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Kathleen Parks iHuman Case Study on Severe
Headaches: Complete 2025/2026 Guide to Ace Your
Exam and Avoid Resits practice questions and
answers with rationals (100 Q&A)
Part 1: History of Present Illness (HPI) - 25 Questions
1. Kathleen Parks is a 26-year-old graphic designer whose chief
complaint is "more frequent severe headaches." According to the
case, what is the most critical element to clarify first in her History
of Present Illness (HPI)?
A. Her dietary habits
B. The onset, frequency, and characteristics of the headaches
C. Her family history of cancer
D. Her last eye exam date
Answer: B
Rationale: The HPI must characterize the pain completely using the
OLD CARTS mnemonic. For a headache, defining the onset (new vs.
chronic), frequency (how often), and characteristics (throbbing,
pressing) is the priority to differentiate between primary and secondary
headache disorders .
2. Kathleen describes her headaches as "throbbing" and "severe."
Which of the following associated symptoms is she MOST likely to
report, according to the case history?
A. Fever and nuchal rigidity
B. Nausea, photophobia, and phonophobia
C. Unilateral weakness and numbness
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D. Tearing and nasal congestion
Answer: B
Rationale: Nausea, photophobia (sensitivity to light), and phonophobia
(sensitivity to sound) are classic migrainous features and are
documented as pertinent positives in the Kathleen Parks case. Fever and
nuchal rigidity would suggest meningitis, and unilateral weakness would
suggest a stroke or TIA .
3. The patient reports occasional visual disturbances before the
headache, such as "flashes of light or blind spots." This
phenomenon is known as:
A. Diplopia
B. A scotoma or aura
C. Blurred vision
D. Ptosis
Answer: B
Rationale: Visual auras, such as scintillating scotomas (zig-zag lines),
flashes of light (photopsia), or blind spots, are classic for migraine with
aura. They are fully reversible and typically precede the headache
phase .
4. Kathleen identifies several factors that make her headaches
worse. Which of the following is identified as a primary aggravating
factor in her case?
A. Lying down in a dark room
B. Drinking caffeinated coffee
C. Long periods of computer use
D. Eating aged cheeses
Answer: C
Rationale: As a graphic designer, Kathleen spends long hours at a
computer. This leads to eye strain, poor posture, and mental stress, all of
which are identified as triggers or aggravating factors for her headaches .
5. According to the case, what provides Kathleen with temporary
relief from her headaches?
A. Taking a hot shower and going for a walk
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B. Rest and lying down in a dark, quiet environment
C. Drinking a glass of red wine
D. Increasing her caffeine intake
Answer: B
Rationale: Rest and sensory isolation (dark, quiet environment) are
classic behaviors for migraine sufferers. This "relieving factor" is a key
diagnostic clue, as it directly counteracts the photophobia and
phonophobia .
6. Kathleen rates her headache pain as 8/10. This level of severity is
most consistent with which type of headache disorder?
A. Tension-type headache
B. Migraine
C. Medication-overuse headache
D. Sinus headache
Answer: B
Rationale: Migraines are typically classified as moderate to severe in
intensity (often 7-10/10), which is debilitating and interferes with daily
activities. Tension-type headaches are typically mild to moderate .
7. In the HPI, documenting that Kathleen has NO history of head
trauma is important because it helps to:
A. Rule out a post-concussive syndrome.
B. Confirm the diagnosis of migraine.
C. Support the need for an immediate CT scan.
D. Establish a baseline for her blood pressure.
Answer: A
Rationale: Recent or significant head trauma is a red flag for secondary
headache disorders like subdural hematoma. Its absence is a key
pertinent negative that makes a post-traumatic cause less likely .
8. The mnemonic "OLD CARTS" is used to assess a symptom. In
the context of Kathleen's pain, what does the "A" stand for?
A. Aura
B. Aggravating factors
C. Alleviating factors
, 4|Page
D. Assessment
Answer: B
Rationale: OLD CARTS stands
for Onset, Location, Duration, Characteristics, Aggravating
factors, Relieving factors, Timing, and Severity. It ensures a
comprehensive assessment of any symptom, including headaches .
9. Kathleen mentions her headaches have been happening for about
3 months but have worsened recently. This pattern of a new or
changing headache pattern is significant because it:
A. Confirms she has chronic migraines.
B. Is a "red flag" that requires investigation to rule out secondary causes.
C. Means she needs a stronger pair of glasses.
D. Indicates she is dehydrated.
Answer: B
Rationale: Any new headache or a significant change in a pre-existing
headache pattern (especially in frequency or severity) is considered a
"red flag." While it often turns out to be a primary disorder, it
necessitates a thorough workup to exclude secondary causes like a tumor
or bleed .
10. The patient reports her sleep pattern averages 5-6 hours per
night. This information is most relevant as:
A. A potential trigger for her headaches.
B. A sign of a sleep disorder unrelated to headaches.
C. A normal finding for her age.
D. An indication she needs a sleep study.
Answer: A
Rationale: Lack of sleep and irregular sleep patterns are among the
most common triggers for migraines. This lifestyle factor is a key target
for non-pharmacologic intervention .
