A 65-year-old woman comes to the physician’s office with facial pain. The pain is located along her right forehead and began 3 days ago. She describes it as constant, “burning,” and very painful with even light touch. She has never had this kind of pain before. She denies headache, photophobia, changes in vision, eye pain, pain with chewing, fever, or chills. Her past medical history is significant for migraine headaches, but this pain is different from her “typical” headaches. She also has mild hypertension and folate deficiency secondary to inadequate dietary intake. Her temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 138/90 mm Hg. There are clusters of erythematous papules and vesicles extending from her right frontal prominence down to her nasal bridge. There are small crusted erosions as well. The rash is exquisitely tender to light touch. Which of the following complications is this patient most likely to experience?

A 62-year-old woman comes to the emergency department because of severe jaw pain. Over the past day, she has had progressively worsening pain in the right side of her jaw, which occurs predominantly when chewing and talking. A few hours ago, the vision in her right eye "totally blacked out" but returned to normal within a few minutes. She has a history of hypertension and migraines. Her only current medication is losartan. Her temperature is 37.8°C (100°F), pulse is 88/min, respirations are 18/min, and blood pressure is 126/78 mm Hg. Physical examination shows tenderness to palpation along the right jawline and right side of the scalp. Visual acuity is 20/30 bilaterally. Fundoscopic examination shows mild bilateral retinal vein dilation but no other abnormalities. There is no conjunctival injection or lacrimation. Laboratory studies show:Hemoglobin 10 mg/dLMean corpuscular volume 90 µm3Platelet count 500,000/mm3Leukocyte count 9000/mm3Erythrocyte sedimentation rate 92 mm/hWhich of the following is the most appropriate next step in the management of this patient?A. High-dose intravenous methylprednisoloneB. High-dose oral prednisoneC. Intravenous immunoglobulinD. Low-dose oral aspirinE. Low-dose oral prednisoneF. Oral methotrexateShow Explanation

A 67-year-old female presents to the ED after a transient episode of visual loss in her right eye. She reports that she has had right-sided headache for several months, for which she takes ibuprofen, with some relief. On physical examination, she has tenderness over her scalp in the left temporal region and complains that her jaw “gets tired with chewing.” Neurologic examination is normal with no focal deficits. Vital signs are as follows: Temperature 101.1°F, HR 72, RR 16, BP 140/82. Which of the following is associated with this condition?Ask StudybuddyGroup of answer choicesInflammatory bowel diseaseAortic aneurysmHepatitis BAlcohol historySmoking history

