Rheumatology: giant cell arteritis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: giant cell arteritis

Sample item

A 72-year-old woman has a two-week history of new temporal headache, jaw pain on chewing, scalp tenderness and one episode of transient blurring of vision. ESR is 98 mm in the first hour. What is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Start high-dose prednisolone immediately and arrange temporal artery biopsy

Giant cell arteritis is an ophthalmic emergency because untreated arteritis can cause permanent bilateral visual loss from anterior ischaemic optic neuropathy. High-dose glucocorticoids (about 40 to 60 mg prednisolone daily) are started at once, and biopsy within about 2 weeks is still diagnostic. Aspirin, bone protection and tocilizumab as a steroid-sparing option may follow.

Option by option

  • A. Wait for temporal artery biopsy results before any treatment

    Delaying steroids risks permanent blindness, and biopsy stays positive for days to weeks after starting treatment.

  • B. Start high-dose prednisolone immediately and arrange temporal artery biopsy (correct)

    Correct. Treatment must not wait for biopsy because blindness is irreversible.

  • C. Start prednisolone 10 mg daily

    A low dose is inadequate to prevent vascular complications.

  • D. Start a triptan for migraine

    A triptan would not treat vasculitis and would delay therapy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Start high-dose prednisolone immediately and arrange temporal artery biopsy. Giant cell arteritis is an ophthalmic emergency because untreated arteritis can cause permanent bilateral visual loss from anterior ischaemic optic neuropathy.

Why is "Wait for temporal artery biopsy results before any treatment" not the answer?

Delaying steroids risks permanent blindness, and biopsy stays positive for days to weeks after starting treatment.

Why is "Start prednisolone 10 mg daily" not the answer?

A low dose is inadequate to prevent vascular complications.

Why is "Start a triptan for migraine" not the answer?

A triptan would not treat vasculitis and would delay therapy.

What concept does this question test?

It tests Rheumatology: giant cell arteritis in General Medicine. High-dose glucocorticoids (about 40 to 60 mg prednisolone daily) are started at once, and biopsy within about 2 weeks is still diagnostic. Aspirin, bone protection and tocilizumab as a steroid-sparing option may follow.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: giant cell arteritis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.