Giant Cell Arteritis with Visual Symptoms: An Emergency
A branching clinical case simulation for a patient presenting with two-week temporal headache, jaw claudication, scalp tenderness, and transient loss of vision in the left eye this morning. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 4medium20 min5 stages
- Patient
- 72 years, female
- Presenting complaint
- Two-week temporal headache, jaw claudication, scalp tenderness, and transient loss of vision in the left eye this morning.
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment
The presentation
You are a foundation doctor in the Emergency Department of a district general hospital. At 15:00, a 72-year-old woman is brought in by her daughter. She reports a two-week history of right-sided temporal headache, pain when chewing, and scalp tenderness. This morning, she had an episode of transient visual loss in her left eye that lasted about 10 minutes and resolved. She has also noticed poor appetite and weight loss. Your task is to assess, diagnose, and manage her promptly.
What this case teaches
Recognise giant cell arteritis with visual symptoms as an emergency; start high-dose steroids before biopsy; arrange urgent ophthalmology and temporal artery biopsy; give bone and gastric protection.
How the case unfolds
- 1Focused HistoryHistory
- 2Physical ExaminationExamination
- 3InvestigationsInvestigations
- 4Diagnosis and Immediate ManagementDiagnosis
- 5Further ManagementTreatment
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.