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  #1  
Old 06-02-2012
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Question what test next? patient have headache and stiff neck !

A 46-year-old man developed a severe headache this morning while working at his car dealership. He also has nausea and has had one episode of emesis. He has shoulder and neck stiffness that developed today. He denies any history of migraine
headaches or any similar headaches.
Which diagnostic test should be ordered?
A. MRI scan
B. CT scan without contrast
C. CT scan with contrast
D. Lumbar puncture
E. None of the above
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  #2  
Old 06-02-2012
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was this the only info in the question stem??
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Quote:
Originally Posted by mbbs2010 View Post
was this the only info in the question stem??
enough to suspect SAH
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Old 06-02-2012
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Can this not be meningitis?

Neck stiffness, vomitting..?

I'd do an LP
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that is what confused me too.. between being meningitis and some kind of hemorrhage.

but i guess i agree with bisho cos of the acute onset of headache.


then again something concrete to rule out other answers wud be good
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Originally Posted by mbbs2010 View Post
that is what confused me too.. between being meningitis and some kind of hemorrhage.

but i guess i agree with bisho cos of the acute onset of headache.


then again something concrete to rule out other answers wud be good
Ah! I think that's key. I missed the acute portion.... so just normal CT is answer
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Originally Posted by tyagee View Post
A 46-year-old man developed a severe headache this morning while working at his car dealership. He also has nausea and has had one episode of emesis. He has shoulder and neck stiffness that developed today. He denies any history of migraine
headaches or any similar headaches.
Which diagnostic test should be ordered?
A. MRI scan
B. CT scan without contrast
C. CT scan with contrast
D. Lumbar puncture
E. None of the above
I think B......case of SAH......????
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Originally Posted by tyagee View Post
A 46-year-old man developed a severe headache this morning while working at his car dealership. He also has nausea and has had one episode of emesis. He has shoulder and neck stiffness that developed today. He denies any history of migraine
headaches or any similar headaches.
Which diagnostic test should be ordered?
A. MRI scan
B. CT scan without contrast
C. CT scan with contrast
D. Lumbar puncture
E. None of the above
its severity and acute onset which can decide lp vs ct..lolZ.
i did D
ans is B
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Quote:
Originally Posted by tyagee View Post
its severity and acute onset which can decide lp vs ct..lolZ.
i did D
ans is B
i made the exact same mistake.

didnt look at the acute onset.. anyway guess its better to be wrong here than the actual test
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B. CT scan without contrast since no fever
Maybe he hit his head on a jacked up car ?
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Originally Posted by Novobiocin View Post
B. CT scan without contrast since no fever
Maybe he hit his head on a jacked up car ?
....or his customer did this to him
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Quote:
Originally Posted by tyagee View Post
its severity and acute onset which can decide lp vs ct..lolZ.
i did D
ans is B
But isn't the absence of fever the biggest clue against Meningitis?
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