AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 72-year-old female presents with a 2-month history of a new-onset, unilateral headache localized to her right temple, accompanied by jaw claudication, scalp tenderness, and visual disturbances. Her erythrocyte sedimentation rate (ESR) is significantly elevated at 90 mm/hr. What is the most critical immediate diagnostic step?
- AInitiate high-dose corticosteroids
- BLumbar puncture
- CTemporal artery biopsy
- DMRI of the brain
Show answer & explanationAnswer & explanation
Correct answer: A. Initiate high-dose corticosteroids
Given the high suspicion for Temporal Arteritis (Giant Cell Arteritis) with symptoms and elevated ESR, immediate initiation of high-dose corticosteroids is crucial to prevent irreversible vision loss, even before biopsy confirmation.
Why the other options are wrong
- B. A lumbar puncture is indicated for suspected meningitis or encephalitis, which is inconsistent with this patient's presentation.
- C. Temporal artery biopsy is the gold standard for definitive diagnosis, but treatment should not be delayed pending the biopsy result due to the urgency of preventing vision loss.
- D. While an MRI might be considered to rule out other causes, it is not the most critical immediate step in suspected Temporal Arteritis due to the risk of vision loss.
Temporal Arteritis (Giant Cell Arteritis)
A systemic vasculitis affecting large and medium-sized arteries, particularly those of the head and neck, common in older adults.
- Symptoms include headache, jaw claudication, scalp tenderness, and visual changes.
- Elevated ESR is a classic laboratory finding.
- Risk of irreversible blindness if not treated promptly with corticosteroids.
Memory trick: Temp. Artery: Timely Steroids Avert Vision's End.