Jaw Claudication PPV GCA — SCE Rheumatology MCQ
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Correct answer: B — Start high-dose glucocorticoid treatment immediately and arrange urgent diagnostic assessment
The best answer is “Start high-dose glucocorticoid treatment immediately and arrange urgent diagnostic assessment”. Jaw claudication and visual symptoms create a high-risk giant-cell-arteritis presentation; urgent glucocorticoid treatment and same-day specialist assessment take priority over quoting an unstable symptom-level predictive value. The remaining choices—“Calculate a symptom-specific positive predictive value before treatment, with clinical reassessment”, “defer pending temporal artery biopsy before giving glucocorticoid, within a rheumatology pathway”, “Use NSAID treatment and review in four weeks, after safety review”, “Arrange routine optometry in the absence of rheumatology involvement, after specialist assessment”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.
Reference: BSR guideline on giant cell arteritis: https://academic.oup.com/rheumatology/article/59/3/e1/5714024