Giant Cell Arteritis: The Daily PANCE Blueprint
A 72-year-old woman presents to your clinic complaining of a new-onset headache localized to the temples, along with jaw pain when chewing. She also reports feeling fatigued and having lost some weight unintentionally over the past month. Her ESR is elevated at 60 mm/hr. You suspect giant cell arteritis. What is the most appropriate next step in management?
A. Start low-dose aspirin
B. Initiate high-dose corticosteroids
C. Perform a temporal artery biopsy
D. Order a head CT scan
E. Start methotrexate
Answer and topic summary
The answer is B. Initiate high-dose corticosteroids.
Explanation: The patient’s age, new-onset headache localized to the temples, jaw claudication, and elevated ESR are highly suggestive of giant cell arteritis. Immediate initiation of high-dose corticosteroids is crucial to prevent irreversible complications like vision loss. Temporal artery biopsy can be performed later to confirm the diagnosis but should not delay treatment.
Incorrect Answers:
- A. Start low-dose aspirin: Aspirin is not sufficient for the acute management of giant cell arteritis.
- C. Perform a temporal artery biopsy: While this is the gold standard for diagnosis, treatment should not be delayed awaiting biopsy results.
- D. Order a head CT scan: Imaging is generally not useful in the initial evaluation of suspected giant cell arteritis.
- E. Start methotrexate: Methotrexate may be used as a steroid-sparing agent in chronic management but is not appropriate for initial treatment.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Cardiology ⇒ ⇒
Also covered as part of the Internal Medicine EOR topic list
