A 73-year-old woman has new temporal headache, jaw claudication and ESR 90 mm/h. What is the correct immediate management?
Answer and explanation
Correct answer: D. Start high-dose prednisolone immediately and arrange urgent specialist assessment
- Step 1: This is suspected giant cell arteritis.
- Step 2: Treatment is not delayed for biopsy because of the risk of irreversible blindness.
Answer
Start high-dose prednisolone immediately and arrange urgent specialist assessment.
Why not the others: Start aspirin 75 mg daily on its own and refer routinely to the neurology clinic: Aspirin alone is not adequate. Prescribe paracetamol and codeine for the headache and review in two weeks: Paracetamol does not treat arteritis. Wait for the temporal artery biopsy result before starting any steroid treatment: Delay risks sight loss.
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