uncertain reversibility; the cumulative toxicity of steroids and B-cell depletion; and a relapsing-remitting disease that needs a maintenance and monitoring plan. I would like to consolidate remission, protect her from treatment complications, support her renal recovery or transition, and agree a relapse-surveillance plan with her." [6] [7]
You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Physician Medicine fellowship atlas.
References9Show ledgerHide ledger
- [1]Stone JH, Merkel PA, Spiera R, et al. Rituximab versus cyclophosphamide for ANCA-associated vasculitis N Engl J Med, 2010.PMID 20647199
- [2]Jones RB, Tervaert JW, Hauser T, et al. Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis N Engl J Med, 2010.PMID 20647198
- [3]Walsh M, Merkel PA, Peh CA, et al. Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis N Engl J Med, 2020.PMID 32053298
- [4]Guillevin L, Pagnoux C, Karras A, et al. Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis N Engl J Med, 2014.PMID 25372085
- [5]Smith RM, Jones RB, Specks U, et al. Rituximab versus azathioprine for maintenance of remission for patients with ANCA-associated vasculitis and relapsing disease: an international randomised controlled trial Ann Rheum Dis, 2023.PMID 36958796
- [6]Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Arthritis Rheumatol, 2021.PMID 34235894
- [7]Hruskova Z, Casian AL, Konopasek P, et al. Long-term outcome of severe alveolar haemorrhage in ANCA-associated vasculitis: a retrospective cohort study Scand J Rheumatol, 2013.PMID 23374071
- [8]Ioachimescu OC, Stoller JK Diffuse alveolar hemorrhage: diagnosing it and finding the cause Cleve Clin J Med, 2008.PMID 18491433
- [9]Jayne DR, Gaskin G, Rasmussen N, et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis J Am Soc Nephrol, 2007.PMID 17582159