neuro4 - nishi

[ArchivalUser]

An elderly woman is seen at your office with a complaint of loss of
vision in her left eye, which had been transient on a couple of occasions but
is now persisting. She has been seen recently at urgent care centers for multiple
complaints including generalized fatigue, left-sided dull boring headaches
with occasional sharp jabbing sensations, and arthritic complaint in
the hips. In addition, she reports some recent loss of 7 to 10 pounds. The
only remarkable finding on the routine labs obtained from her prior evaluations
is an elevated alkaline phosphatase. You determine that the likely
cause of her condition is
a. Glaucoma
b. Brain tumor arising anterior to the optic chiasm
c. Optic neuritis
d. Temporal arteritis

[ArchivalUser]

dddddd

[ArchivalUser]

d??

[ArchivalUser]

DD

[ArchivalUser]

ans - D

There is a high
correlation between temporal arteritis and the occurrence of polymyalgia
rheumatica, and this would explain the proximal muscle girdle pain that is
a frequent finding in temporal arteritis. This disease is an inflammation of
the small arteries although there may be some involvement of the middlesized
arteries. The only laboratory test to attempt to confirm your diagnosis
is to obtain an ESR, which should be elevated above 100. Definitive
diagnosis is by temporal artery biopsy. Treatment with steroids prevents
the occurrence of blindness as a complication. The elevated level of alkaline
phosphatase is an incidental finding, perhaps because of alcohol consumption.