ABSTRACT
Questions Investigations: SBAs Question 59 A 43-year-old lady presents to the emergency department with a severe sudden-onset occipital headache. She describes the headache as 10/10 in severity with associated neck stiffness. She also mentions feeling a little drunk. There is no history of fever, and she has not suffered from headaches in the past. What is the most appropriate initial investigation? Please choose the single best answer from the following answers: 1) Blood cultures 2) Clotting screen 3) CT head 4) Lumbar puncture 5) MRI head
Question 60 A 38-year-old teacher presents to her GP with a 4-month history of headaches. She describes the headaches as a tight band around her forehead. The headaches are worse in the afternoons and exacerbated by stress. There is no neck stiffness, nausea or vomiting, and there is no focal neurological deficit on examination. What is the most likely diagnosis? Please choose the single best answer from the following answers: 1) Cluster headache 2) Migraine 3) Sinusitis 4) Subarachnoid haemorrhage (SAH) 5) Tension headache
Question 61 A 21-year-old television presenter visits the emergency department with a 4-hour history of headache. She complains when the light is on and has
vomited three times. On examination, she is drowsy, has neck stiffness, has a non-blanching rash on her legs and is pyrexial. What is the most likely diagnosis? Please choose the single best answer from the following answers: 1) Cluster headache 2) Encephalitis 3) Meningococcal meningitis 4) Migraine 5) SAH
Answers Investigations: SBAs Answer 59 3) CT head: The history should raise the suspicion of a SAH; therefore, the most appropriate investigation would be a CT head scan. Ten per cent of SAH can be missed on CT head scans, but imaging would be required before doing a lumbar puncture to assess for xanthochromia. MRI is not a first-line investigation in this case, and as there is no fever, blood cultures are unnecessary. A clotting screen would be an appropriate investigation before a lumbar puncture.
