07-06-2006, 02:09 PM
A 26-year-old medical student comes to the office because of a 1-month history of an excruciating left-sided headache. She says that the pain is almost constant and that there is nothing that exacerbates or relieves it. She has had headaches in the past but "nothing like this." She tells you that she is not exactly sure what a brain tumor feels like, but she would not be surprised if this is it. She does not have any other symptoms, takes no medications, does not smoke cigarettes, and rarely drinks alcohol. Her temperature is 36.7 C (98.0 F), blood pressure is 110/80 mm Hg, pulse is 60/min, and respirations are 14/min. A complete physical examination, including a neurologic and funduscopic examination, is unremarkable. Against your better judgement, you decide to order an MRI of the head and a lumbar puncture, in which of course, you do not find any abnormalities. You prescribe her lithium, ergotamine, sumatriptan, propranolol, and amitriptyline. She returns one month later and complains that none of these medications were helpful and that the pain has gotten so bad that she had one of her "resident friends" prescribe narcotic agents. At this time you should
A. advise her to see a psychiatrist
B. begin immediate corticosteroids
C. refer her to a dentist
D. refer her to a pain management specialist
E. take a temporal artery biopsy
A. advise her to see a psychiatrist
B. begin immediate corticosteroids
C. refer her to a dentist
D. refer her to a pain management specialist
E. take a temporal artery biopsy