#june2020mccqe1
A 73-year-old retired woman is evaluated in the emergency department 6 hours after experiencing the sudden, explosive onset of a severe headache. The patient has hypertension controlled by diet and exercise. There is no relevant family history. She has no allergies and takes no over-the-counter medications. On physical examination, she is in obvious distress from the headache. Temperature is normal, blood pressure is 179/108 mm Hg, pulse rate is 119/min, and respiration rate is 14/min. There is no meningismus. Neurologic examination shows a normal level of consciousness and no focal abnormalities. Results of laboratory studies and a CT scan of the head without contrast are normal.
Which of the following is the most appropriate next management step?
(A) Lumbar puncture
(B) MRI of the brain
(C) Observation
(D) Sumatriptan, orally
A 73-year-old retired woman is evaluated in the emergency department 6 hours after experiencing the sudden, explosive onset of a severe headache. The patient has hypertension controlled by diet and exercise. There is no relevant family history. She has no allergies and takes no over-the-counter medications. On physical examination, she is in obvious distress from the headache. Temperature is normal, blood pressure is 179/108 mm Hg, pulse rate is 119/min, and respiration rate is 14/min. There is no meningismus. Neurologic examination shows a normal level of consciousness and no focal abnormalities. Results of laboratory studies and a CT scan of the head without contrast are normal.
Which of the following is the most appropriate next management step?
(A) Lumbar puncture
(B) MRI of the brain
(C) Observation
(D) Sumatriptan, orally
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