A fictional 76-year-old reports new temporal headache, jaw claudication and brief episodes of visual loss. Inflammatory markers are raised.
Listen for the assumption.
I will wait for biopsy confirmation before starting treatment.
What is the immediate harm you are trying to prevent?
Irreversible visual loss. I will use the urgent local GCA pathway, arrange same-day specialist assessment and document visual symptoms carefully.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- New temporal headache and jaw claudication
- Transient visual loss
- Raised inflammatory markers
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
Obtain a careful visual and neurological history, then speak to the relevant same-day service.
Treat this as a sight-threatening emergency. Explain that testing remains important even after treatment begins.
I will record visual symptoms, examination, treatment time and the plan for imaging/biopsy.
What must remain explicit.
- Follow current local GCA/ophthalmology pathways.
- Escalate visual, neurological or systemic deterioration immediately.
- Do not use historic dose memorisation as a substitute for the current protocol.
Where reasoning fails.
- Waiting for biopsy
- Failing to ask about transient visual symptoms
- Missing alternative causes of visual loss
Suspected GCA with visual [symptoms/exam], headache/jaw [history], inflammatory markers [results], pathway treatment [time] and specialist plan [name].
What words would you use to explain why treatment may begin before testing is complete?