18 Scenarios contain the text: 'headache' |
| Title | Description |
|---|---|
| Child or adolescent with a headache | A mother brings her 8 year old NZ European/Chinese boy to their GP because of headache. This has been present for 4 months and is particularly severe when he gets home from school. He is unable to describe the character of the pain and experiences them most days. He is missing at least 2 days of school each week. He has no other systemic symptoms. D/O: General Practice (•••), Paediatrics (•••), Psychiatry/Health Psychology (•••) PTT: Mental health |
| Daytime sleepiness | A 40 year old truck driver who weighs 160kg presents after a minor road traffic crash. He ran into the car in front of him while waiting at traffic lights; he thinks he 'nodded off'. He experiences morning headaches and reports excessive daytime sleepiness. His blood pressure is 180/105 mmHg. D/O: Respiratory Medicine (•••), Respiratory System (•••), Cardiology (•), Cardiovascular System (•) PTT: Respiratory |
| Fever and headache | A 17 year old NZ European man presents with a severe headache and a fever. He was well yesterday and played football after school. On examination he is sleepy, febrile, tachycardic and has neck stiffness. D/O: Infectious Diseases (•••), Microbiology (•••), Intensive Care Medicine (••), Paediatrics (••), Nervous System (•), Neurology (•) PTT: Infectious disease, Seriously ill patient |
| Head trauma | A 26 year old NZ European male presents to the Emergency Department having received a head-high tackle in a rugby game one hour previously. He was knocked out at the scene and now has ongoing headache. He is repetitively questioning and has a reduced level of consciousness. He has no other injuries. D/O: Emergency Medicine (•••), Nervous System (•••), Neurosurgery (•••) PTT: Seriously ill patient |
| Headache | A 50 year old NZ European woman presents to her GP with frontal headaches for three months. When her headache is at its worst her vision seems blurred. There have been no other neurological symptoms. She is a married factory worker who is facing redundancy. D/O: General Practice (•••), Neurology (•••), Nervous System (••), Otorhinolaryngology (•) PTT: Neurological |
| Headache, morning stiffness and shoulder pain | A 70 year old NZ European woman sees her GP with a 6 week history of aching and morning stiffness in the shoulders, hip girdle and neck. This has slowly worsened and in the last 2 days she has developed a severe headache with scalp tenderness. Her body mass index (BMI) is calculated and is 18. You organise an erythrocyte sedimentation rate (ESR) and the result is 66 mm in 1 hour (normal 0-30). D/O: Musculoskeletal System (•••), Rheumatology (•••), Anatomical Pathology (••) PTT: Musculoskeletal |
| Medically unexplained physical symptoms | While on your Medicine attachment you are asked to see a 28 year old NZ European woman who is suffering from chest pains. She is in the Radiology Department undergoing an X-ray when you come to see her on the ward so you decide to review her electronic patient record. You are shocked to find she has a huge number of presentations with visits to multiple outpatient clinics and many discharge summaries from different hospitals. You also have time to review her blood tests and ECG which are all unremarkable. When she has returned from her X-ray you go to speak with her. She explains that she is constantly unwell and no one has been able to correctly diagnose her. She says the problems have been present for years and can present in a variety of different ways; she has presented with abdominal pain, dyspepsia, pelvic pain and headaches. Things definitely got worse when she lost her job 3 years ago. D/O: General Practice (•••), Psychiatry/Health Psychology (•••) PTT: Mental health |
| Polycythaemia | A 54 year old man presents to his GP with headache and lethargy for 2 months. He is overweight with a body mass index (BMI) of 32, and has been smoking a packet of cigarettes each day for the last 20 years. No abnormalities are detected on neurological examination but on examination of the abdomen you can tip the edge of the spleen on deep inspiration. A full blood count shows an elevated haemoglobin of 203 g/L and elevated haematocrit of 0.61. The WBC is normal but platelets are elevated at 603 x 109/L. D/O: Haematology (•••), Respiratory Medicine (•) PTT: Blood and lymph, Respiratory |
