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+--- Thread: nbme 4, 3 - sammy06 (/showthread.php?tid=327432)
nbme 4, 3 - sammy06 - ArchivalUser - 08-11-2008
3. A 55-year-old African-American woman is transported to the emergency department by paramedics. She was sitting at the dinner table, and suddenly said to her husband, "I have a terrible headache." She then dropped her fork and slumped in her chair. The husband went to her aid, and she said, "I can't move my right side." He then called emergency medical services. On arrival the patient is alert and oriented. She is holding her head and is in obvious distress. Vital signs are: pulse 101/min, respirations 28/min and blood pressure 190/118z mm Hg. The patient's husband tells you that she has been treated for hypertension for the past 10 years and that she has a 25-year history of simple migraines that occur every 3 to 4 months. On physical examination the patient has an obvious right hemiparesis with an associated hemisensory deficit and hyperreflexia. Blood is drawn for laboratory studies, electrocardiography is done and CT scan of the head is ordered. Her husband asks, "What do you think happened, Doctor?" Based on her clinical presentation and past medical history, which of the following is the most likely cause?
A
) Cerebellar hemorrhage
B
) Complicated migraine
C
) Embolic cerebral infarct
D
) Intracerebral hemorrhage
E
) Subarachnoid hemorrhage
0 - ArchivalUser - 08-11-2008
e...
0 - ArchivalUser - 08-11-2008
E............
0 - ArchivalUser - 08-11-2008
e.
0 - ArchivalUser - 08-11-2008
EEEEEEEE
0 - ArchivalUser - 08-11-2008
Why not D. Should "Subarachnoid hemorrhage" have headache only and D has headche + local nero syptomes ?
0 - ArchivalUser - 08-16-2008
I think is D, I agree with snowbell. Hemorrhagic stroke..pt has hx/o hypertension!
0 - ArchivalUser - 08-17-2008
D for sure.....guys donot get misleaded by the headache only, usually the neurologic symptoms are not that quick in subarachnoid hemorrhage.