A 72-year-old man presents to his primary care provider complaining of fatigue, mild headache, and discomfort with chewing for roughly 1 week. Before this, he felt well overall, but now he is quite bothered by these symptoms. His medical history is notable for hypertension and hyperlipidemia, both controlled. On examination, he is uncomfortable but nontoxic-appearing. There is mild tenderness to palpation over his right temporal artery, but otherwise the exam is not revealing. Prompt recognition and treatment can prevent which of the following feared complications:
ARenal failure
BCognitive impairment
CBlindness
DPulmonary fibrosis
EPericarditis
A 58-year-old woman presents to the physician with a throbbing headache. She says she had it for the last year and it’s usually located in the right temporal area. There is localized tenderness over the scalp. During the last 2 weeks, she experienced 3 episodes of transient loss of vision on the right side, without ocular pain. On physical examination, her vital signs are normal. Palpation reveals that the pulsations of the superficial temporal artery on the right side are reduced in amplitude. Laboratory studies show: Blood hemoglobin 10.7 g/dL (6.64 mmol/L) Leukocyte count 8,000/mm3 (8.0 x 109/L) Platelet count 470,000/mm3 (470 x 109/L) Erythrocyte sedimentation rate 60 mm/h (60 mm/h) Which of the following conditions is most likely to co-exist with the presenting complaint in this woman?
AAmyloidosis
BSjogren’s syndrome
CFibromyalgia
DPolymyalgia rheumatica
EDermatomyositis
A 4-year-old boy is brought to the emergency department by his parents after 10 days of fever, varying from 38.0–40.0°C (100.4–104.0°F). On physical examination, the child is ill-looking with an extensive rash over his trunk with patchy desquamation. His hands are swollen, and he also shows signs of a bilateral conjunctivitis. The laboratory test results are as follows: Hemoglobin 12.9 g/dL Hematocrit 37.7% Mean corpuscular volume 82.2 μm3 Leukocyte count 10,500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Platelet count 290,000/mm3 Erythrocyte sedimentation rate (ESR) 35 mm/h What is the next best step in the management of this patient’s condition?
AHigh-dose aspirin
BInfluenza vaccine
CEchocardiography
DLow-dose aspirin
ECorticosteroids
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