A 70-year-old woman presents with sudden visual loss in the right eye. The disc appears segmental oedema with pallor, flame haemorrhages at the disc, and ESR is 85 mm/hr. She has jaw claudication and scalp tenderness. What is the MOST URGENT investigation and treatment?
- A MRI orbit; start IV methylprednisolone 1 g daily
- B Temporal artery biopsy first; start steroids only after biopsy confirmation
- C ESR and CRP; start high-dose oral prednisolone 1-1.5 mg/kg/day immediately without waiting for biopsy ✓
- D FFA; intravitreal anti-VEGF injection
Correct answer: C. ESR and CRP; start high-dose oral prednisolone 1-1.5 mg/kg/day immediately without waiting for biopsy
Explanation
The clinical picture — elderly woman with jaw claudication, scalp tenderness, elevated ESR (>50 mm/hr), and arteritic anterior ischaemic optic neuropathy (AION) — is highly suggestive of giant cell arteritis (GCA). High-dose oral prednisolone (60-80 mg/day or 1 mg/kg/day) must be started IMMEDIATELY without waiting for temporal artery biopsy results, as steroid initiation does not affect biopsy findings for up to 2 weeks, and delay risks fellow eye involvement. Temporal artery biopsy is then performed to confirm the diagnosis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.