A 21-Year-Old Woman Is Evaluated for Nausea, Vomiting, and a Severe

question 455

Multiple Choice

A 21-year-old woman is evaluated for nausea, vomiting, and a severe headache.  The patient developed a headache last night after getting out of bed and walking to the newborn nursery.  Her headache has not improved with acetaminophen or ibuprofen, and the only thing that makes it better is lying down and sleeping.  Now she has a severe headache, nausea, and vomiting whenever she gets out of bed.  The patient has had no dizziness, changes in vision, or loss of consciousness.  She had a spontaneous vaginal delivery 2 days ago after an induction of labor for gestational hypertension.  She had an epidural placed for analgesia that was removed immediately after delivery.  Temperature is 37.2 C (99 F) , blood pressure is 136/88 mm Hg, and pulse is 108/min.  The patient has neck stiffness and is unable to sit up due to severe nausea.  There is no papilledema, and the pupils are equal and reactive.  Bilateral lower extremities have pitting edema to the knees.  Deep tendon reflexes are 2+.  Which of the following is the most likely diagnosis in this patient?

• A)Bacterial meningitis
• B)Benign paroxysmal positional vertigo
• C)Migraine with aura
• D)Postdural puncture headache
• E)Preeclampsia with severe features
• F)Tension-type headache

---

Definitions:

UCC

Stands for the Uniform Commercial Code, which is a comprehensive set of laws governing commercial transactions in the United States, including sales, leases, negotiable instruments, and secured transactions.

Sufficient Funds

A term indicating that an account has enough available money to cover transactions such as withdrawals, checks, or payments.

Money Orders

Payment orders for a specified amount of money that are a secure alternative to cash or personal checks.

UCC

Refers to the Uniform Commercial Code, a set of laws governing sales and commercial transactions in the United States.