q1 - gujan

[ArchivalUser]

You are seeing a 34-year-old woman in the emergency department who is now 10 days post emergent C-section for preeclampsia at 29 weeks, and presents with a 3-day history of a headache. She describes it as "pain starting at the right temple and shooting through the head to the left temple". There is some associated photophobia and phonophobia. At its worst, the headache is a 10 of 10 on the pain scale, with 10 being the worst pain that she ever felt in her life. This is similar to a headache she was having a month ago during her pregnancy. There is no relief with acetaminophen. Prior to delivery she had numbness of her right cheek that was transient. Her blood pressure is 160/90 mm Hg. Examination shows bilateral papilledema. The most appropriate next step in management is to
A. begin intravenous heparin
B. call a neurosurgical consult
C. discharge the patient with a prescription for naratriptan
D. discharge the patient with a soft cervical collar and prescription for metaxalone
E. order a brain MRI and MRV

[ArchivalUser]

no idea may be B

[ArchivalUser]

E?

[ArchivalUser]

E or A-postpartum hypercoagulability-cerebral thrombosis?

[ArchivalUser]

e is the correct answer.

[ArchivalUser]

what's the explanation plz??

[ArchivalUser]

E is the correct answer.
This presentation is concerning for venous sinus thrombosis. MRV is the best noninvasive test to confirm this diagnosis. If the MRI/MRV is negative, then she should have a lumbar puncture to rule out idiopathic intracranial hypertension (pseudotumor cerebri).

Intravenous heparin (choice A) is the usual treatment for a venous sinus thrombosis, however, the diagnosis should be confirmed first if possible. Therefore, a brain MRI and MRV is the most appropriate next step in management.

A neurosurgical consult (choice B) is not indicated in this case.

Naratriptan (choice C) is used for the acute treatment of migraine headaches. This is atypical for a migraine, but she should be further evaluated before she is discharged and treated.

Soft cervical collar and metaxalone (choice D) are used to treat headaches from cervical muscle spasms. There was no neck muscle spasms noted on exam, and she should be further evaluated before she is discharged.

[ArchivalUser]

eee

[ArchivalUser]

good q gujan thanx