A 32-Year-Old Woman with a History of Migraine Headaches Comes

question 202

Multiple Choice

A 32-year-old woman with a history of migraine headaches comes to the emergency department with severe left-sided headache and nausea that started 3 hours ago.  Earlier in the morning she had blurry vision and saw halos around lights.  She took ibuprofen an hour ago but vomited shortly afterward.
Her vital signs are within normal limits.  The patient feels uncomfortable when her eyes are examined with a flashlight.  The pupils are equal and reactive.  Muscle strength and tone are normal and deep-tendon reflexes are symmetrical.  She is treated with intravenous metoclopramide.  One hour later, she complains of neck pain.  Physical examination shows sustained contraction of the posterior neck muscles associated with neck extension and tenderness.
What is the best next step in management of this patient?

• A)Intramuscular haloperidol
• B)Intravenous diphenhydramine
• C)Lumbar puncture
• D)Noncontrast CT of the head
• E)Subcutaneous sumatriptan

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Definitions:

Natural Ecosystems

Biological communities interacting with their physical environment in a way that has not been significantly altered by human activity, maintaining natural processes and biodiversity.

Self-Maintenance

The ability of an organism, system, or machine to maintain or repair itself without external assistance.

Self-Renewal

The process by which living organisms and cells maintain their population by continuously dividing and reproducing, preserving tissue integrity and function.