Headache

Question 1

how can giant cell arteritis present?

Answer 1

temporal/frontal headache, jaw claudication, scalp tenderness, visual symptoms (e.g amaurosis fugax)

Question 2

what other rheumatological condition is associated with GCA?

Answer 2

polymyalgia rheumatica: 25% of GCA patients will have this

Question 3

what are some signs on examination suggestive of GCA?

Answer 3

thickened and tender temporal arteries and scalp tenderness

Question 4

what investigations are helpful in the diagnosis of GCA?

Answer 4

increased ESR, temporal artery biopsy

Question 5

does a negative biopsy exclude the possibility of GCA?

Answer 5

no as skip involvement is common in GCA

Question 6

What is the treatment for GCA? how does this differ if there are ischaemic visual symptoms?

Answer 6

High dose oral prednisolone (40-60mg) until symptoms settle (5-7 days)
If ischaemic visual symptoms then IV methyl prednisolone for 3 days prior to oral steroids

Question 7

what is a complication of GCA?

Answer 7

blindness

Question 8

when would you give antibiotics before doing an LP in suspected bacterial meningitis?

Answer 8

can’t be done within 1 hour, signs of severe sepsis or rapidly evolving rash, signs of raised intracranial pressure, significant bleeding risk