Shadow Health HEENT Tina Jones Exam
ACTUAL EXAM 2026/2027 | Complete
Exam-Style Questions | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: HISTORY OF PRESENT ILLNESS – HEADACHES (Questions 1-15)
Q1. During the HEENT interview, Tina Jones states: "The headache is like a band around my forehead. It's
throbbing, you know? I've had these since I was a kid. They happen maybe four or five times a month and
last like four to six hours. Lying down in a dark room helps sometimes." The student documents in the
HPI: "Patient reports frontal, throbbing headaches since childhood occurring 4-5 times per month lasting
4-6 hours, relieved by lying in a dark room." This documentation is:
A. Correct – captures location, quality, onset, frequency, duration, and relieving factor [CORRECT]
B. Incorrect – missing pain severity rating (e.g., 6/10)
C. Incorrect – "throbbing" is an interpretation, not an exact patient quote
D. Incorrect – missing associated symptoms (nausea, photophobia)
Correct Answer: A
Rationale: This documentation correctly synthesizes Tina's statements using professional paraphrase.
Shadow Health does not require verbatim quotes for all HPI elements; location (frontal), quality
(throbbing – directly stated by patient), onset (since childhood), frequency (4-5/month), duration (4-6
hours), and relieving factor (dark room) are all captured. Option B – severity was not documented but
was not asked; its absence does not make this entry incorrect. Option C incorrectly claims "throbbing" is
interpretation – Tina used that exact word. Option D – patient did not mention nausea or photophobia
in this statement; those would be documented elsewhere.
Q2. (Select All That Apply) Tina Jones reports that her headaches are sometimes triggered by which of
the following factors? (Based on Shadow Health case data)
,A. Stress [CORRECT]
B. Lack of sleep [CORRECT]
C. Caffeine withdrawal
D. Menstrual cycle [CORRECT]
E. Certain foods (aged cheese, chocolate)
F. Menopause
Correct Answer: A, B, D
Rationale: According to the Tina Jones Shadow Health case, she explicitly identifies stress, lack of sleep,
and her menstrual cycle as headache triggers. Caffeine withdrawal (common migraine trigger) is not
mentioned by Tina. Certain foods are a known trigger but Tina denies food triggers. Menopause is not
applicable (Tina is premenopausal).
Q3. Tina Jones reports she takes ibuprofen 400mg for her headaches. Which of the following is a
potential concern regarding her medication use?
A. Ibuprofen is not effective for migraines
B. She may be at risk for medication-overuse headache (MOH) [CORRECT]
C. Ibuprofen interacts with her albuterol inhaler
D. She should be taking acetaminophen instead due to asthma
Correct Answer: B
Rationale: Tina's headache frequency (4-5 per month) does not yet meet diagnostic threshold for MOH
(≥10-15 days/month), but ibuprofen taken on those days carries theoretical risk if frequency increases.
Option A is false – NSAIDs are first-line for mild-moderate migraine. Option C is false – no significant
interaction between ibuprofen and albuterol. Option D is false – asthma is not a contraindication to
ibuprofen.
Q4. The student asks Tina: "Does the pain get worse when you're stressed?" Tina responds: "Yeah,
sometimes." Shadow Health would mark this interview technique as:
A. Correct – the patient confirmed the association
B. Incorrect – the student used a leading question [CORRECT]
,C. Incorrect – the student should have asked about all triggers at once
D. Incorrect – stress is not a relevant trigger for headaches
Correct Answer: B
Rationale: Shadow Health specifically penalizes leading questions in the feedback. The student
suggested "stressed" rather than asking an open-ended question such as "What makes the pain better
or worse?" or "Are there any triggers you've noticed?" This compromises data validity because the
patient may have agreed due to suggestion rather than true association. Even though stress IS a trigger
for Tina, the interview technique is flawed.
Q5. Tina states: "I'd say the pain is about a 6 out of 10 when it's at its worst." The student documents:
"Patient rates headache severity 6/10 at peak intensity." Which OLDCARTS element does this
documentation capture?
