Systemic Vasculitides and Autoimmune Syndromes — WACS Viva & Clinical Scenarios (Rheumatology and Clinical Immunology)

Exam-style systemic vasculitides and autoimmune syndromes viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 68-year-old woman presents with a 2-week history of severe right temporal headache, pain in the jaw muscles while chewing, scalp tenderness when brushing her hair, and acute blurring of vision in her right eye. Laboratory testing shows an erythrocyte sedimentation rate of 110 mm/hr and elevated C-reactive protein. Outline your immediate emergency management, confirmatory diagnostic pathway, and long-term therapeutic monitoring plan.
• SCENARIO 2: A 32-year-old man presents with progressive cough, haemoptysis, dyspnoea, nasal crusting with epistaxis, active urinary sediment with red blood cell casts, and an acute rise in serum creatinine from normal baseline to 420 micromol/L. Chest radiography reveals bilateral cavitary nodules. Discuss your diagnostic workup to differentiate pulmonary-renal syndromes, the definitive diagnostic criteria, and the initial immunosuppressive remission induction protocol.
• SCENARIO 3: A 44-year-old man with known chronic hepatitis B virus infection presents with severe periumbilical abdominal pain, digital ischaemia of the right second and third digits, asymmetric bilateral wrist drop, painful testicular swelling, and accelerated hypertension. Urinalysis shows no significant proteinuria or red cell casts. Detail the diagnostic strategy, angiographic features, and treatment regimen tailored to this disease entity.
• SCENARIO 4: A 29-year-old woman presents with recurrent, painful oral aphthous ulcers occurring four to five times per year, painful genital ulcerations, bilateral panuveitis with hypopyon, and painful erythematous subcutaneous nodules over the anterior shins. Formulate the clinical diagnostic criteria, potential vascular and neurological complications, and evidence-based therapeutic protocols for both mucocutaneous and severe ocular manifestations.
• SCENARIO 5: A 50-year-old woman presents with recurrent palpable purpura on the lower extremities, symmetrical polyarthralgias, peripheral paraesthesias, and generalized weakness. Laboratory investigations reveal markedly decreased serum complement C4, elevated rheumatoid factor titre, and positive hepatitis C virus antibodies with detectable viral RNA. Describe the underlying immunopathology, essential diagnostic investigations, and targeted management strategy.