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Giant cell arteritis — SCE Rheumatology MCQ

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HardVasculitisGiant cell arteritisSCE Rheumatology

A 29-year-old woman has new temporal headache, scalp tenderness and jaw claudication. Examination shows the temporal artery is tender and pulsation is reduced. Investigations show ESR is 96 mm/hour with thrombocytosis. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: D — Temporal artery ultrasound

Temporal artery ultrasound is the best answer because temporal artery ultrasound is the investigation most likely to resolve the immediate diagnostic or monitoring question in giant cell arteritis. Tissue biopsy is a plausible distractor, but it does not account for the key discriminator in the stem. Urinalysis and Plain radiograph would be more appropriate in a different clinical pattern or at another point in the pathway, while CT angiography is suboptimal for this presentation. Clinical pearl: autoantibodies are supportive tests and should be interpreted alongside phenotype, inflammatory markers, urinalysis and imaging.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF