Reccurent Headaches in a 31-yr-old Woman

Physical Examination

  • General appearance: Woman who appears uncomfortable because of headache.

  • Vital signs:
  • Temperature: 37.6° C
  • Pulse: 104 beats/min
  • BP: 150/90 mm Hg
  • Respirations: 20/min
  • Oxygen saturation: 99% on room air

  • Skin: No pallor, rashes, or skin lesions.

  • HEENT: Neck supple, no adenopathy. Scalp nontender, no focal swelling. Conjunctiva and sclera appear normal; no hemorrhage, exudate, or papilledema in fundi. Nasal passages clear. No erythema or exudate in pharynx.

  • Pulmonary: Chest is clear to auscultation bilaterally.

  • Cardiovascular: Jugular venous pressure is normal; heart rate is tachycardic and regular with normal heart sounds. No murmurs. Well-perfused peripheries with normal pulses and no peripheral edema.

  • Gastrointestinal: Soft with mild tenderness to palpation in epigastric area; patient states that the palpation worsened her palpitations. No guarding, rigidity, or rebound. Bowel sounds are normal.

  • Genitourinary: No costovertebral angle tenderness.

  • Musculoskeletal: Unremarkable

  • Neurologic: Alert, oriented to person, place, and time, and cooperating fully with examination. Pupils equal and reactive to light and accommodation. Remainder of cranial nerve examination also normal. Strength, sensation, and deep tendon reflexes normal and symmetric throughout. Gait not tested because of discomfort, but finger-nose and heel-shin test normal. Negative Kernig and Brudzinski signs.

  • Mental status: The patient appears anxious.