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Giant cell arteritis with transient visual loss — MSRA MCQ

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Hardall topics relevant for this examGiant cell arteritis with transient visual lossMSRA

A 74-year-old woman presents to her GP with a 6-day history of new right-sided temporal headache, scalp tenderness and fatigue. She has had bilateral shoulder girdle stiffness for 3 weeks. This morning she experienced a painless 'curtain coming down' over her right eye for 10 minutes, which has fully resolved. She reports jaw pain when chewing. Visual acuity is currently unchanged from baseline. ESR is 11 mm/hour, CRP is 4 mg/L and platelet count is normal. She has type 2 diabetes managed with metformin. Which is the most appropriate immediate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Start oral prednisolone 60 mg daily and arrange same-day ophthalmology assessment

This patient has a high-probability presentation of giant cell arteritis (GCA): age over 50 years, new temporal headache, scalp tenderness, polymyalgia symptoms and jaw claudication. Transient monocular visual loss is an ischaemic visual symptom and is a warning of threatened permanent visual loss. Normal ESR, CRP and platelet count do not safely exclude GCA in this clinical context and must not delay treatment. She requires immediate high-dose prednisolone and same-day ophthalmology assessment. Ophthalmology may consider admission and intravenous methylprednisolone where visual involvement is suspected. Her diabetes increases the need for glucose monitoring and safety-netting, but does not justify reducing or delaying initial treatment when vision is threatened. A is unsafe because repeat markers and a 48-hour pathway delay are inappropriate with visual symptoms. B uses a lower dose and prioritises investigation over the visual emergency. C incorrectly delays glucocorticoids for imaging. E starts an appropriate oral dose but fails to arrange the required same-day ophthalmology assessment for transient visual loss.

Reference: Giant Cell Arteritis (GCA) (Guidelines) (Reviewed February 2026) — https://www.rightdecisions.scot.nhs.uk/tam-treatments-and-medicines-nhs-highland/therapeutic-guidelines/rheumatology/giant-cell-arteritis-gca-guidelines/ Temporal arteritis (2023) — https://www.nhs.uk/conditions/temporal-arteritis/