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  #1  
Old 04-06-2011
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Arrow Practice Question: Musculoskeletal Pathology #2

A 72 year old female patient presents to your office with a primary complaint of headache. She says that is has been bothering her for a few weeks. She also complains of jaw pain, especially when she is eating. Her labs show an elevated ESR. Which additional finding would most likely be present in this patient?

A. Weakness and inflammation of proximal muscles
B. A rash covering her eyelids
C. Pain in the proximal muscles
D. Papilledema
E. Urinary incontinence
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  #2  
Old 04-06-2011
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D: papilledema

papilledema complication of horton's disease ( temporal arteritis)

Diagnosis factor : elderly women, jaw claudication ,
complication: irreversible blindness
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Old 04-06-2011
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Quote:
Originally Posted by tinhi View Post
D: papilledema

papilledema complication of horton's disease ( temporal arteritis)

Diagnosis factor : elderly women, jaw claudication ,
complication: irreversible blindness
Note: Temporal arteritis and polymyalgia rheumatica are the best friends...
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Old 04-06-2011
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could be polymyalgia reumatica.. closely linked with temporal arteritis..
so maybe muscle pain ..
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Old 04-06-2011
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temporal arteritis...either pain of mastication muscles or papilledema
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Quote:
Originally Posted by aktorque View Post
Note: Temporal arteritis and polymyalgia rheumatica are the best friends...
yessss but temporal arteritis > 50 y and fibromyalgia rheumatica <50 Y
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Arrow Answer: C

This patient is presenting with signs of Temporal/Giant Cell Arteritis (headache + jaw claudication + elevated ESR)

The two most important associations of GCA are 1) Polymyalgia rheumatica and 2) Blindness due to ophthalmic artery occlusion

tinhi, you are correct in associating GCA with blindness, but papilledema will not generally be present in these patients. The mechanism of blindness or loss of visual acuity is occlusion of the ophthalmic artery due to granulomatous inflammation. Papilledema is a sign of increased intracranial pressure, which would not be present in GCA.

The best answer to this question is C, muscle pain (polymyalgia rheumatica). The hallmark of PR is muscle pain without inflammation in the muscle. (Inflammation of proximal muscles is associated with poly/dermatomyositis).

Good pick up aktorque and bash rcs!
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Quote:
Originally Posted by tinhi View Post
yessss but temporal arteritis > 50 y and fibromyalgia rheumatica <50 Y
I think you are confusing Fibromyalgia with Polymyalgia Rheumatica
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Old 04-07-2011
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Quote:
Originally Posted by apx85 View Post
This patient is presenting with signs of Temporal/Giant Cell Arteritis (headache + jaw claudication + elevated ESR)

The two most important associations of GCA are 1) Polymyalgia rheumatica and 2) Blindness due to ophthalmic artery occlusion

tinhi, you are correct in associating GCA with blindness, but papilledema will not generally be present in these patients. The mechanism of blindness or loss of visual acuity is occlusion of the ophthalmic artery due to granulomatous inflammation. Papilledema is a sign of increased intracranial pressure, which would not be present in GCA.

The best answer to this question is C, muscle pain (polymyalgia rheumatica). The hallmark of PR is muscle pain without inflammation in the muscle. (Inflammation of proximal muscles is associated with poly/dermatomyositis).

Good pick up aktorque and bash rcs!
I m confused, it's says that the main complain in this patient is headache and jaw claudication. there is no other complains( shoulder pain...etc)

so what the cause of papilledema in this patient??
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Originally Posted by tinhi View Post
I m confused, it's says that the main complain in this patient is headache and jaw claudication. there is no other complains( shoulder pain...etc)

so what the cause of papilledema in this patient??
The headache and jaw claudication is meant to help you get to the diagnosis of Temporal Arteritis (or Giant Cell Arteritis)

Knowing this, we are asked to choose what additional finding we would expect to find. We were given two symptoms of GCA and are asked to pick out another possible symptom/sign of GCA.

Potential answers include: Muscle pain (polymyalgia rhematica), Loss of visual acuity, Blindness, or granulomatous inflammation of blood vessels

Of these, only muscle pain is an answer choice listed. Papilledema was a distractor choice because although GCA can cause blindness, it does not usually caused papilledema
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  #11  
Old 04-08-2011
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Default Musculoskeletal Pathology #2

Answer should be :C
Reason : Giant cell arteritis associated with PMR which has the whole mark proximal muscle pain .

Very good question !
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