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Giant cell arteritis — MCCQE Part 1 MCQ

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HardVisual DisturbanceGiant cell arteritisMCCQE Part 1

73-year-old woman presents with new headache and transient monocular visual loss. ESR is high and she has jaw claudication. Which of the following is the most appropriate next step?

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Correct answer: E — Start high-dose corticosteroids immediately and arrange temporal artery/vascular assessment

Start high-dose corticosteroids immediately and arrange temporal artery/vascular assessment is best because visual symptoms with jaw claudication in an older patient suggest GCA. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Do not wait for biopsy before treating threatened vision.

Reference: Canadian Rheumatology Association guidance