AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisHard
A 72-year-old female presents with a 2-month history of a new-onset, unilateral headache, primarily in the temporal region, accompanied by jaw claudication when chewing. She also reports scalp tenderness and malaise. Her erythrocyte sedimentation rate (ESR) is significantly elevated at 85 mm/hr (normal < 20 mm/hr). What is the most appropriate initial diagnosis to consider and manage urgently?
- AMigraine without aura
- BTemporal Arteritis (Giant Cell Arteritis)
- CTension-type headache
- DTrigeminal neuralgia
Show answer & explanationAnswer & explanation
Correct answer: B. Temporal Arteritis (Giant Cell Arteritis)
The patient's age, new-onset unilateral temporal headache, jaw claudication, scalp tenderness, malaise, and especially the markedly elevated ESR are highly suggestive of Temporal Arteritis (Giant Cell Arteritis). This condition requires urgent diagnosis and treatment to prevent irreversible vision loss.
Why the other options are wrong
- A. Migraines typically start at a younger age, have a throbbing quality, and are not associated with jaw claudication, scalp tenderness, or elevated ESR.
- C. Tension headaches are usually bilateral, pressing, and lack inflammatory signs or specific features like jaw claudication.
- D. Trigeminal neuralgia causes sudden, shock-like facial pain, not a continuous temporal headache with systemic symptoms and inflammation.
Temporal Arteritis (Giant Cell Arteritis)
A systemic vasculitis affecting medium and large arteries, primarily the temporal artery, common in older adults, requiring urgent treatment to prevent blindness.
- New-onset headache (often temporal), jaw claudication, scalp tenderness.
- Associated with polymyalgia rheumatica in 50% of cases.
- Markedly elevated ESR/CRP is a key diagnostic clue; biopsy is definitive.
Memory trick: GCA: Giant Cell Arteritis Can Affect your Eyes.