Rheumatology and ophthalmology · FICTIONAL CASE

New visual disturbance with headache: do not wait for proof

Recognise sight-threatening giant cell arteritis, begin appropriate urgent treatment and obtain specialist assessment without waiting for confirmatory testing.

Sight-threatening recognition and diagnostic sequencing≈ 14 minutes0/3 decisions explored
PAUSE BEFORE USING

This is educational content, not a clinical protocol. Verify current guidance, use local pathways and seek appropriate senior or specialist help.

THE CASE

A fictional 74-year-old has a new temporal headache, jaw claudication and transient monocular visual loss. Inflammatory markers are elevated.

01 · INITIAL PRESENTATION

Listen for the assumption.

SHO

I planned to wait for temporal-artery ultrasound before starting glucocorticoids.

Registrar

Visual symptoms make delay unsafe. Treatment and urgent ophthalmology/rheumatology assessment should proceed while confirmation is arranged.

SHO

I will document the visual history and examination before treatment when this causes no delay.

WHERE IS THE CONSULTANT?

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 ↓
EVOLVING INFORMATION

The picture develops.

  1. Transient monocular visual loss
  2. Jaw claudication
  3. No alternative explanation identified on initial assessment
02 · DECISION CHECKPOINTS

Commit before you reveal.

After you select an option, reveal the model reasoning and the consultant’s feedback.

DECISION 1What is the immediate priority?
DECISION 2Does a normal inflammatory marker exclude GCA?
DECISION 3What should be recorded before or alongside treatment?
03 · CONSULTANT-LED SYNTHESIS

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.

Registrar

Ask specifically about transient loss, diplopia, jaw or tongue claudication and polymyalgia symptoms, and examine both eyes.

Consultant

Start the locally recommended sight-threatening regimen and coordinate urgent ophthalmology and rheumatology review; testing must not introduce delay.

SHO

I will document risk counselling, treatment and the route to rapid confirmatory assessment.

CLINORA DECISION TRACE
01 · CUENew headache and jaw claudication with visual symptoms
02 · INTERPRETSight-threatening giant cell arteritis
03 · ACTTreat immediately and coordinate urgent specialist assessment and confirmation
SAFETY CHECK

What must remain explicit.

  • Use the current local GCA pathway and BSR guidance.
  • Do not delay treatment for biopsy or imaging when sight is threatened.
  • Arrange urgent ophthalmological assessment for visual symptoms.
COMMON ERRORS

Where reasoning fails.

  • Waiting for diagnostic proof
  • Inadequate visual baseline
  • False reassurance from one test
STRUCTURED HANDOVER
Suspected GCA with headache/claudication [details], visual symptoms/examination [baseline], inflammatory markers [results], treatment [time/regimen] and ophthalmology/rheumatology plan [status].
REFLECTIVE PAUSE

How does your service provide same-day assessment for GCA with visual symptoms?

CONTINUE INTO EXAM PRACTICE

Test the related knowledge.

Move from discussion to MRCP Part 1 questions mapped to the same clinical domains.

Practise Rheumatology →Practise Ophthalmology →