Headache OSCE Part 3: A 22-Year-Old Woman Presents to the Emergency Department After Waking Up With the Sudden Onset of a Severe Headache

Abstract

OPEN ACCESSDecember 2, 2013Headache OSCE Part 3: A 22-Year-Old Woman Presents to the Emergency Department After Waking Up With the Sudden Onset of a Severe Headache Diana Barratt, MD, MPH, Daniel Segui, Fauzia Nausheen Diana Barratt, MD, MPH Florida International University Herbert Wertheim College of Medicine Google Scholar More articles by this author , Daniel Segui Florida International University Google Scholar More articles by this author , Fauzia Nausheen Florida International University Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9630 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail Abstract Introduction: This 15-minute objective structured clinical exam (OSCE) requires that the examinee take a detailed headache history from a standardized patient, generate an initial differential diagnosis, request and interpret diagnostic tests, and defend the final diagnosis. Methods: This OSCE features a 22-year-old obese female presenting with headache. Her young age of onset brings into question the common primary headache disorders, including migraine and tension headache. Her obesity and fertility bring into question vision-threatening and life-threatening secondary headache disorders such as pseudotumor cerebri (idiopathic intracranial hypertension) and venous sinus thrombosis. Criteria for passing and a grading system have been established. Remediation plans are prescribed, depending on the type of error made by the examinee. Results: Forty-four medical students completed this assessment. Seventy-three percent of students passed the OSCE. Sixteen percent of students required remediation because they did not order a lumbar puncture. After writing an essay on the indications for lumbar puncture, these students received a score of 80. Eleven percent of students failed the OSCE because they misdiagnosed the patient. After writing an essay comparing and contrasting the correct diagnosis with the erroneous diagnosis, failing students received a score of 75. The scores ranged from 75–98, with a mean of 90. Normative data for each section are detailed in the Facilitator's Guide. Discussion: We recommend spending 5 additional minutes for structured feedback. This OSCE can be altered by having the patient present with signs and symptoms of potentially life-threatening neurological conditions, such as increased intracranial pressure and subarachnoid hemorrhage. Educational Objectives By the end of this objective structured clinical exam, participants will be able to: Systematically evaluate a patient with headache.Obtain a complete and reliable history.Formulate a differential diagnosis based on lesion localization, time course, and relevant historical and demographic features.Interpret abnormal findings of the neurologic examination.Use and interpret common tests used in diagnosing neurologic disease.Recognize and evaluate potentially life-threatening neurologic conditions. ReferencesGelb DJ, Gunderson CH, Henry KA, et al. The neurology clerkship core curriculum. Neurology2002;58(6):849–859.http://dx.doi.org/10.1212/WNL.58.6.849Medline, Google ScholarThe recommended curriculum guidelines for family medicine residents, Conditions of the nervous system, AAFP Reprint No. 272. Available at www.AAFP.org (online). Accessed August 23, 2013.Google ScholarAmerican Academy of Neurology, Headache and Facial Pain Section. Resident Core Curriculum. Available at: www.AAN.com (online). Accessed August 23, 2013.Google ScholarConnolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2012;43:1711–1737. http://dx.doi.org/10.1161/STR.0b013e3182587839Medline, Google ScholarHeadache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2013 Jul;33(9):629–808. http://dx.doi.org/10.1177/0333102413485658Medline, Google ScholarBarratt D, Obeso V. Headache OSCE: A 22-year old woman presents to the emergency department with a severe headache. MedEdPORTAL; 2012. Available from: www.mededportal.org/publication/9250.Google ScholarBarratt D, Obeso V, Brown A. Headache OSCE Part 2: A 22-year Old Woman Presents to the Emergency Department with the Subacute Onset of Severe Headache. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9361.Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Facilitator's Guide OSCE Part 3.pdf SP script OSCE Part 3.pdf Headache OSCE part 3.pdf Examinee Clip Board Part 3.pdf FIU.SPEVAL.pdf Blank Examinee Evaluation of OSCE Part 3.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationBarratt D, Segui D, Nausheen F. Headache OSCE Part 3: A 22-Year-Old Woman Presents to the Emergency Department After Waking Up With the Sudden Onset of a Severe Headache. MedEdPORTAL. 2013;9:9630. https://doi.org/10.15766/mep_2374-8265.9630 Related Headache OSCE: A 22-Year-Old Woman Presents to the Emergency Department With a Severe Headache Headache OSCE Part 2: A 22-Year-Old Woman Presents to the Emergency Department With the Subacute Onset of Severe Headache Headache OSCE Part 3: A 22-Year-Old Woman Presents to the Emergency Department After Waking Up With the Sudden Onset of a Severe Headache Neck Pain OSCE: A 65-Year-Old Patient Presents to the Emergency Department With Neck Pain Copyright & Permissions© 2013 Barratt et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial-Share Alike license.KeywordsSubarachnoid hemorrhageOSCEHeadacheMigraine Disclosures None to report. Funding/Support None to report. Loading ...