AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 72-year-old female presents with a 2-month history of unilateral headache, jaw claudication, and scalp tenderness. She reports recent onset of blurred vision in her right eye. On examination, the right temporal artery is palpable, nodular, and tender with diminished pulsation. Her erythrocyte sedimentation rate (ESR) is 100 mm/hr (normal <20 mm/hr). What is the most critical immediate diagnosis to consider?
- ATrigeminal Neuralgia
- BMigraine with Aura
- CTemporal Arteritis (Giant Cell Arteritis)
- DTension-Type Headache
Show answer & explanationAnswer & explanation
Correct answer: C. Temporal Arteritis (Giant Cell Arteritis)
The patient's age (>50), unilateral headache, jaw claudication, scalp tenderness, blurred vision (suggesting ophthalmic involvement), and elevated ESR are classic findings for Temporal Arteritis (Giant Cell Arteritis). Vision loss is a medical emergency due to irreversible blindness if untreated.
Why the other options are wrong
- A. Trigeminal neuralgia causes severe, sharp, lancinating facial pain in the distribution of the trigeminal nerve, without headache, jaw claudication, or elevated inflammatory markers.
- B. Migraine with aura typically affects younger individuals, lacks jaw claudication, scalp tenderness, or an elevated ESR, and visual changes are usually transient and specific (e.g., scintillating scotoma).
- D. Tension-type headache is usually bilateral, pressing/tightening quality, mild to moderate intensity, without associated systemic symptoms, visual changes, or elevated ESR.
Temporal Arteritis (Giant Cell Arteritis)
A systemic vasculitis affecting medium and large arteries, primarily the temporal artery, common in older adults. It is a medical emergency due to the risk of irreversible vision loss.
- Symptoms include new-onset headache, jaw claudication, scalp tenderness, and visual disturbances.
- Diagnosis supported by elevated ESR/CRP and confirmed by temporal artery biopsy.
- Requires immediate high-dose corticosteroid treatment to prevent blindness.
Memory trick: GCA: Giant Cell Arteritis, Critical, Age > 50, Jaw claudication, Scalp tenderness, Vision loss risk, ESR high.