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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is GCA. While this may seem a odd practice, it is useful to see multiple examples of how GCA will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for GCA.
- Classic symptoms:
- Headache
- Jaw claudication
- Visual disturbances
- Polymyalgia rheumatica (very common associated condition):
- Classic findings:
- Tender temples/tender temporal artery
- Elevated ESR
QUESTION EXAMPLES
Question # 1
A 80 year old woman comes to the clinic because she has been experiencing a 4 month history of left sided headaches, malaise, and myalgia. Her past medical history is notable for hypertension that is treated with atenolol. Her surgical history is remarkable for a bilateral hernia repair that was conducted 30 years ago. She has never smoked and does not consume any alcohol. A HEENT exam reveals palpable temporal arteries bilaterally and her left temporal artery is tender. The patient’s ESR is 90 mm/h. What is a likely diagnosis in this patient?
Explanation # 1
Headaches + palpable and tender temporal artery + elevated ESR = GCA
Question # 2
A 70 year old woman comes to the hospital because she has experienced the sudden onset of complete vision loss in her right eye. She explains that her vision has been blurry from he past few days, however it quickly worsened an hour ago. She also admits to experiencing 2 months of right sided headaches for which she has been taking ibuprofen without much relief. She denies experiencing any nausea/vomiting, but has been having malaise and fatigue. Her past medical history is notable for type 2 diabetes, hypertension, and degenerative joint disease. Currently her vitals are as follows: temperature 99.0°F, blood pressure 145/80 mm Hg, and heart rate of 80/min. A neurological exam reveals complete vision loss in the right eye. Fundoscopy shows a swollen pale disc with blurred margins. The patient’s heartbeat is regular, and a bruit is heard in the right subclavicular area. The motor and sensory exams are unremarkable. The patient’s ESR is 80 mm/h. What is the likely diagnosis in this patient?
Explanation # 2
Acute vision loss + headache + elevated ESR = GCA
Question # 3
Explanation # 3
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- What to do if suspect GCA?
- Treat with steroids FIRST
- Obtain temporal artery biopsy SECOND: to confirm the diagnosis
Page Updated: 01.22.2017