Exam (elaborations)
USMLE Step 2 CS Minicrashes ALL Are Questions And Answers Graded A
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USMLE Step 2 CS Minicrashes ALL Are Questions And Answers Graded A
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USMLE Step 2 CS Minicrashes ALL Are QuestionsAnd Answers Graded A+
HEADACHE
Key History Correct Answer: *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 Correct Answer: 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. Correct Answer: *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. Correct Answer: *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. Correct Answer: *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. Correct Answer: *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. Correct Answer: *Tension headache*
Migraine
Depression
Caffeine or analgesic withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
CBC
Electrolytes
ESR
CT—head
LP
35 yo M presents with sudden severe
headache, vomiting, confusion, left
hemiplegia, and nuchal rigidity. Correct Answer: *Subarachnoid hemorrhage*
Migraine
Meningitis/encephalitis
Intracranial hemorrhage
Intracranial neoplasm, vertebral a. dissection, intracranial venous thrombosis, acute htn
CBC
PT/PTT
CT head w/o contrast
MRI/MRA brain
LP
25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig's and Brudzinski's
signs are positive. Correct Answer: *Meningitis*
Migraine
Subarachnoid hemorrhage
Sinusitis/encephalitis
Intracranial or epidural abscess
CBC
CT—head
MRI—brain
LP—CSF analysis (cell count,
, protein, glucose, Gram stain,
PCR for antigens, culture)
18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2-3 weeks. She is taking
OCPs. Correct Answer: *Pseudotumor cerebri*
Tension headache
Migraine
Cluster headache
Meningitis
Intracranial venous thrombosis
Intracranial neoplasm
Urine hCG
CBC
CT—head
LP—opening pressure and CSF
analysis
57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2-4 minutes. Correct Answer: *Trigeminal neuralgia*
Tension headache
Migraine
Cluster headache
TMJ dysfunction
Intracranial neoplasm
CBC
ESR
MRI—brain
CONFUSION/MEMORY LOSS
Key History Correct Answer: Make sure to get hx from family members/caregivers
*Timing*: course of cognitive deficits (acute vs. gradual)
*Associated sx*: constitutional, incontinence, ataxia, hypothyroid sx, depression
Screen for delirium, falls, medications, hx of stroke, vascular disease, syphilis, HIV, EtOH, B12
deficiency
*Family hx* of Alzheimer's or other neuro disorders
CONFUSION/MEMORY LOSS
Physical Exam Correct Answer: Vitals
Neuro exam
MMSE
Gait
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