STEP 2 CS - CASES, DIFFERENTIALS, DIAGNOSES, DIFFERENTIAL DIAGNOSES, DIFFERENTIAL
DIAGNOSES, USMLE CS DDX, USMLE CS CASES, USMLE CS, COMBO WITH "USMLE STEP 2 CS
MINICASES" AND 1 OTHER, KFP STUDY TEMPLATE, RED FLAGS FOR DIFFERENTIAL DIAGNOSIS
(COMPLETE)
Headache DDX - Migraine (complicated)
- Tension headache
- Cluster headache
- Pseudotumor cerebri
- Trigeminal neuralgia
- CNS vasculitis - Temporal Arteritis
- Subarachnoid hemorrhage (SAH)
- Partial seizure
- Intracranial neoplasm
- Sinusitis
Headache Physical Exam • VS - state or say wnl (wnl except...)
• General: Patient is in no acute distress
• HEENT: Inspect Nose (Noses, mouth, teeth, and throat) and Palpate entire head (including sinuses
(ENT) and temporomandibular joints (Jaw)), Fundoscopic Exam
=> NC/AT, nontender to palpation, PERRLA, EOMI, no papilledema, no nasal congestion, no pharyngeal
erythema or exudate, good dentition
• Heart: Auscultate => RRR, S1, S2 wnl, No murmurs, rubs or gallops (distal pulses intact bilaterally, 2+)
,• Neuro Exam: MSE, CN, Motor, DTR => Mental Status: Alert and oriented x 3, good concentration;
Cranial Nerves (CN) 2 - 12 grossly intact; Motor Strength 5/5 throughout; DTR: 2+ intact, symmetric
Headaches Work-up - CBC with diff
- ESR
- CT—head
- MRI—brain/MRA—brain
- Lumbar Puncture (LP)
- XR-sinues
21 yo F presents with several episodes of throbbing L temporal pain that lasts
for 2-3 hours.
Prior to its onset, she sees flashes of light in her right visual field 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.
DDX?
Physical Exam?
Work up? HEADACHE DDX
- Migraine (complicated)*
- Tension headache
- Cluster headache
,- Pseudotumor cerebri
- Trigeminal neuralgia
- CNS vasculitis - Temporal Arteritis
- Subarachnoid hemorrhage (SAH)
- Partial seizure
- Intracranial neoplasm
- Sinusitis
HEADACHE PHYSICAL EXAM (in general)
- VS
- HEENT: Inspect (Noses, mouth, teeth, and throat) and Palpate entire head (including sinuses (ENT) and
temporomandibular joints (Jaw)), Fundoscopic Exam,
- Neuro Exam: MSE, CN, Motor, DTR
HEADACHE WORK-UP (in general)
- CBC with diff
- CT—head
- MRI—brain
- LP
- X-Ray of Sinuses
Migraine Characteristics (Headache DDX) Symptoms
- Unilateral throbbing
- Photophobia
- Sonophobia
, - Aura
- Recurrent
Physical Exam
- No fever
- No weakness in extremities
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.
HEADACHE DDX
- Cluster headache*
- Migraine
- Tension headache
- Sinusitis
- Pseudotumor cerebri
- Trigeminal neuralgia
- Intracranial neoplasm
HEADACHE WORK-UP
- CBC with diff, ESR
- CT—head
- MRI—brain
- LP
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