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Temporal arteritis visual symptom — ABIM Board MCQ

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HardNeurologyTemporal arteritis visual symptomABIM Board

A 76-year-old has sudden painless monocular visual loss after weeks of scalp tenderness and jaw claudication. ESR and CRP are markedly elevated, and funduscopy shows a pale swollen optic disc. What is the immediate treatment?

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Correct answer: D — Start high-dose glucocorticoid while arranging diagnostic confirmation

The best answer is “Start high-dose glucocorticoid while arranging diagnostic confirmation”. The presentation is arteritic anterior ischemic optic neuropathy from giant cell arteritis. Immediate systemic high-dose glucocorticoid is required to protect the other eye and prevent further ischemia; diagnostic imaging or biopsy follows without delaying treatment. Aspirin or topical therapy alone cannot control large-vessel inflammation, and established visual loss signals an emergency.

Reference: 2021 ACR/Vasculitis Foundation Giant Cell Arteritis Guideline: https://rheumatology.org/vasculitis-guideline