A 65-Year-Old Man Comes to the Emergency Department with a 3-Day

question 381

Multiple Choice

A 65-year-old man comes to the emergency department with a 3-day history of headaches localized to the right temporal region.  The headaches are accompanied by intermittent blurring of vision in both eyes.  He has also felt fatigued for the past week, with stiffness in his shoulders and hips.  On examination, temperature is 37.5 C (99.5 F) .  There is tenderness on palpation of the right temporal region with enlargement of the underlying artery, as shown in the exhibit. 

Funduscopic examination reveals edematous optic discs in both eyes.  The patient has limited active abduction of the shoulder joints bilaterally.  Laboratory studies show an erythrocyte sedimentation rate of 115 mm/hr.  Which of the following is the most important mediator of this patient's current condition?

• A)Antibodies to myeloperoxidase
• B)Antibodies to proteinase-3
• C)B cell-activating factor
• D)Interleukin-6
• E)Matrix metalloproteinase

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Definitions:

First Grade

The initial grade of primary education in many schooling systems, following kindergarten and typically involving children aged six to seven.

Assassinated

refers to the act of deliberately killing someone, especially a prominent or public figure, for political or ideological reasons.

Eidetic Imagery

The ability to recall images, sounds, or objects in memory with high precision for a few minutes without using mnemonics; often referred to as photographic memory.

Analogy

An examination of the similarities or differences between two items, usually to explain or make something clearer.