USMLE Step 2 CS Minicases ALL
HEADACHE
Key History ✔️✔️*Onset*: acute vs. chronic
*Location*: u/l vs. b/l
*Quality*: dull, stabbing
*Intensity*: worst HOL?
*Duration*
*Timing*: disturb sleep?
*Neuro sx*: paresthesias, visual changes, weakness, ataxia, photophobia, dizziness, auras, neck stiffness
*Other sx*: N/V, jaw claudication, recent trauma, dental surgery, sinusitis sx
*Exacerbating/alleviating factors*
*Patient hx
Family hx*
HEADACHE
Physical Exam ✔️✔️Vital signs
Inspection and palpation of head
ENT inspection
Neuro exam
Fundoscopic exam
26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
,same time every night for the past week
and last for 45 minutes. ✔️✔️*Cluster headache*
Migraine
Tension headache
Sinusitis
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2-3 hours. Prior to its onset, she sees
fl ashes of light in her right visual fi eld
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine. ✔️✔️*Migraine (complicated)*
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
,Partial seizure
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing. ✔️✔️*Temporal arteritis (giant cell arteritis)*
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
, 30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis. ✔️✔️*Sinusitis*
Migraine
Tension headache
Meningitis
Intracranial neoplasm
CBC
XR—sinus
CT—sinus
LP
50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3-4 times a week, typically
toward the end of her work day. She is
experiencing signifi cant stress in her life. ✔️✔️*Tension headache*
Migraine
Depression
Caffeine or analgesic withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
CBC
Electrolytes
HEADACHE
Key History ✔️✔️*Onset*: acute vs. chronic
*Location*: u/l vs. b/l
*Quality*: dull, stabbing
*Intensity*: worst HOL?
*Duration*
*Timing*: disturb sleep?
*Neuro sx*: paresthesias, visual changes, weakness, ataxia, photophobia, dizziness, auras, neck stiffness
*Other sx*: N/V, jaw claudication, recent trauma, dental surgery, sinusitis sx
*Exacerbating/alleviating factors*
*Patient hx
Family hx*
HEADACHE
Physical Exam ✔️✔️Vital signs
Inspection and palpation of head
ENT inspection
Neuro exam
Fundoscopic exam
26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
,same time every night for the past week
and last for 45 minutes. ✔️✔️*Cluster headache*
Migraine
Tension headache
Sinusitis
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2-3 hours. Prior to its onset, she sees
fl ashes of light in her right visual fi eld
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine. ✔️✔️*Migraine (complicated)*
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
,Partial seizure
Intracranial neoplasm
CBC
ESR
CT—head
MRI—brain
LP
65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing. ✔️✔️*Temporal arteritis (giant cell arteritis)*
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
CBC
ESR
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
, 30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis. ✔️✔️*Sinusitis*
Migraine
Tension headache
Meningitis
Intracranial neoplasm
CBC
XR—sinus
CT—sinus
LP
50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3-4 times a week, typically
toward the end of her work day. She is
experiencing signifi cant stress in her life. ✔️✔️*Tension headache*
Migraine
Depression
Caffeine or analgesic withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
CBC
Electrolytes
