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Be easy in ur answer

Post  Mohammad Tayeb on Tue Jan 01, 2008 11:46 am

65 years old woman come to see u complaining of severe headache of several weeks, & of now having lost of vision in 1 eye. initial investigations show:

Hb: 10.5 g/dl

WBC: 8000 cells/m3

ESR: 90 mm/h.

1- What features would u pay attention in your physical examination?

2- What is the probable Dx?

3- What further diagnostic investigation that u arrange?

4- What treatment would u give?

5- What possible complications of this treatment would concern u in the age of this patient ?

Mohammad Tayeb

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Re: Be easy in ur answer

Post  Ahmed Al-Kaisy on Thu Jan 03, 2008 9:02 am

hi dear, the diagnosis is mostly giant cell arteritis involving temopral and ophthalmic arteries...
the most imporatnt clinical features are:
headache, jaw pain on chewing (due to masseter ischemia), and visual disturbance due to occlusion of the posterior ciliary may cause loss of visual acuity, field, and reduce color perception, blindness...

on physical examination we expect that there is tenderness over the temporal area, on fundoscopy, the optic disc may appear pale and swollen with hemorrhages...

definitive diagnosis is done by temporal artey biopsy...the characteristic biopsy findings are: fragmentation of the internal elastic lamina with necrosis of the media in combination with a mixed inflammatory cell infiltrate. however, skip lesions are common and a negative biopsy does not exclude the diagnosis...

systemic steroids should be started immediately to prevent the loss of the other eye...

for more details about this subject, check davidson new edition page 1139, 1140..

Ahmed Al-Kaisy

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