Reference no: EM133397927

Case: A 49 year old woman, accompanied by her husband, comes into the clinic complaining of a severe headache since that morning. Patient describes the headache as 8/10 and states that it started suddenly this morning after she attended a breakfast at the garden club. While she was sitting at the table, she felt an urge to have a BM, went to the bathroom, and returned to the table. Shortly after that, her headache started. She states she felt nauseous, but there was no vomiting. She drove home and tried to lie down.

Questions:

1. What history questions do you want to ask?

Physical Examination

• Patient in mild distress due to headache, but not in acute distress. BP 150/80 (high for her), HR 78, RR 20

• HEENT: Head normal on inspection, without any areas of tenderness. Ears, nose, and throat

clear. Pupils both small at 2 mm but reactive to light. Symmetrical extraocular movements and no nystagmus. Slight photophobia. Fundi and optic discs appear normal. No masses detected on examination of neck, no carotid bruits. Mild nuchal rigidity.

• CV: Heart RR&R. Abdomen soft and nontender.

• Respiratory: Lungs clear to auscultation bilaterally and normal respiratory effort.

• Neuro: Patient fully alert, oriented, and calm. CNs intact. Motor strength symmetrical, with brisk and symmetric deep tendon reflexes without clonus. Cerebellar function and sensory systems normal.

2. What are four tentative differential diagnoses for this patient?

3. What are some other possible differentials?

4. What is your next step?