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Peri-operative Steroid Cover — UKMLA MCQ

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MediumPharmacologyPeri-operative Steroid CoverUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A 74-year-old woman has a new temporal headache, jaw claudication and two episodes of transient monocular visual loss today. ESR is 82 mm/hour. What is the most appropriate management?

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Correct answer: D — Start immediate high-dose glucocorticoid treatment and obtain same-day specialist assessment

This is suspected giant cell arteritis with visual ischaemic symptoms, creating imminent risk of permanent blindness. Start high-dose glucocorticoid treatment immediately and arrange same-day ophthalmology/specialist assessment; visual involvement may require intravenous therapy under urgent specialist care. Biopsy or ultrasound should be organised promptly but must not delay steroids. Aspirin alone is inadequate, and neither migraine treatment nor routine optometry addresses the vascular emergency. A normal inflammatory marker would not completely exclude GCA if clinical suspicion remained high.

Reference: British Society for Rheumatology. Guideline on diagnosis and treatment of giant cell arteritis. https://academic.oup.com/rheumatology/article/59/3/e1/5714024