QUESTION: A 47-year-old woman with a history of hypertension presents to the ED with a severe headache that began suddenly 3 hours prior to arrival. She has a history of recurrent frontal headaches for the last month and is currently being treated for a migraine headache.  Today, she also complains of blurry vision, diplopia, nausea, vomiting, and confusion. Her vital signs are BP 95/45 mm Hg, HR 118, RR 23, T 98.2°F, and pulse oximetry of 98% on room air. On exam, she appears somnolent. Neurologic exam reveals a dilated, minimally reactive left pupil, a globe that is deviated inferiorly, and bitemporal hemianopsia. Lab results only reveal hyponatremia of 129. Normal saline is administered and a CT scan reveals an intraseller mass. Which of the following is an appropriate step in the management of this patient?

A. Administer intravenous 3% saline
B. Administer intravenous hydrocortisone
C. Administer intravenous mannitol
D. Arrange for rapid radiation therapy




# Mini Board Review: March 2013 EditionDiane Gilliland 2013-03-07 20:37
Thank you for putting together the questions for the mini board review. I find them very helpful!
# Mini Board reviewDr Zahn 2013-03-10 09:37
Good review....but alot of medical info, very specific...not known when you are out for years in practice.
# MDSam Morale 2013-03-11 17:06
Thanks for your effort. Nice to review uncommon diseases to keep us up to speed. It is amazing how many diseases, pathogens etc... have had their names changed : Granulomatosis with Polyangiitis (GPA) (formerly referred to as Wegener’s granulomatosis) .
# Robert Ditrolio 2013-03-12 17:10
Excellent review questions. Please keep them coming in future issues!

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