A 65-year-old woman presents with new-onset temporal headache, scalp tenderness, jaw claudication, and ESR of 95 mm/hr. Vision is normal at presentation. Which is the MOST important immediate management step?

• A Await temporal artery biopsy result before starting steroids
• B Start low-dose aspirin as monotherapy
• C Start high-dose prednisolone immediately without waiting for biopsy ✓
• D Perform MRI head and start steroids only if MRI confirms vasculitis

Explanation

Giant cell arteritis (GCA) is a medical emergency due to the risk of irreversible visual loss from anterior ischemic optic neuropathy. High-dose prednisolone (1 mg/kg/day up to 60 mg/day) must be started immediately upon clinical suspicion — before temporal artery biopsy. Biopsy should ideally be performed within 1–2 weeks of starting steroids as histological changes persist, but treatment must never be delayed waiting for the result. Low-dose aspirin is an adjunct (reduces ischemic complications) but not sufficient as monotherapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.