7 - The Point Questions with accurate answers, rated A. 2022/2023

7 - The Point Questions with accurate answers, rated A. 2022/2023 Document Content and Description Below 7 - The Point Questions with accurate answers, rated A. 2022/2023 A 55‐year‐old woman with a headache explains to the clinician that she has had headaches before, but this one is unusual bec ause of some new symptoms. Which of the following symptoms would prompt an immediate investigation? a) The patient lost her glasses. b) The headache comes and goes. c) The headache is similar in nature to prior ones she has had for decades but more severe. d) The patient also has developed fever and night sweats and thinks she lost some weight. e) The patient had a car accident and minor head trauma about 3 months ago. - d) The patient also has developed fever and night sweats and thinks she lost some weight. Concomitant fever, night sweats, and weight loss are concerning systemic symptoms and suggest a serious underlying cause of the headaches. The headache is similar in nature to prior ones she has had for decades but more severe is incorrect. Most headaches follow a classic pattern and even if this one is more severe, the same pattern to prior headaches makes this one likely to be benign. The patient had a car accident and minor head trauma about three months ago is incorrect. Although recent head trauma is a concerning history, trauma 3 months ago is unlikely to have produced changes that lead to a headache at this time. The headache comes and goes is incorrect. Headaches that come and go tend to be benign. For example, migraines come and go. The patient lost her glasses is incorrect. Losing glasses can cause squinting and subsequent development of headache. In any case, this is not a serious concern although she should get new glasses. In the case of a middle‐aged female with a pounding headache, what is an effective question to ask the patient? a) Is she feeling stressed? b) Does she think she is losing her memory? c) Has she ever seen anyone with a stroke? d) Does the patient have any aura prior to the headaches? e) How old is the patient? - d) Does the patient have any aura prior to the headaches? An aura or a prodrome of unusual feelings or neurological symptoms may increase the likelihood that this is a migraine. "How old is the patient?" is incorrect. Age of the patient does not produce a useful clue. "Is she feeling stressed?" is incorrect. Most patients report feeling stressed. Also, headaches themselves can stress out a patient. "Does she think she is losing her memory?" is incorrect. Losing memory may be an early symptom of dementia but is not typically linked to headaches. "Has she ever seen anyone with a stroke?" is incorrect. This is unlikely to be a stroke, and asking such a question will only increase the patient's stress. A 35‐year‐old female patient has had migraines for much of her adult life. Ather regular checkup, she is healthy, takes no medications except oral contraceptive pills (OCPs), exercises, and has a steady job. Her only complaint is that her migraines seem to have become worse, and, for the past few weeks, she has been waking up at night with headache and also nausea. Which of the following is the best course of action? a) Take a further history and perform a very careful neurological examination. b) Prescribe a strong medication for her migraines. c) Reassure her that this is a common pattern with migraines. d) Order studies to evaluate potential transient ischemic attacks (TIAs) because she is on OCPs. e) Treat her for sinusitis. - a) Take a further history and perform a very careful neurological examination. The history of nightly awakening and nausea is concerning for increased intracranial pressure from a tumor or other mass. (Brain tumor is not common in a 35‐year‐old.) A careful neurological examination may uncover deficits. Reassure her that this is a common pattern with migraines is incorrect. The new symptoms are not typical of migraines. Order studies to evaluate potential TIAs because she is on OCPs is incorrect. Despite her being on OCPs, the new symptoms are not typical of TIAs or strokes. Treat her for sinusitis is incorrect. Headaches from sinusitis are typically frontal, worse when leaning forward, and do not typically cause such nighttime nausea. Prescribe a strong medication for her migraines is incorrect. Treatment without further workup is not prudent, particularly since these symptoms are not typical of migraines. A 74‐year‐old man is being seen because of a 1‐day history of a painful right eye. He also mentions that he has blurred vision in that eye. He thought something had blown into his eye, but after flushing it out, the pain and blurred vision remains. What is the