322.A 67-year-old woman presents to the ED complaining of a 2-day his-
tory of general malaise, subjective fevers, chills, diffuse headache, and right-
sided jaw pain. She also notes diminished vision in her right eye. Her
symptoms are minimally relieved with acetaminophen. She denies any sick
contacts. The patient’s vitals include an oral temperature of 100.6°F, HR is
95 beats per minute, BP is 130/75 mm Hg, and RR is 16 breaths per minute
with oxygen saturation of 99% on room air. She is tender on the right side
of her scalp. You initiate empirical treatment. Which of the following tests
will confirm your diagnosis?
a. Influenza A/B assay
b. Rapid strep test
c. Erythrocyte sedimentation rate (ESR)
d. Complete blood count (CBC)
e. Temporal artery biopsy
323.A 25-year-old stockbroker presents to the ED complaining of 6 weeks
of daily headaches. Her headaches are band-like in distribution and are not
associated with nausea, vomiting, visual phenomena, or neurologic symp-
toms. Normally they respond to acetaminophen, but they have increased in
frequency in the past week as she stopped taking a medication that had
been prescribed to prevent them. What type of primary headache syndrome
is the patient likely experiencing?
a. Migraine headaches
b. Cluster type headaches
c. Trigeminal neuralgia
d. Postherpetic neuralgia
e. Tension headache
346 Emergency Medicine