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USMLE-Rx Step 1 Qmax Challenge #4055

Check out today’s Step 1 Qmax Question Challenge.

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A 65-year-old woman presents to her physician with the new onset of a severe headache and malaise. The headache is constant, unilateral, and located in the frontotemporal region. The pain is not aggravated by light neck flexion. She has not experienced nausea, vomiting, or a rash, and there is no history of head trauma or headache syndromes, but she has noted a 10-lb (4.5-kg) weight loss in the past 3 weeks. On physical examination, her temperature is 38.1°C (100.6°F), blood pressure is 120/70 mm Hg, and heart rate is 90/min. MRI of the brain shows no abnormality. A biopsy is performed over the area of pain. Some of the vessels in the biopsy specimen, shown in the image, show granulomatous inflammation with plentiful multinucleated giant cells.

What agent is most likely to be an effective treatment for this patient’s condition?

A. Aspirin and intravenous immune globulin
B. Azathioprine
C. Doxycycline
D. Prednisone
E. Sumatriptan

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