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A 74-year-old woman visits her physician complaining of a new onset of fatigue and temporal headache. She lost about 5-7 pounds over the last year. She also has morning stiffness for one hour accompanied by aching in the shoulders and hips. Yesterday, she lost her vision in the right eye and got it back in about 30 min. Physical examination is unremarkable. Laboratory tests indicate high erythrocyte sedimentation rate.

What is the most appropriate next step?

A- CT scan of the head

B- Carotid Doppler studies

C- Temporal artery biopsy

D- Start prednisone

E- Refer to a neurologist




Answer:

This patient has a typical presentation of giant cell arteritis (temporal arteritis). She should start immediately taking prednisone orally otherwise she will lose her vision permanently. Clinical picture and high ESR are enough for diagnosis. In some cases of doubt, temporal artery biopsy can be performed. CT scan of the head and carotid Doppler studies are not helpful in diagnosis of temporal arteritis.

The correct answer is D