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Giant cell arteritis — USMLE Step 2 CK MCQ

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EasyInternal MedicineGiant cell arteritisUSMLE Step 2 CK

A 82-year-old Native American woman comes to the hospital because of neurologic symptoms. History and focused examination are notable for new headache, jaw claudication, scalp tenderness, and elevated ESR. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: D — Immediate high-dose glucocorticoids and temporal artery biopsy

The vignette describes Giant cell arteritis, supported by new headache, jaw claudication, scalp tenderness, and elevated ESR. Immediate high-dose glucocorticoids and temporal artery biopsy is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American College of Rheumatology 2021 Vasculitis Guideline