saadtazjam
Forum Elite
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Kap q:Milldel age lady with h/o Migraine for almost 10 yrs comes with worsening of headache,nver been on prophylaxis.takes ibuprofen for headaches.She notices stiffness(morning) in her shoulders and neck.Neuro exam is normal.which is the most ppropriate next step in management of this patients?
1)Head CT
2)LP and CSFanalysis
3)ESR
4)start Prophylaxis with beta blockers
5)start sumatriptan
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| cbenitesch
Forum Senior
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5????
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| docnikki
Forum Guru
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I guess 5
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| saadtazjam
Forum Elite
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HEy Guys why dou you all
think 5?
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| saadtazjam
Forum Elite
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Posts: 160
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The answer given is not 5?Any clue or any other guess
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| study_ing
Forum Fanatic
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1. head cT..stiffening of the shoulders and neck with migraine..spooky
but WORSENING o fthe headache--spookier..i wud always ask y so.
i wud do head CT so that i know B is safe.
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| study_ing
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5 wud not be the answer as it assumes the pt has a migraine.
4. even if it was a migraine, u need treatment, not prophylaxis
3. if old lady with visual problems, jaw claudication...( basically any hints of giant ceell arteritis) id choose thiis as the answer. no use here.
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| saadtazjam
Forum Elite
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U are close, but give another shot
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| study_ing
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unless its polymyalgia rheumatica they r taking about ..in which ESR wud be the ans
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| robin082006
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agree with choice 3
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| study_ing
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lets see whether saadtazjam does 
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| saadtazjam
Forum Elite
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Answer Given is Choice 3,Kaplan explanation is to watch out for redflags of head ache here are some
1)Significant change in pattern of headache
2)Morning stiffness and asstd symptoms,fever, wt loss,jaw claudication etc suggestive of giant cell arteritis in this case-hence going for ESR
Well done guys-Thanks
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