A 63-year-old woman comes to the office because of a 3-week history of a "dull, achy"

Discussion in 'Plab 1 and 2 forum' started by Santosh Jadhav, Oct 25, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    A 63-year-old woman comes to the office because of a 3-week history of a "dull, achy" headache. She says that it started out as an intermittent headache that was exacerbated by bending down, lifting heavy objects, sneezing, defecating, and coughing, but lately it has become constant. She cannot associate the headaches with food or hunger, alcohol, weather or barometric pressure changes, sounds, or irregular sleep patterns. She is generally very healthy, but recalls having some nausea and vomiting a few weeks before the headaches started. She has never had headaches before. She does not take any medications, rarely drinks alcohol, and exercises regularly. Her temperature is 37.0 C (98.6 F), 130/80 mm Hg, pulse is 70/min, and respirations are 15/min. Physical examination is unremarkable. An erythrocyte sedimentation rate, complete blood count, and electrolytes are normal. A trial of oral prednisone, sublingual ergotamine, and oral sumatriptan is ineffective. The most appropriate next step is to

    A. administer glucocorticoids, intravenously
    B. administer sumatriptan, intramuscularly
    C. give her oxygen inhalation therapy
    D. obtain a temporal artery biopsy
    E. order an MRI of the head
    F. perform a lumbar puncture

Share This Page