An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her husband.
He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician who prescribed azithromycin twice a day. The husband reports that he is making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last night and was extremely agitated, left the house, and was walking outside. She did not recognize her husband and wanted to call the police. Which of the following is an appropriate question for the history?
A. Does your wife have dementia or frequent episodes of confusion?
B. Has your wife been running a fever?
C. Is your wife allergic to any medication?
D. Has your wife ever had a mental status exam?
Question 2A 41-year-old male patient presents to the emergency department complaining of severe headache pain. He describes it as a piercing, right sided head pain that occurred earlier in day for about 1 hour and now is recurring.
You note lacrimation and rhinorrhea on the right side of the face. Which of the following types of headache is the patient describing?
A. Sinusitis
B. Cluster headache
C. Migraine
D. Subdural hematoma
Question 3A 60-year-old female complains of several episodes of dizziness and nausea that started this morning. She denies trauma, falling, or loss of consciousness.
She has a 5-year history of hypertension and takes a beta blocker daily. On physical examination, there are no neurologic deficits or any abnormal findings and ECG is normal. Which of the following tests should be performed?
A. Test the patient for Kernig's sign
B. Test the patient for Brudzinski sign
C. Perform the Hallpike maneuver
D. Assess for Babinski's sign
Question 4A 44-year-old male presents to the emergency room with the worst headache of his life. He is holding his head and appears severely distressed. This is a patient symptom that should prompt a clinician to look for signs of a:
A. Migraine headache
B. Subdural hematoma
C. Subarachnoid haemorrhage
D. Brain tumor
Question 5When examining the carotid arteries, the clinician should:
A. Ask the patient to hold his/her breath while auscultating the carotid arteries
B. Use the bell of the stethoscope to listen over the carotid arteries
C. Palpate one carotid artery at a time
D. All of the above
Question 6An 8-year-old child presents to the emergency room with a severe unilateral, throbbing headache. She is lying on the gurney with her eyes closed while holding her head. She denies ever having this kind of headache in the past.
She complains of sensitivity to light and noise. An appropriate history question to ask the parent would be:
A. What do you think triggered the headache?
B. Have you had a fever?
C. Does anyone in your family suffer from migraine headache?
D. B and C
Question 7A 36-year-old female patient complains of foot pain when she wears high heels. There is no history of trauma or arthritis. On physical examination, there is tenderness at the space between the third and fourth metatarsal bones.
Foot x-ray shows no evidence of stress fracture. This history is typical of:
A. Plantar fasciitis
B. Morton's neuroma
C. Achilles tendonitis
D. None of the above
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