06-22-2007, 08:27 AM
A 57-year-old man comes to the emergency department because of a severe headache. The
headache came on suddenly as he was leaving the light show at the planetarium. He also has right eye
pain and nausea and he vomited twice during the car ride over to the hospital. He has no significant
past medical history. He has had other headaches in the past, but has never experienced anything like
this. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 75/min, and
respirations are 18/min. Physical examination shows a tender red right eye with a partially dilated pupil,
but is otherwise unremarkable. The most appropriate next step is to
A. administer glucocorticoids, intravenously
B. administer sumatriptan, intramuscularly
C. give him oxygen therapy, 100% for 15 minutes
D. measure intraocular pressure
E. order a CT scan of the head
F. order an erythrocyte sedimentation rate
G. perform a lumbar puncture
headache came on suddenly as he was leaving the light show at the planetarium. He also has right eye
pain and nausea and he vomited twice during the car ride over to the hospital. He has no significant
past medical history. He has had other headaches in the past, but has never experienced anything like
this. His temperature is 36.7 C (98.0 F), blood pressure is 130/90 mm Hg, pulse is 75/min, and
respirations are 18/min. Physical examination shows a tender red right eye with a partially dilated pupil,
but is otherwise unremarkable. The most appropriate next step is to
A. administer glucocorticoids, intravenously
B. administer sumatriptan, intramuscularly
C. give him oxygen therapy, 100% for 15 minutes
D. measure intraocular pressure
E. order a CT scan of the head
F. order an erythrocyte sedimentation rate
G. perform a lumbar puncture