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Hollie Harrison
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… / 35 pts
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History of Presenting Complaint
Marking 6 pts of criteria...
Asks about onset, duration, and progression of headaches
Explores headache characteristics (location, quality, severity, timing, frequency)
Inquires specifically about worsening with Valsalva or in the morning
Asks about associated visual symptoms (transient visual obscurations, blurred vision, progression)
Inquires about other associated symptoms (nausea, vomiting, photophobia, phonophobia, focal neurological deficits)
Clarifies response to analgesia and use of over-the-counter medications
Past Medical, Social, and Family History
Marking 6 pts of criteria...
Asks about previous similar episodes or migraine history
Screens for risk factors: BMI/weight, sedentary lifestyle, recent weight gain
Inquires about hormonal status (e.g., recent contraceptive use, menstrual changes)
Asks about recent infections, trauma, or systemic symptoms (fever, weight loss)
Clarifies medication history including over-the-counter and recent new medications
Asks about family history of neurological or ophthalmological diseases
Focused Neurological and Ophthalmological Examination
Marking 6 pts of criteria...
Assesses visual acuity in both eyes
Performs confrontation visual field testing
Performs fundoscopy to assess for papilledema
Examines extraocular movements and cranial nerves II, III, IV, VI
Screens for focal neurological deficits (motor, sensory, coordination)
Assesses for meningeal signs (neck stiffness, photophobia)
Red Flag and Risk Factor Assessment
Marking 4 pts of criteria...
Identifies red flag features (progressive headache, visual loss, morning worsening, Valsalva aggravation)
Assesses for features of raised intracranial pressure
Screens for symptoms of mass lesion or malignancy (e.g., seizures, focal deficits, personality change)
Assesses for medication overuse contributing to headache
Differential Diagnoses and Clinical Reasoning
Marking 4 pts of criteria...
Identifies idiopathic intracranial hypertension as leading diagnosis
Considers and justifies exclusion of primary headache syndromes (migraine, tension-type)
Considers secondary causes: mass lesion, cerebral venous thrombosis, meningitis
Appropriately rules out medication overuse headache
Initial Investigations and Management Plan
Marking 5 pts of criteria...
Recommends urgent neuroimaging (MRI/CT) prior to lumbar puncture
Suggests lumbar puncture for opening pressure and CSF analysis if imaging is normal
Advises early referral to neurology and ophthalmology
Discusses lifestyle modification and weight reduction strategies
Mentions potential medical therapy (e.g., acetazolamide) if IIH confirmed
Communication and Patient-Centered Skills
Marking 4 pts of criteria...
Explains likely diagnosis and need for urgent assessment in clear, non-alarming terms
Describes rationale for investigations and referrals
Addresses patient concerns, anxieties, and expectations
Uses appropriate non-verbal cues and demonstrates empathy