04-15-2007, 04:15 PM
You are working in the emergency department and asked to see an 82-year-old man who was brought in by his wife because of a new, severe headache. His wife tells you that the patient awoke a week ago in the middle of the night with bad left-sided headache and periorbital pain that has persisted ever since. He denies an increase in pain with cough or sneeze or any neck pain. The wife has been giving him acetaminophen, which seems to help a bit. Over the last 2 days he has noticed that his jaw "gets tired" when he is chewing. He denies other neurologic symptoms, including facial and limb numbness or weakness and denies any changes in speech. Examination shows mild temporal tenderness on the left. Laboratory results are significant for a normal cell count and an erythrocyte sedimentation rate of 117 mm/hr. A CT scan of the head is normal. The most appropriate next step in management is to
A. arrange an immediate temporal artery biopsy
B. give intravenous prochlorperazine
C. prescribe a small amount of oxycodone and follow up in clinic in 2 weeks
D. prescribe a soft cervical collar, diazepam, and follow up in clinic in 2 weeks
E. prescribe gabapentin and follow up in clinic in 2 weeks
A. arrange an immediate temporal artery biopsy
B. give intravenous prochlorperazine
C. prescribe a small amount of oxycodone and follow up in clinic in 2 weeks
D. prescribe a soft cervical collar, diazepam, and follow up in clinic in 2 weeks
E. prescribe gabapentin and follow up in clinic in 2 weeks