These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a headache case in the USMLE Step 2 CS exam:
BLUE SHEET HEADACHE:
HEADACHE MNEMONIC:
AT&T WIRELESS (ATNT WIRELESS): Sometimes the AT&T service gives us headaches, right?.
A: Aura (warning signs).
T: Time of the day.
N: Nausea/Vomiting.
T: Tearing/Visual changes
W: Weakness/numbness.
I: Injury to the head.
R: Runny nose during pain
E: Estrogen OCP use.
L: Limb-muscle pain (PMR)
E: Energy level
S: Stress
S: Speech problems
PHYSICAL EXAMINATION
1. HEENT:
Inspection head and face
Palpation of the head and face, and temporomandibular joint.
Palpation of the sinuses
Fundoscopy
Inspection of the mouth and throat
Neck:
Inspection
Auscultation for bruits, lymphadenopathy.
2. Lungs:
Auscultation
3. Heart:
Auscultation
Neuro:
Mental status: A/O x 3, backward spelling and 3 object recall.
Cranial nerves.
Motor: Strength.
DRT’s.
Sensory.
POSSIBLE DIAGNOSTIC STUDIES:
- CBC.
- Lumbar puncture with CSF analysis.
- CT of the head.
- MRI of the brain.
- CT of the sinuses.
- ESR.
DIFFERENTIAL DIAGNOSIS:
- Tension headache.
- Migraine.
- Cluster headaches.
- Meningitis.
- Encephalitis.
- Intracranial tumors.
- Subarachnoid hemorrhage.
- Trigeminal neuralgia.
- Temporomandibular joint disorder.
- Pseudotumor cerebri or Idiopathic intracranial hypertension.
- Giant cell arteritis.
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