American College of Physicians: Internal Medicine — Doctors for Adults ®


The MKSAP Challenge

From the November ACP Observer, copyright 2004 by the American College of Physicians.

A 78-year-old woman is evaluated because she has had a headache for the past eight days and has noted the onset of blurring and double vision. The double vision lasted for approximately 15 minutes this morning but then resolved. She has lost 6.8 kg (15 lb) over the past two months. She had been taking lisinopril for mild hypertension for five years.

Which of the following is the best next step in this patient's management?

A. Refer her to an ophthalmologist or a neurologist.
B. Schedule a temporal artery biopsy as soon as possible.
C. Test her erythrocyte sedimentation rate and schedule a temporal artery biopsy if it is >50 mm/h.
D. Administer sumatriptan.
E. Administer prednisone, 60 mg, immediately and schedule a temporal artery biopsy.



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