Case Study 4
Sample Questions for UMLE/COMLEX
A 45-year-old male comes to his primary care physician for headaches that he has been experiencing over the past year. The headaches are usually intense (7-8/10), with no radiation during most episodes. When a headache comes on, the patient states that he is incapacitated and needs to go to a dark, quiet room and just wait till it passes. Sometimes, just prior to the onset of headaches, the patient sees flashes of light. Yesterday, while driving back to New York from Chicago with his friend, a particularly severe headache started. During this episode, the patient also began to feel numb and weak over the left side of his face. This was particularly worrisome, and prompted him to finally seek out medical help. A complete physical exam is performed. Pulse is 87. Respiratory rate is 17. Blood pressure is 136/85. There is no perceptual asymmetry to fine touch, temperature, vibration, or pain throughout the body. The sclera is anicteric. Pupils are round and equally reactive to light and accommodation. No carotid bruits are present. No wheezes are appreciated on pulmonary exam. Cardiac exam reveals no gallops or murmurs. Strength is 5/5 in bilateral upper and lower extremities. Romberg sign is negative. The patient is sent for a diffusion weighted MRI scan, which shows no abnormalities. Trans-esophageal echocardiography with bubble contrast shows some right to left shunting. Urinalysis shows trace blood, but no leukocyte esterase. Specific gravity is slightly increased.
1. Which of the following conditions is this patient most likely to be suffering from?
A. Bell’s Palsy
B. cerebrovascular accident
C. trigeminal neuralgia
D. patent foramen ovale
E. primary migraine disorder
2. What percent of individuals in the population at large are affected by this disease?
3. What intervention would be most appropriate in this clinical setting?
A. immediate IV heparin infusion
B. 5-HT1 receptor agonist
C. selective serotonin reuptake inhibitor
E. careful observation