acute severe headache scenario
candidate brief
80% history taking, 20% clinical reasoning
actor brief
scenario 1
25yo headache post-exercise
Usually fit and well
10/10 severe pain within seconds
scenario 2
19yo recently started university
3/7 worsening headache, neck stiffness, feverish
Preceded by flu-like illness - cough, coryza for 2-3 days
Thought it was a migraine but now feeling feverish - thinks might be 'bad flu'
examiner brief
- Washes hands, introduces self
- Confirms patient identity
- Checks patient comfort before starting
- Elicits HPC
- Duration and onset of pain
- Nature of pain
- Asks about specific associated symptoms
- Meningitis red flags: fever, meningism
- SOL red flags: worst in the morning, vomiting, focal neurology
- SAH red flags: maximal onset within seconds, meningism
- States need to examine patient
- Appropriate management plan (see below)
- Explains differentials
- Invites questions
- Address patient concerns
- Thanks patient
- Global mark examiner
- Global mark patient
scenario 1
- suggests investigations - CT head, LP for xanthochromia
- BP control
scenario 2
- suggests investigations - bloods, LP
- states will start initial treatment - dexamethasone, IV antibiotics, IV aciclovir
- states need for admission