Giant Cell Arteritis Jeopardy Template

Epidemiology	Diagnosis	Treatment	Physical exam findings	Miscellaneous
100 Is GCA more common in men? or women? Women.	100 If the ESR and CRP are low, can you rule out GCA? No. Sensitivity of ESR for GCA is ~86.9% and CRP 84.1%	100 If you suspect GCA, what therapy should be instituted promptly? High-dose glucocorticoids.	100 Where is the headache usually located? Temporal! but can also be in frontal, occipital, unilateral, or generalized.	100 What is giant cell arteritis also known as? Temporal arteritis. Horton disease. Cranial arteritis.
200 Which ethnicity does GCA affect most commonly? Caucasians	200 What is the gold standard diagnostic test for GCA? Temporal artery biopsy	200 What if patient cannot tolerate steroids? or relapses? what other alternative/ adjunctive treatment are available? Tocilizumab (IL-6 inhibitor) or methotrexate.	200 How does PMR present? Hip and shoulder, proximal muscle stiffness.	200 What percentage of patients with GCA also have PMR? 40-50%
300 GCA only affects intracranial branches of the aorta. True or False. False. GCA can be widespread and systemic, affecting branches of large vessels such as the aorta.	300 What would you expect to see on color doppler ultrasound ? Halo sign "hypoechogenic circumferential dark area around lumen" Sensitivity of 68% Specificity 91%.	300 What are some common side effects of systemic steroid use? Osteoporosis, adrenal gland suppression, insulin resistance, immunosuppression, etc.	300 What percentage of patients with GCA present initially with constitutional symptoms ie: a low grade fever, fatigue, weight loss? Approximately 10%	300 Which cytokine drives the elevation of CRP? (Hint: adjunctive therapy) IL-6
400 What is an associated condition that is commonly found in patients with GCA. Polymylagia rheumatica.	400 What other imaging modality can we use to evaluate for GCA if biopsy and ultrasound cannot be done? MRA. Sensitivity 93. Specificity 81 compared to biopsy.	400 How should we monitor for relapse? Might need to resort to self-reported symptoms, ESR and CRP. There is currently no perfect biomarker for GCA.	400 Which physical exam finding is the most highly associated with a positive biopsy? - Fever - Vision loss - Jaw claudication - Muscle stiffness Jaw claudication.	400 What is a compression sign? Compression sign "persisting visibility of the halo during compression of lumen" Sensitivity
500 What is the age group in which GCA peaks in incidence? Mostly above the age of 50, but peak incidence in 7th decade.	500 What are some cardinal signs and symptoms of GCA? Headaches, visual disturbance/loss, jaw claudication, fever, anemia, elevated ESR and or CRP. Also shoulder and hip muscle stiffness seen in PMR	500 Which clinical presentation should prompt IV methyprednisolone instead of PO prednisone? Threatened/ established visual loss.	500 If vision is intact, prompt initiation of glucocorticoid treatment virtually abolishes subsequent risk of vision loss? True or false? TRUE!!	500 What might you see on a CXR in a patient with GCA? Aneurysmal dilation of the ascending aorta, although sensitivity is limited.

Giant Cell Arteritis

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