Pain and Neck Stiffness, which consultation needed! - USMLE Forums
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Old 08-11-2011
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Rheumatology/Orthopedics Pain and Neck Stiffness, which consultation needed!

A 52-year-old female presents with pain and stiffness in her neck, shoulders and hips. She denies muscle weakness. She has also had fevers, malaise and weight loss. Laboratory results show elevated ESR and CRP, but normal CK levels. Which consultation should be obtained first?
A. Neurosurgery
B. Cardiology
C. Nephrology
D. Ophthalmology
E. Orthopedics
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Old 08-11-2011
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Neuro-opthalmology. You're worried about blindness. Temporal arteritis. Polymyalgia rheumatica.
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Old 08-11-2011
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E) Orthopedics .. i think!
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Old 08-11-2011
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ophthalmology...
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Old 08-11-2011
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orthooo...
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Old 08-11-2011
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Answer is E-orthopedics
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Old 08-11-2011
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orthopedics
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Old 08-12-2011
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Correct Answer

The correct answer is D.
The patientís symptoms and laboratory results are consistent with polymyalgia rheumatica. Patients who have polymyalgia rheumatica may also have temporal arteritis, which causes inflammation that damages large and medium size arteries, requiring ophthalmology consult. Ophthalmology consult is required as temporal arteritis is considered one of the most important ophthalmic emergencies as bilateral blindness can occur in up to one-third of patients.
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Old 08-12-2011
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Quote:
Originally Posted by ricko335 View Post
The correct answer is D.
The patientís symptoms and laboratory results are consistent with polymyalgia rheumatica. Patients who have polymyalgia rheumatica may also have temporal arteritis, which causes inflammation that damages large and medium size arteries, requiring ophthalmology consult. Ophthalmology consult is required as temporal arteritis is considered one of the most important ophthalmic emergencies as bilateral blindness can occur in up to one-third of patients.
bt pt refuses any proximal muscle weakness which is present in polymyalgia rheumatica eventhough CK is negative. . . also there s no facial pain or scalp pain or jaw/tongue claudication which r classic for GCA. . then hw can u justify an opthal consult..jst on the basis of elevated ESR . .
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Polymyalgia Rheumatica - NO muscle pain, the name is misleading. That's really one of the important things to know about it.. its pretty clear its temporal arteritis due to the locations of the pain (polym. rheum association) and classically elevated ESR... and as other have said, blindness is the feared complication! Hope that makes sense!

Last edited by zeyad; 08-12-2011 at 05:26 AM.
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