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Giant Cell Arteritis Recognition — ORE Part 1 MCQ

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HardOral MedicineGiant Cell Arteritis RecognitionORE Part 1

A 60-year-old man attends with a sudden severe unilateral temporal headache. He reports pain in the jaw muscles when chewing, and the temporal artery is tender on palpation. His ESR is 85 mm/hour. What is the most important immediate action?

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Correct answer: E — Arrange urgent medical assessment for suspected giant cell arteritis

This is suspected giant cell arteritis (GCA): age over 50 years, new temporal headache, jaw claudication, temporal artery tenderness and a markedly raised ESR are highly concerning. GCA is a medical emergency because cranial ischaemia can cause irreversible visual loss and stroke. The patient requires urgent same-day medical assessment through the local GCA pathway, with systemic high-dose corticosteroid treatment started promptly and not delayed for ultrasound or temporal artery biopsy. Analgesia with delayed review risks missed ischaemic complications. TMJ dysfunction may cause jaw pain, but does not explain the systemic vascular features or inflammatory marker rise. Antibiotics and panoramic radiography do not address the likely vasculitis and would inappropriately delay definitive care.

Reference: NHS, "Temporal arteritis", treatment section, reviewed 23 April 2023: https://www.nhs.uk/conditions/temporal-arteritis/