Friday, April 15, 2016

Step 2 CS: Headache / photophobia

Think of differentials, then ask  -

Migraine - Ask about aura, catamenial migraine

Cluster headache - Ask about tearing of eyes, rhinorrhea

Tension headache - Ask about stresses in life

Meningitis - Ask for neck stiffness, fever


Sinusitis - Ask for sinus tenderness

Temporal arteritis - Ask for pain on movement of joint

Intracranial lesion - Ask for headache that wakes up the patient at night

ROS - Ask for weakness / numbness / weight appetite / nausea vomiting

Skip sexual, exercise, diet in this history. Save time :)

When you dim the light in step 2 CS, it completely blacks out. You might wanna switch on the lights to examine, in which case you can tell them - I know this is uncomfortable but I need to switch the lights to examine you. Is that okay with you? Please cover your eyes and bear with me for a moment.
It's hard to write notes in the dark, be prepared for it.

What to examine:

"I'm going to press on your face, let me know if there is any pain."
*check for sinus tenderness*
"I want you to lie down for me, let me help you with the bed rest."
"I am going to lift you leg, let me know if there is any pain and I'll stop"
*Do kernigs*
"I am going to bend your neck, let me know if there is any pain."
*Do Brudzinkis*
"Let me help you sit back up"

If time permits:
Do eye movements, visual acuity.
Check ears, nose throat

If you have even more time, do Cranial nerves.

Your patient note would look like:

PATIENT IS IN SEVERE PAIN
VS - WNL

HEENT - NC/AT
NO SINUS TENDERNESS (Or you could write NON TENDER TO PALPATION)
EOMI (Do not shine light in the patient's eyes just to write PERRLA xD)
NO NASAL CONGESTION
NO TONSILLAR ENLARGEMENT, NO ERYTHEMA OR EXUDATES

NEURO - AAO X 3
CN 2-12 GROSSLY INTACT

NO NECK STIFFNESS
KERNIGS -VE
BRUDZINSKI -VE


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