11. Kathleen mentions skipping meals due to work demands. This is
an important piece of data because:
A. It explains her low energy levels.
B. Fasting or skipping meals is a well-known migraine trigger.
Kathleen Parks iHuman Case Study on Severe
Headaches: Complete 2025/2026 Guide to Ace Your
Exam and Avoid Resits practice questions and
answers with rationals (100 Q&A)
Part 1: History of Present Illness (HPI) - 25 Questions
1. Kathleen Parks is a 26-year-old graphic designer whose chief
complaint is "more frequent severe headaches." According to the
case, what is the most critical element to clarify first in her History
of Present Illness (HPI)?
A. Her dietary habits
B. The onset, frequency, and characteristics of the headaches
C. Her family history of cancer
D. Her last eye exam date
Answer: B
Rationale: The HPI must characterize the pain completely using the
OLD CARTS mnemonic. For a headache, defining the onset (new vs.
chronic), frequency (how often), and characteristics (throbbing,
pressing) is the priority to differentiate between primary and secondary
headache disorders .
2. Kathleen describes her headaches as "throbbing" and "severe."
Which of the following associated symptoms is she MOST likely to
report, according to the case history?
A. Fever and nuchal rigidity
B. Nausea, photophobia, and phonophobia
C. Unilateral weakness and numbness
,2|Page
D. Tearing and nasal congestion
Answer: B
Rationale: Nausea, photophobia (sensitivity to light), and phonophobia
(sensitivity to sound) are classic migrainous features and are
documented as pertinent positives in the Kathleen Parks case. Fever and
nuchal rigidity would suggest meningitis, and unilateral weakness would
suggest a stroke or TIA .
3. The patient reports occasional visual disturbances before the
headache, such as "flashes of light or blind spots." This
phenomenon is known as:
A. Diplopia
B. A scotoma or aura
C. Blurred vision
D. Ptosis
Answer: B
Rationale: Visual auras, such as scintillating scotomas (zig-zag lines),
flashes of light (photopsia), or blind spots, are classic for migraine with
aura. They are fully reversible and typically precede the headache
phase .
4. Kathleen identifies several factors that make her headaches
worse. Which of the following is identified as a primary aggravating
factor in her case?
A. Lying down in a dark room
B. Drinking caffeinated coffee
C. Long periods of computer use
D. Eating aged cheeses
Answer: C
Rationale: As a graphic designer, Kathleen spends long hours at a
computer. This leads to eye strain, poor posture, and mental stress, all of
which are identified as triggers or aggravating factors for her headaches .
5. According to the case, what provides Kathleen with temporary
relief from her headaches?
A. Taking a hot shower and going for a walk
,3|Page
B. Rest and lying down in a dark, quiet environment
C. Drinking a glass of red wine
D. Increasing her caffeine intake
Answer: B
Rationale: Rest and sensory isolation (dark, quiet environment) are
classic behaviors for migraine sufferers. This "relieving factor" is a key
diagnostic clue, as it directly counteracts the photophobia and
phonophobia .
6. Kathleen rates her headache pain as 8/10. This level of severity is
most consistent with which type of headache disorder?
A. Tension-type headache
B. Migraine
C. Medication-overuse headache
D. Sinus headache
Answer: B
Rationale: Migraines are typically classified as moderate to severe in
intensity (often 7-10/10), which is debilitating and interferes with daily
activities. Tension-type headaches are typically mild to moderate .
7. In the HPI, documenting that Kathleen has NO history of head
trauma is important because it helps to:
A. Rule out a post-concussive syndrome.
B. Confirm the diagnosis of migraine.
C. Support the need for an immediate CT scan.
D. Establish a baseline for her blood pressure.
Answer: A
Rationale: Recent or significant head trauma is a red flag for secondary
headache disorders like subdural hematoma. Its absence is a key
pertinent negative that makes a post-traumatic cause less likely .
8. The mnemonic "OLD CARTS" is used to assess a symptom. In
the context of Kathleen's pain, what does the "A" stand for?
A. Aura
B. Aggravating factors
C. Alleviating factors
, 4|Page
D. Assessment
Answer: B
Rationale: OLD CARTS stands
for Onset, Location, Duration, Characteristics, Aggravating
factors, Relieving factors, Timing, and Severity. It ensures a
comprehensive assessment of any symptom, including headaches .
9. Kathleen mentions her headaches have been happening for about
3 months but have worsened recently. This pattern of a new or
changing headache pattern is significant because it:
A. Confirms she has chronic migraines.
B. Is a "red flag" that requires investigation to rule out secondary causes.
C. Means she needs a stronger pair of glasses.
D. Indicates she is dehydrated.
Answer: B
Rationale: Any new headache or a significant change in a pre-existing
headache pattern (especially in frequency or severity) is considered a
"red flag." While it often turns out to be a primary disorder, it
necessitates a thorough workup to exclude secondary causes like a tumor
or bleed .
10. The patient reports her sleep pattern averages 5-6 hours per
night. This information is most relevant as:
A. A potential trigger for her headaches.
B. A sign of a sleep disorder unrelated to headaches.
C. A normal finding for her age.
D. An indication she needs a sleep study.
Answer: A
Rationale: Lack of sleep and irregular sleep patterns are among the
most common triggers for migraines. This lifestyle factor is a key target
for non-pharmacologic intervention .
11. Kathleen mentions skipping meals due to work demands. This is
an important piece of data because:
A. It explains her low energy levels.
B. Fasting or skipping meals is a well-known migraine trigger.
