Headache 349329.A 55-year-old woman presents to the ED complaining of 1 day of a
left-sided headache that is associated with scalp and ear pain. She describes
the pain as gradual in onset, dull, and constant. She describes a week of
constitutional symptoms prior to the onset of her headache syndrome
including joint pain, tenderness of the muscles of her lower extremities,
and fatigue. She is afebrile with no nuchal symptoms, photophobia, or
phonophobia. Physical examination reveals a tender scalp and a thickened,
painful temporal artery. Which of the following is the most appropriate
next step in management?
a. Initiate corticosteroid therapy
b. LP to rule out subarachnoid hemorrhage (SAH)
c. Injection of lidocaine at the base of the occiput
d. Initiate antibiotic therapy
e. Send an ESR
330.A 28-year-old male military recruit presents to the ED complaining
of headache, fever, and neck stiffness. His temperature is 102.2°F and he
refuses to move his neck. He is somewhat lethargic appearing and winces
when the lights are turned on in the examining room. He has a nonfocal
neurologic examination and you proceed with LP. Which of the following
is the most specific finding for suspected bacterial meningitis?
a. The presence of phonophobia, photophobia, and neck stiffness
b. Fever higher than 102.2°F
c. Elevated polymorphonuclear white blood cell (WBC) count on CSF analysis
d. Elevated protein on CSF analysis
e. Increased glucose on CSF analysis