A 44-year-old female presents to the emergency department with a right-sided headache. She states the headache is located on the right temple region, is non-radiating, and does not cause photophobia. She is otherwise healthy and has no reported medical problems and has only taken acetaminophen for the pain, which has minimal relief. On physical exam she is alert, awake, and oriented. Her vitals are T 98.8, P 78, R 18, and BP 128/76. Her head is normocephalic, atraumatic, and pupils are equal and reactive. She has tenderness to the right temporal area of the temporal artery, and there is no noted swelling, redness, or abnormalities noted. There is no tenderness to the cervical muscles. She exhibits a non-focal neurological exam. Based on the clinical presentation, what test is the best test in confirming an accurate diagnosis? A C-reactive protein B Erythrocyte sedimentation rate (ESR) C Computed tomography of head D Temporal artery biopsy E Complete blood count (CBC)

The initial test for confirmation of a case like Giant Cell Arteritis should be an Erythrocyte Sedimentation Rate (ESR). It is used to detect inflammation in the body. However, the most accurate test for this condition is Temporal Artery Biopsy.

Explanation:

Based on the patient's symptoms and the details provided, the suspected condition may potentially be Giant Cell Arteritis (Temporal Arteritis). This condition causes inflammation of the arterial walls, predominantly affecting the temporal arteries, which can result in headaches and tenderness around the temporal area. As per the options given, the best preliminary test for confirming this would be an Erythrocyte Sedimentation Rate (ESR) because it would indicate inflammation in the body. Here, an elevated ESR would suggest the presence of an inflammatory condition like Giant Cell Arteritis. Nevertheless, the most accurate diagnostic test for Giant Cell Arteritis is a Temporal Artery Biopsy. However, it is an invasive procedure and is generally performed when initial tests suggest the possibility of this condition.

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