#august2020mccqe1
A previously healthy 42-year-old woman is evaluated in the emergency department for the sudden onset of a severe occipital headache during defecation 8 hours ago, followed by two episodes of vomiting. The headache reached maximum intensity within seconds. She has never had a headache like this before. She reports no neck stiffness or neurologic symptoms. Her mother and two sisters have a history of migraine. On physical examination, temperature is 36.8°C (98.2°F), blood pressure is 148/88 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. The patient is in significant distress as a result of the pain. There is no evidence of meningismus, papilledema, or focal neurologic signs. Which of the following is the most appropriate next step in management?
(A) CT angiography of the head and neck
(B) Lumbar puncture
(C) Noncontrast CT of the head
(D) Subcutaneous administration of sumatriptan
A previously healthy 42-year-old woman is evaluated in the emergency department for the sudden onset of a severe occipital headache during defecation 8 hours ago, followed by two episodes of vomiting. The headache reached maximum intensity within seconds. She has never had a headache like this before. She reports no neck stiffness or neurologic symptoms. Her mother and two sisters have a history of migraine. On physical examination, temperature is 36.8°C (98.2°F), blood pressure is 148/88 mm Hg, pulse rate is 90/min, and respiration rate is 20/min. The patient is in significant distress as a result of the pain. There is no evidence of meningismus, papilledema, or focal neurologic signs. Which of the following is the most appropriate next step in management?
(A) CT angiography of the head and neck
(B) Lumbar puncture
(C) Noncontrast CT of the head
(D) Subcutaneous administration of sumatriptan
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