BOF: 7
An 80-year-old female presents with a history of severe
constant headache of 3 days duration.
She had not felt well for several weeks being generally
unwell with loss of weight and night sweats. She has had difficulty in
mobilising and has been finding it difficult to get out of bed in the morning
and had difficulty combing her hair.
She is a widow lives alone, does not smoke or drink and
is on no medications.
On examination there was marked tenderness on palpation
of her scalp. There was minimal weakness of the girdle muscles.
Investigations:
Hb 10.2 g/dL
WBC 12.4 x109/L
ESR 95 mm in 1st hour
You want to arrange a temporal artery biopsy but the
surgical team on call are unable to perform this as it is weekend cover only
and they say that it can only be done in 2 days time.
You know that in this condition the maximum time period
the biopsy may be delayed is:
a)
48 hours
b)
72 hours
c)
5 days
d)
7 days
e)
10 days
Answer: d)
The clinical features and the investigation suggest the
patient has giant cell arteritis .
In this condition steroid treatment should be initiated
as soon as possible . If temporal artery biopsy cannot be performed
immediately it can be delayed and steroids started but the biopsy should be
performed within 7 days
Revision Tip
Revise giant cell arteritis KEYS to SUCCESS in Medicine
pages 523-524
