An 18-Year-Old Woman Comes to the Physician Complaining of Headaches

question 210

Multiple Choice

An 18-year-old woman comes to the physician complaining of headaches for the past 3 months.  She says that the headaches occur almost daily, are holo-cranial, and have a pulsatile quality.  They are especially bothersome at night.  She has no photophobia, phonophobia, nausea, vomiting, fever, or neck stiffness.  The patient has no other medical problems and takes no medications.
Her blood pressure is 144/90 mm Hg and pulse is 77/min.  Her BMI is 34 kg/m².  Visual field examination is unremarkable.  Cranial nerves are intact.  Muscle strength is normal and the deep-tendon reflexes are symmetric.  Romberg's test and urine pregnancy test are negative.
Magnetic resonance imaging and magnetic resonance venography of the head reveal an empty sella but no other significant abnormalities.
Which of the following is the best next step in managing this patient?

• A)Lumbar puncture
• B)Morning serum cortisol
• C)Oral sumatriptan
• D)Serum 17-hydroxyprogesterone
• E)Thyroid function tests

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Definitions:

Human Syntax

The set of principles and processes that govern the structure of sentences in human language.

Semantics

The study of meaning in language, including the analysis of the meanings of words, phrases, sentences, and texts.

William Stern

A psychologist known for his work in intelligence testing and the development of the intelligence quotient (IQ) measurement.

Twin Study

A research method used to study the genetic and environmental influences on traits by comparing the similarity between monozygotic (identical) and dizygotic (fraternal) twins.