SP Cases 4 Debrief Part 2

All right So uh we will get back to where

we were which was the headache case.

The differential diagnosis and meningitis who we're talking about.

Risk factors from meningitis which include um splenectomy, sickle cell

disease, I.

V. Drug use malignancy.

And so in this case in this case this patient

patient does have a diffuse severe headache.

The patient does have fota phobia and phone a phobia.

But there's no rash.

There's no Patika.

Um There is a long history of six months of

this headache and uh it comes and goes so meningitis

is less likely at least a acute bacterial meningitis.

And so you know could a other type of meningitis

a syphilis syphilitic meningitis or lyme disease or something That's

possible. But not your it's not going to be your

acute permanent bacterial meningitis.

All right.

So before we end, just some sample questions on this

headache case.

So let's say um which of the following diagnosis would

be would you most likely rule out based on the

clinical scenario and physical exam?

Migraine headache, tension, headaches, subarachnoid hemorrhage and cluster headache.

Give you a moment to think about that.

Mhm. And the answer is subarachnoid hemorrhage.

Okay. And so we're doing rule outs based on physical

exam. So subarachnoid hemorrhage patient usually has often will have

some sort of altered mental status or localizing, finding some

sort of neurological deficit um headache case which of the

following helps to rule out a brain tumor.

The patient reports nausea, the patient reports over the counter

meds did not help the headache.

The patient has a normal neuro exam.

The patient's headaches are worsening.

I know we didn't talk about brain tumors but this

is just an example of how to do rule addicts

and rule out questions.

So I'll give you a moment to think about that

and the answer the patient has a normal neurological exam.

So again, oftentimes patients with brain tumors can, tumors can

have nausea, 70 space occupying lesions because some pressure in

the brain, so it can have nausea um uh pain

meds and may or may not help.

And the headaches as the lesions grow are going to

get worse and worse.

And as there is a lesion brain, a space occupying

area, the neuro exam is less likely to be normal

and they're likely to have some sort of neuro deficits.

All right, so that's the end of the sp cases.

Debrief video review and good luck with your quiz.

SP Cases 4 Debrief Part 2

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