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Statin primary prevention — USMLE Step 3 MCQ

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HardPreventive Medicine, Epidemiology, BiostatisticsStatin primary preventionUSMLE Step 3

A 73-year-old has new temporal headache, jaw claudication, ESR 96 mm/h, and two episodes of transient monocular blindness. Funduscopic examination is currently normal. Which management is most appropriate?

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Correct answer: E — Start high-dose intravenous glucocorticoids immediately and arrange temporal-artery confirmation

The best answer is “Start high-dose intravenous glucocorticoids immediately and arrange temporal-artery confirmation”. Transient visual loss is threatened permanent vision loss from giant cell arteritis. High-dose IV glucocorticoids begin immediately; diagnostic confirmation follows and remains useful after treatment starts. Aspirin or biologic monotherapy does not replace urgent glucocorticoid therapy. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: American College of Rheumatology/Vasculitis Foundation Guideline: https://rheumatology.org/giant-cell-arteritis-guideline