A 76-year-old woman comes to the physician because of a 4-month history of increasing muscle pain and stiffness, weakness of her shoulders and legs, and generalized fatigue. She has been having great difficulty getting out of bed in the morning. On two occasions, her son had to come over and help her stand up. She has had a 4-kg (9-lb) weight loss and has not been sleeping well during this period. She has had multiple episodes of left-sided headaches and pain in the jaw while chewing over the past 2 months. Her temperature is 38.0°C (100.4°F), pulse is 101/min, and blood pressure is 128/88 mm Hg. Examination shows conjunctival pallor. Range of motion of the shoulder and hip is mildly limited by pain. Muscle strength in bilateral upper and lower extremities is normal. Deep tendon reflexes are 2+ bilaterally. Which of the following is the best initial test for this patient?

Question

Quizplus · Accepted Answer

Eductional Objective: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have very high sensitivity for giant cell (temporal) arteritis.  Patients with suspected giant cell arteritis who have an elevated ESR or CRP level should be referred for temporal artery biopsy to confirm the diagnosis.

A 76-Year-Old Woman Comes to the Physician Because of a 4-Month