Rosh Emergency Medicine Practice Test

In a case of suspected giant cell arteritis with optic nerve edema, which of the following would be an expected clinical manifestation?

1. Conjunctival injection and tearing of the right eye

2. Mandibular pain brought on by mastication

3. Scintillating scotoma prior to the onset of headache

4. Vesicular lesion on the tip of the nose

The correct answer is: Mandibular pain brought on by mastication

In cases of suspected giant cell arteritis (GCA), one of the hallmark clinical manifestations is associated with the involvement of the temporal arteries and can include headache, scalp tenderness, and jaw claudication. Jaw claudication, characterized by headaches or pain in the jaw during activities such as chewing (mastication), occurs due to ischemia of the muscles supplied by the affected arteries. This symptom arises because GCA often leads to inflammation and narrowing of blood vessels, impacting blood flow to the structures they supply, including those involved in the mastication process. The presence of mandibular pain during mastication is highly suggestive of GCA and is an important clinical finding that can guide further investigation and treatment. Recognizing this symptom can prompt timely interventions to prevent complications, such as vision loss due to optical artery involvement. In contrast, other options portray symptoms that may arise from different conditions. For instance, conjunctival injection and tearing may suggest an ocular inflammatory condition or allergic response; scintillating scotoma typically indicates a migrainous or neurological issue; and vesicular lesions on the tip of the nose are associated with herpes zoster or other viral conditions, rather than GCA. Understanding the specific presentations associated with GCA, like the significant jaw