08-18-2011, 07:51 AM
A 76-year-old white woman presents to you because of complaints
of new-onset headache. She thinks it has been present
for about 2 months. It occurs daily. She also has had some
fatigue and has lost about 5 pounds during the past month.
On further questioning, she complains of morning stiffness
lasting about 1 hour. Physical examination is essentially within
normal limits for her age. Results of initial laboratory studies
show a mild normochromic anemia and an increased erythrocyte
sedimentation rate (55 mm in 1 hour).
Which of the following would be the next most appropriate step?
a. Temporal artery biopsy
b. Bone marrow biopsy
c. Initiation of prednisone therapy 15 mg/day orally
d. Electromyography
e. Upper aortic arch angiography
of new-onset headache. She thinks it has been present
for about 2 months. It occurs daily. She also has had some
fatigue and has lost about 5 pounds during the past month.
On further questioning, she complains of morning stiffness
lasting about 1 hour. Physical examination is essentially within
normal limits for her age. Results of initial laboratory studies
show a mild normochromic anemia and an increased erythrocyte
sedimentation rate (55 mm in 1 hour).
Which of the following would be the next most appropriate step?
a. Temporal artery biopsy
b. Bone marrow biopsy
c. Initiation of prednisone therapy 15 mg/day orally
d. Electromyography
e. Upper aortic arch angiography