---easy Q:but confusing sometimes -- - meti

[ArchivalUser]

so, clear it up.
--------------------------

A 23-year-old female graduate student with acne
and asthma presents to you with a chief complaint
of headaches. She has noted a gradual increase in
the intensity and frequency of the headaches to the
point where they are interfering with her daily
activities and studies. Your examination shows an
obese young lady with papilledema. The remainder
of your physical examination is normal.

1. Which of the following is the most appropriate
management at this time?

(A) order an erythrocyte sedimentation rate
(ESR)
(B) order a glucose tolerance test
© urine pregnancy test
D) obtain a lumbar puncture to measure
opening pressure
(E) obtain an MRI of the brain and orbits,
with and without contrast

2. The test ordered above was negative. Which
of the following is your most appropriate next
step?

(A) instruct the patient on a weight loss
program and follow-up in 3 months
(B) begin diuretic therapy
© start the patient on sumatriptan for
migraine headaches
(D) perform a lumbar puncture to measure
opening pressure
(E) obtain an MRI of the brain and orbits,
with and without contrast

3. Which of the following is most commonly associated
with this condition?

(A) obesity
(B) steroid use during asthma attacks
© tetracycline treatment for acne
(D) oral contraceptives
(E) pregnancy

4. Which of the following interventions is most
appropriate initially for the patient™s suspected
diagnosis?

(A) this condition is self-limited
(B) ventricular-peritoneal shunt placement
© optic nerve fenestration
(D) serial lumbar punctures
(E) acetazolamide therapy

[ArchivalUser]

E
D
A
E

[ArchivalUser]

d
e
a
e

[ArchivalUser]

the case is pseudotumor cerebri ..il go with edae

[ArchivalUser]

E
D
A
E

[ArchivalUser]

great!

E...
D..
A..
E...

1)
Papilledema is optic disc swelling and implies
raised intracranial pressure. Headache is a
common associated symptom.

The initial evaluation of papilledema should involve imaging,
either by MRI or CT scan with and without contrast,
to exclude mass lesions. If these studies are
negative, then the subarachnoid opening pressure
should be measured by lumbar puncture.

2)
Pseudotumor cerebri is a condition of
idiopathic intracranial hypertension. It is a
diagnosis of exclusion that would be made in
the presence of papilledema, normal imaging
studies, and elevated opening pressure on
lumbar puncture with normal CSF studies.

3)The majority of patients with pseudotumor
cerbri are young, female, and obese.

4)This condition is treated with a carbonic anhydrase
inhibitor, such as acetazolamide, which lowers
intracranial pressure by reducing the production
of CSF. Weight reduction, while
important, is often unsuccessful in improving
the condition by itself.
Use of medications such as acetazolamide
or furosemide is considered a first-line
therapy, with the aim of reducing CSF production.
If pharmacologic treatment proves unsuccessful,
alternative treatment options include
surgical options such as optic nerve fenestration
or creation of a ventricular-peritoneal
shunt. Performing serial lumbar punctures is
also possible but carries a number of associated
risks including development of infections or
headaches. (Cecil Textbook of Medicine, p. 2229)