Headache
Questions
320.A 21-year-old college student is brought by her roommate to the
emergency department (ED). The roommate states that earlier in the day
the patient complained of a severe headache, stiff neck, and photophobia.
On their way to the ED, the roommate states that the patient was confused.
Her vital signs are blood pressure (BP) 110/80 mm Hg, heart rate (HR)
110 beats per minutes, respiration rate (RR) 16 breaths per minute, and
temperature 102°F. What is the next step in the management of this patient?
a. Start empiric antibiotics, noncontrast head computed tomography (CT) prior
to performing lumbar puncture (LP).
b. Order a noncontrast head CT and start antibiotics once the results are back.
c. Give 1 g of acetaminophen, start fluid hydration, and perform an LP.
d. Perform an LP and start antibiotics once the results are back.
e. Order a noncontrast head CT, perform an LP, then start antibiotics.
321.A 29-year-old woman presents to the ED complaining of a general-
ized headache over the last 2 months. She has seen many doctors for it but
has yet to get a correct diagnosis. She describes the headache as moderate
in intensity and worse with eye movement. Occasionally, it awakes her from
sleep and is worse when tying her shoes. She is scared because her vision gets
blurry for a few minutes everyday. Her only medication is acetaminophen
and an oral contraceptive. Her BP is 140/75 mm Hg, HR is 75 beats per
minute, temperature is 98.9°F, and RR is 16 breaths per minute. On physical
examination you appreciate papilledema. Which of the following is the most
appropriate next step in management?
a. Consult neurosurgery.
b. Administer 2 g of ceftriaxone then perform an LP rule out meningitis.
c. Order a magnetic resonance imaging (MRI) to look for a carotid artery dissection.
d. Diagnose a migraine headache and prescribe her a triptan.
e. Perform a CT scan and if negative perform an LP specifically to measure the
opening pressure.
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