| Pupil abnormality | A 72yr female longsighted teacher presents with a 2 day history of headache and blurred vision. She reports the pain starting in the evening while watching TV and subsequently worsening with right eye blurring, nausea and vomiting. On examination she has a hazy right cornea and mid-dilated pupil that has minimal reaction to light. D/O: Ophthalmology (•••), General Practice (••) PTT: Eyes |
| Sudden loss of vision and headache | An 83 year old NZ European woman presented with a 1 month history of new onset headache, jaw claudication and one day history of sudden loss of vision in the left eye. On examination, she was noted to have reduced vision in the left eye of count fingers only, a left relative afferent papillary defect, constricted visual fields on confrontation testing and a pale swollen left optic nerve. She underwent a temporal artery biopsy which revealed significant inflammation. D/O: General Practice (•••), Ophthalmology (•••), Rheumatology (••) PTT: Eyes |
| Sudden onset severe headache | A 45 year old NZ European woman presents to the Emergency Department with the worst headache of her life. She was sitting at home watching the television and the headache came 'out of the blue'. She is now in the resuscitation room and finds the light very uncomfortable. Her blood pressure is noted to be 180/120 mmHg. D/O: Emergency Medicine (•••), Nervous System (•••), Neurosurgery (•••) PTT: Neurological |
| Diplopia | A 66 year old Māori woman presents with intermittent double vision which has been gradual in onset, but steadily worsening and has now become constant. She had cataract surgery 2 years ago with good vision in each eye postoperatively and she has had reasonably controlled type 2 diabetes for 10 years. D/O: Neurology (•••), Ophthalmology (•••), Endocrinology (••) PTT: Eyes |
| Space occupying lesion / progressive unilateral weakness | A 48 year old Māori man presents with progressive left sided weakness. His partner tells you that he has been increasingly difficult to live with over the last few months with inability to make decisions and is becoming increasingly forgetful. D/O: Nervous System (•••), Neurology (•••), Neurosurgery (•••), Anatomical Pathology (••), Oncology (••), Infectious Diseases (•) PTT: Neurological |
| Chronic bowel motility problems | A 35 year old South African man presents to his GP with alternating loose stools and constipation. He has not lost any weight but finds his symptoms distressing, because they have been present for a few months. D/O: Digestive System (•••), Gastroenterology & Hepatology (•••), General Surgery (•••), Oncology (•) PTT: Digestive |
| Late pregnancy complications | A 34 year old Korean woman on the antenatal ward is 33 weeks pregnant, in her second pregnancy. The midwife calls you because she has developed abdominal pain and feels unwell. D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••), Paediatrics (•) PTT: Women's health |
| Risk assessment in early pregnancy | A 38 year old NZ European woman presents to her GP as she has not had a period for 7 weeks. She has a positive pregnancy test at the clinic. When you examine her, you note a blood pressure of 135/85 mmHg and a body mass index (BMI) of 34. D/O: Obstetrics & Gynaecology (•••), Reproduction & Development (•••) PTT: Women's health |
| Secondary hypertension | A 35 year old NZ European woman visits her GP as she wants to start the oral contraceptive pill. You are asked to take her blood pressure and it is 180/105 mmHg. The GP looks back through her records and notes that her blood pressure was as high as this last time she came for an insurance medical. D/O: Endocrinology (•••), General Practice (••), Renal Medicine (••), Obstetrics & Gynaecology (•) PTT: Homeostasis |
| Stable angina | You are on your GP placement and you are asked to see a 69 year old Tongan man who has a background of hypertension. He complains of chest pain when he walks and comments that it is particularly bad when he walks up hills or stairs. It gets better when he rests. You note that he is obese. D/O: Cardiology (•••), Cardiovascular System (•••) PTT: Cardiovascular |
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