Rosh Internal Medicine Practice Exam

Starting high-dose corticosteroids immediately is the top priority in suspected giant cell arteritis. The threat of irreversible vision loss from ophthalmic artery involvement means you cannot wait for biopsy or lab tests to confirm the diagnosis. Begin effective anti-inflammatory treatment at once—for most patients this is oral prednisone 40–60 mg daily (about 1 mg/kg/day). If there are signs of acute visual risk or actual vision changes, use intravenous methylprednisolone, such as 1 g daily for 3 days, then continue with an oral taper. After therapy is started, pursue diagnostic confirmation with temporal artery biopsy and supportive tests (ESR/CRP, imaging if available). Note that steroids can affect biopsy results if given too long before the procedure, but patient safety and vision protection take priority. If ocular symptoms are present, involve ophthalmology promptly, but treatment should not be delayed for that referral. Hospital admission is considered based on overall risk and comorbidities, not as the initial step in all cases.