archer medicine question 161 - misshyd

[ArchivalUser]

208) A 31 Year old woman with suspected diagnosis of Idiopathic intracranial hypertension underwent a lumbar puncture. An MRI of the brain that was obtained prior to lumbar puncture did not reveal any structural abnormalities or mass effect. Laboratory investigations including coagulation parameters were normal. About 12 hours after the procedure, she complains of moderate to severe headache. Headache is mainly in the occipital region which increases while sitting up and improves on lying flat. She has two episodes of vomiting in the last one hour. She also complains of dizziness and ringing sensation in her ears. Physical examination does not reveal any papilledema or focal neurological deficits. Most appropriate next step in managing this patient?
A) Blood cultures
B) MRI of the Lumbar Spine
C) Non-Contrast CT scan of brain
D) Observation
E) Acetazolamide

[ArchivalUser]

If it is spinal leakage or hematoma, tinnitus should not be there.

Pseudotumour can occur without papilloedema in some cases, may need repeated LP and medical tm.

I choose E.

[ArchivalUser]

D- observation, for spinal headache.

[ArchivalUser]

Can spinal head ache cause tinnitus and vomiting?

If pt is that symptomatic, treatment should start iv fluid, should not be observation. Am I right?

[ArchivalUser]

It can be very severe and causes these symtoms. plz check this

http://www.mayoclinic.com/health/spinal-...N=symptoms

[ArchivalUser]

PPH---> D) Observation

forever, u can get tinnitus in PPH

[ArchivalUser]

Yes, I noted, thanks for the link ghada.

Thanks Sami, Missy.

[ArchivalUser]

eee

[ArchivalUser]

Answer D