linical Case Study: Migraine PatientAuthor/ Source of Case Presentation:SummaryA 34-year-old woman with worsening migraines, now occurring 4-5 times a month. Headaches are severe, unilateral, and temporal, with aura, nausea, and photophobia. She misses work and struggles with household chores and childcare during attacks. Naratriptan is partially effective, causing her to consider switching medications due to weight gain from valproic acid.Chief Complaint: “This new medication is not working for my migraines. My headaches are worse around my period and I have gained 10 pounds!”Case Presentation:Presenting to the neurology clinic is a 34-year-old female who states that she used to get about two migraines every month; however, she recently went back to work full-time and has two young children, ages 3 and 5, to care for. Since then, the frequency of her migraines has increased to about four to five per month. She states her migraines usually occur in the morning and are more frequent around her menses. Her typical headache evolves quickly (within 1 hour) and involves severe throbbing pain, which is unilateral and temporal in distribution. Her headaches are preceded by an aura, which consists of nausea and pastel lights flashing throughout her visual field. Photophobia occurs frequently, and vomiting may occur with an extreme headache. She reports experiencing severe migraine attacks that cause her to miss one day of work each month. She is unable to complete household chores and has a difficult time caring for her children on the days she has severe migraine attacks. She also complains of having mild migraine attacks lasting three days per month, during which her productivity at work and home is reduced by half. She typically has to retreat to a dark room and avoid any noise, or the severity of the migraine increases. She rates her migraines as 7–8 on a headache scale of 1–10, with ten being the worst. At her previous visit to the Neurology Clinic 3 months ago, she was prescribed naratriptan 2.5 mg orally to be taken at the onset of headache. However, naratriptan has not been effective for half of the migraines she has had in the last three months. During two of the attacks, she experienced partial pain relief, with the pain returning later in the day. She mentions that she was prescribed naratriptan when the Cafergot she was taking stopped working. She states she has taken her medications precisely as advised. She was started on valproic acid at her last clinic visit for headache prophylaxis and has noticed a 10-lb weight gain. She inquires about switching from valproic acid to another medication.Physical Exam Findings:Migraine with aura since 29, previous medical workup, increasing an EEG and a head MRI, demonstrated no PVD, CVA, brain tumor, infection, cerebral aneurysm or epileptic component. Vital Signs: Vital SignsVital Signs- BP: 142/86 mmHg- HR: 76 bpm- RR: 18- Temp: 37.2°C- Weight: 75 kg- Height: 5’3” Family Medical History: The patient's mother has a history of migraines, hypertension, and Type II Diabetes. The patient's father also has a history of migraines.Social History: The patient is a mother to two boys aged 3 and 5. She recently started working full-time as a secretary.Lifestyle: The patient stopped smoking 3 months ago but occasionally consumes caffeine. She does not consume alcohol or use illicit drugs.Diagnostic TestsLaboratory ResultsSerum Electrolytes:Sodium (Na): 142 mEq/LPotassium (K): 4.2 mEq/LChloride (Cl): 101 mEq/LCarbon Dioxide: 23 mEq/LHematology:Hemoglobin: 13.0 g/dL (Reference Range: 12-16 g/dL)Hematocrit: 40% (Reference Range: 36-46%)WBC: 8.0 × 103 / mm3 (Reference Range: 5-10 × 103 / mm3)Differential Count:Blood Urea Nitrogen (BUN): 12 mg/dL (Reference Range: 10-20 mg/dL)Serum Creatinine (SCr): 0.8 mg/dL (Reference Range: <1.5 mg/dL)Glucose (Glu): 95 mg/dL (Reference Range: <140 mg/dL)AST: 23 U/L (Reference Range: 5 - 40 U/L)ALT: 23 U/L (Reference Range: 29 - 33 U/L)Alk Phos: 35 U/L (Reference Range: 44 – 147 U/L)Platelet: 302 × 103 / mm3 (Reference Range: 150–450 × 103 / mm3)Previous Drug Therapies:Abortive therapies:Simple analgesics, NSAIDs and Cafergot (good efficacy until 3 months ago)Narcotics ( good efficacy, but puts her “ out of commission for days” )Midrin (no efficacy)Naratriptan (minimal efficacy)Prophylactic therapies:Valproic acid 500 mg daily (weight gain)Propranolol 20mg BID (increase episodes of dizziness and light headedness; patient discontinued medication)Treatments for mild depression (for 8 months):Phenelzine 15mg po TID (minimal efficacy, discontinued 2 months ago)Sertraline 50 mg po at bedtime (recently started 1 month ago)

A 62-year-old man comes to the emergency department due to painless vision loss in his left eye.  The patient states that he was watching television when suddenly everything became dark and he could not see out of his left eye.  This resolved spontaneously after approximately 5 minutes and was not associated with headache, slurred speech, numbness, or weakness.  He experienced a similar episode several months ago, at which time he did not seek medical attention.  His medical history is significant for hypertension, type II diabetes mellitus, and hyperlipidemia; he admits that he is not compliant with his medication regimen.  Two years ago, the patient was hospitalized for hyperosmolar hyperglycemic state, and his HbA1c level 4 months ago was 9.5%.  He has a 30-pack-year smoking history.  Temperature is 36.7 C (98 F), blood pressure is 160/90 mm Hg, and pulse is 80/min and regular.  Which of the following is the most likely cause of this patient's symptoms?

In which group of patients is post-dural puncture headache most common?ElderlyMorbidly obeseMale sexFemale sexDiabetics