USMLE (CS:) Should I order (workup) CBC, lytes, even a CT on standard tension and migraine HA?

theWUbear

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The CS First Aid book says order CBC Electrolytes ESR CT head LP as examples of studies for a tension headache. Imagine a world where we scanned and did an LP on every tension headache presenting to their family practice physican lol.

Is it the right thing to do on CS to say "today you present with what you state is your normal level of pain for your headache, which i believe is due to a migraine. This is a clinical diagnosis and does not warrant bloodwork or imaging studies. Let's see how you do with chlorpromazine to help with your nausea and propranolol daily to ward off further attacks. You may also be having a tension headache; we can try advil if the above does not help."
 
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Ismet

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You don't get to write out an assessment and plan on CS, and you do not prescribe anything.

You have boxes to list your differential and boxes to list the tests you plan to get.

FA definitely goes overboard with the tests they suggest, but for CS you tend to be more liberal with your differentials and tests. Don't go overboard and order a ton of tests that are super extraneous, but hey if you choose to include brain mass on your differential then go get that head CT.
 

cbrons

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You don't get to write out an assessment and plan on CS, and you do not prescribe anything.

You have boxes to list your differential and boxes to list the tests you plan to get.

FA definitely goes overboard with the tests they suggest, but for CS you tend to be more liberal with your differentials and tests. Don't go overboard and order a ton of tests that are super extraneous, but hey if you choose to include brain mass on your differential then go get that head CT.
MRI*

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cbrons

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Maybe he has a pacemaker ;)

Though you would do a CT head first for an acute HA, then move on to MRI to evaluate for other things if necessary.
Not many peeps come to outpatient care w SAH complaining of band-like head pain that is 5/10.

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Ismet

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Not many peeps come to outpatient care w SAH complaining of band-like head pain that is 5/10.

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You also see ED patients in CS. And yes, imaging is a stretch if this is the presenting scenario. But depending on what else is going on in the vignette, imaging would be justifiable for CS. In real life, you'd likely do nothing. I had a case in my CS that I wasn't too excited about doing much if any workup, but you're not going to leave your workup empty. If you have any inkling that something worth working up could be going on, then order the test.