Giant cell arteritis — SCE Neurology MCQ

Correct answer: D — Start immediate high-dose glucocorticoid treatment and arrange same-day specialist assessment for threatened vision

The best answer is “Start immediate high-dose glucocorticoid treatment and arrange same-day specialist assessment for threatened vision”. Suspected GCA with visual symptoms is an emergency; treatment must not await biopsy or imaging because delay risks irreversible bilateral visual loss. “Wait for temporal-artery biopsy before giving glucocorticoid” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Use a triptan while awaiting spontaneous resolution” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Begin aspirin alone because inflammation is secondary to thrombosis” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Reassure because fundoscopy is normal between transient episodes” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: BSR guideline on diagnosis and treatment of giant cell arteritis: https://academic.oup.com/rheumatology/article/59/3/e1/5714024