A 73-year-old female presents with sudden onset of severe headache, scalp tenderness over the temple, jaw claudication while chewing, and transient visual blurring in her right eye. Erythrocyte sedimentation rate (ESR) is 105 mm/hr. What is the most urgent step to prevent permanent bilateral blindness?

Answer and explanation

Correct answer: C. Immediately administer high-dose systemic corticosteroids (e.g., prednisone or IV methylprednisolone)

  1. Step 1: Recognize clinical syndrome: Giant cell (temporal) arteritis, a systemic vasculitis of medium and large arteries.
  2. Step 2: Recognize catastrophic complication: Ischemic optic neuropathy causing irreversible blindness.
  3. Step 3: Prioritize treatment: High-dose corticosteroid therapy must be started immediately upon clinical suspicion without waiting for biopsy confirmation.
Answer
Immediately administer high-dose systemic corticosteroids (e.g., prednisone or IV methylprednisolone).
Why not the others: 'Waiting for the biopsy' delays treatment while vision is at risk and prompt steroids do not preclude a later biopsy; 'low-dose aspirin' does not control the vasculitis; 'carotid duplex with dual antiplatelets' targets atherosclerosis, not giant cell arteritis.

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