Page 1 of 1: D/D

Ron09 · Credits: 6242 My Scrapbook

75 yo AAF, NH resident started to c/o occasional jaw pain 4 months ago. She also began to c/o headache 3 weeks ago, throbbing, 5/10, worse in the afternoon, radiating down the neck.

Problem list:
CVA with R hemiparesis, Depression, AFib, OA, Gout, PPD (+), DM2

Medications:
ASA, Clonidine, Colace, Lasix, Glyburide, Lisinopril, Metoprolol, MVT, Nifedipine, MVT, Ambien, Elavil

Physical examination:
WD/WN sitting comfortably in wheelchair
VSS
HEENT: NC/AT, temporal arteries palpable, slightly painful on the right
Neuro: R sided hemiparesis
The rest of the physical exam is WNL

writeD/D,

What is the one test that you should do?
ESR
examine the eyes - visual acuity and fundoscopy.

What happened?
ESR 83
Patient was started on Prednisone 60 mg PO QAM.
She felt better and her pain decreased to 3/10.

What happened next?
You probably remember that the patient has DM . Her HbA1c was 10, one year ago, and was controlled to a level of 7, six months later.

After starting the steroids, 3 weeks ago, patient's BS has been consistently above 200 despite increasing her Glyburide dose to 5 mg PO BID.

What to do to control her BS?
We have 2 options:
-To decrease Prednisone dose
-To increase Glyburide dose

Usually, temporal arteritis treatment continues for at least 4-6 weeks and the response is monitored by symptoms and ESR.

What happened next?
ESR was ordered.
Glyburide dose was increased to 7.5 mg PO QAM, 5 mg PO QPM.

Final diagnosis:
Temporal arteritis. Hyperglycemia as a side effect to steroid treatment in DM patient.

What did we learn from this case?
Suspect temporal arteritis in elderly patients with headache and/or jaw pain.
ESR is a very sensitive test for temporal arteritis.

When treating patients with steroids, monitor for increased BS and BP, and mood changes (the mnemonic is BBP, i.e. BS, BP, Psych)

soko · Credits: 10608 My Scrapbook

DIFFERENTIALS Temporal Arteritis

Glaucoma, Acute Angle-Closure
Headache, Migraine
Iritis and Uveitis
Orbital Infections
Polymyalgia Rheumatica
Retinal Artery Occlusion
Retinal Vein Occlusion
Stroke, Ischemic
Temporal Arteritis
Transient Ischemic Attack
Ultraviolet Keratitis

concorde · Credits: 580 My Scrapbook

AGREE

		Sign In New User? Sign Up Sign in to access your control panel and messenger!
				TechZone \| SpiderNevi \| HowTo? \| Scrapbook!