A. Temporal artery biopsy

B. Full Blood count

C. CT head

D. Give high-dose oral prednisolone

E. Same day referral to an ophthalmologist

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The correct answer is D.

• High dose prednisone, 30 mg twice a day should be started as soon as possible for suspected Temporal arteritis

• It is important to begin therapy as soon as possible without waiting for the biopsy as this patient has noticed symptoms of Anterior ischemic optic neuropathy. To prevent loss of vision, due to the involvement of the temporal artery, high dose corticosteroids are used.

Why not A?

• Temporal artery biopsy is the diagnostic test of choice for a patient with suspected giant cell arteritis. But in this case, steroids should be started as soon as possible for suspected Temporal arteritis, as the patient has noticed visual symptoms, to prevent visual loss. This should be followed by temporal artery biopsy to confirm the diagnosis.

Why C?

• CT head should be obtained for patients with suspected stroke-like symptoms. This patient does not have any focal neurological deficit on the exam.

Why E?

• Urgent ophthalmology review is done after steroids are given. Patients who present with visual symptoms should be seen the same day by an ophthalmologist. Visual damage is often irreversible

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