A 74-year-old white woman presents with a 4week his- 

tory of headache, scalp tenderness when combing her 

hair, and pain in her jaw when chewing. Her exami- 

nation, however, reveals no temporal artery tenderness 

and her erythrocyte sedimentation rate is 45 mm/hour. 

You suspect that she may have giant cell arteritis, but 

you are reluctant to start steroids without more objec- 

tive information. A temporal artery biopsy is performed 

and found to be floridly positive. What percentage 

of cases of giant cell arteritis is associated with an 

erythrocyte sedimentation rate of less than 

50 mm/hour? 

36-year-old woman sees you with the complaint of 

pain in the medial aspect of the wrist. This pain radi- 

ates up the forearm. She has a positive Finkelstein's test 

(pain with lateral deviation of the wrist). What does she 

most likely have? 

Your 42-year-old patient was seen in the emergency 

department for the acute onset of right big toe swelling. 

The toe was aspirated and demonstrated uric acid crys- 

tals. His serum uric acid level was 8.3 mg/dL. The rest 

of his chemistry panel was normal. He was given 

indomethacin, and his symptoms resolved. This is his 

first episode of podagra. What should you do on a fol- 

low-up office visit? 

A 28-year-old man with a history of systemic lupus ery- 

thematosus (SLE) presents to the emergency room for 

evaluation of a possible flare in his SLE. He had pre- 

sented 5 years ago with photosensitivity, malar rash, 

polyarthritis, and ANA (+), and was given the diagno- 

sis of SLE. His disease had recently been quiescent on 

prednisone 10 mg/day and hydroxychloroquine 200 

mg/day. One month ago, on a routine visit, he was 

noted to have a WBC of 3700 and urinalysis showing 

1+ protein. At 10 pm last evening, he had the abrupt 

onset of headache, chills, and confusion. The headache 

became more severe, he developed a low-grade fever, 

and he now presents to the emergency room. Physical 

examination reveals an uncomfortable and lethargic 

man with a temperature of 38.5 °C, BP of 130/78, pulse 

of 100, and respiratory rate of 18; there were no focal 

findings. Laboratory studies show a WBC of 7.2 (20% B) 

and a urinalysis with 1+ protein, and 5 to 10 RBC. A 

chest x-ray is notable for left base atelectasis/infiltrate, 

and CSF is normal. Cultures are sent. What would you 

do next? 

Which disorder occurs predominantly in children?