Rosh Internal Medicine Boost Practice Exam

In an elderly woman with right temporal tenderness and recent onset headaches, what is the most likely diagnosis?

1. Cluster headache

2. Fibromyalgia

3. Giant cell arteritis

4. Trigeminal neuralgia

The correct answer is: Giant cell arteritis

The most likely diagnosis in this scenario is giant cell arteritis, specifically due to the combination of symptoms presented. In elderly individuals, particularly those over 50, new-onset headaches accompanied by tenderness in the temporal region raise a strong suspicion for this condition. Giant cell arteritis, also known as temporal arteritis, is an inflammatory vasculitis affecting the large and medium-sized arteries, often presenting with headaches, scalp tenderness, and sometimes jaw claudication. The temporal tenderness is particularly indicative because it reflects the inflammation of the temporal arteries, which is a hallmark of giant cell arteritis. Furthermore, this condition can lead to serious complications, including vision loss, if not diagnosed and treated promptly. In contrast, other conditions listed do not typically present with the same urgency or combination of symptoms. Cluster headaches, for instance, tend to occur in cycles and involve severe unilateral pain rather than temporal tenderness. Fibromyalgia involves widespread musculoskeletal pain and does not usually present with isolated headache or temporal tenderness. Trigeminal neuralgia primarily presents with sudden, severe facial pain triggered by stimuli and not typically with temporal tenderness or associated headache patterns seen in giant cell arteritis. It is the specific age group, the unilateral temporal tenderness, and the type of headache