A. Onset
B. Location
C. Severity [CORRECT]
D. Timing
Correct Answer: C
Rationale: The 0-10 pain rating scale documents the Severity element of OLDCARTS. This is a critical
component for headache assessment as it helps triage urgency and track treatment response. Option A
(Onset) would document when headaches began. Option B (Location) would document where the pain
is felt. Option D (Timing) would document when during the day or month headaches occur.
Q6. (Select All That Apply) Which headache red flags (SNOOP mnemonic) are present in Tina Jones's
presentation?
A. Systemic symptoms (fever, weight loss, cancer history)
B. Neurologic deficit (weakness, numbness, confusion)
C. Onset sudden (thunderclap headache)
D. Older than 40 with new onset headache
E. Pattern change (progressive worsening)
, F. None of the above [CORRECT]
Correct Answer: F
Rationale: Tina Jones does NOT present with any SNOOP red flags. She has chronic recurrent headaches
since childhood (not new onset), no systemic symptoms, no neurologic deficits, no thunderclap onset,
and no progressive pattern change. Her presentation is consistent with primary headache disorder
(likely migraine or tension-type). The absence of red flags is reassuring and supports outpatient
management.
Q7. The student asks: "Do you ever feel sick to your stomach with the headaches?" Tina responds: "No, I
don't get nauseous or anything like that." The student documents: "Patient denies nausea, vomiting, or
photophobia associated with headaches." This documentation is:
A. Correct – captures pertinent negatives [CORRECT]
B. Incorrect – should only document positive findings
C. Incorrect – photophobia was not specifically asked about
D. Incorrect – "denies" is judgmental language
Correct Answer: A
Rationale: Documenting pertinent negatives (nausea, vomiting, photophobia) is essential for differential
diagnosis. These symptoms help distinguish migraine (often with nausea/photophobia) from tension-
type headache. Option B is incorrect – Shadow Health expects documentation of both positives and
negatives. Option C is partially true but does not make the documentation incorrect; the student
inferred photophobia as a related symptom. Option D is incorrect – "denies" is standard medical
terminology.
Q8. Which of the following is the MOST LIKELY primary headache diagnosis for Tina Jones based on her
presentation?
A. Migraine without aura [CORRECT]
B. Tension-type headache
C. Cluster headache
D. Sinus headache
Correct Answer: A
ACTUAL EXAM 2026/2027 | Complete
Exam-Style Questions | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: HISTORY OF PRESENT ILLNESS – HEADACHES (Questions 1-15)
Q1. During the HEENT interview, Tina Jones states: "The headache is like a band around my forehead. It's
throbbing, you know? I've had these since I was a kid. They happen maybe four or five times a month and
last like four to six hours. Lying down in a dark room helps sometimes." The student documents in the
HPI: "Patient reports frontal, throbbing headaches since childhood occurring 4-5 times per month lasting
4-6 hours, relieved by lying in a dark room." This documentation is:
A. Correct – captures location, quality, onset, frequency, duration, and relieving factor [CORRECT]
B. Incorrect – missing pain severity rating (e.g., 6/10)
C. Incorrect – "throbbing" is an interpretation, not an exact patient quote
D. Incorrect – missing associated symptoms (nausea, photophobia)
Correct Answer: A
Rationale: This documentation correctly synthesizes Tina's statements using professional paraphrase.
Shadow Health does not require verbatim quotes for all HPI elements; location (frontal), quality
(throbbing – directly stated by patient), onset (since childhood), frequency (4-5/month), duration (4-6
hours), and relieving factor (dark room) are all captured. Option B – severity was not documented but
was not asked; its absence does not make this entry incorrect. Option C incorrectly claims "throbbing" is
interpretation – Tina used that exact word. Option D – patient did not mention nausea or photophobia
in this statement; those would be documented elsewhere.
Q2. (Select All That Apply) Tina Jones reports that her headaches are sometimes triggered by which of
the following factors? (Based on Shadow Health case data)
,A. Stress [CORRECT]
B. Lack of sleep [CORRECT]
C. Caffeine withdrawal
D. Menstrual cycle [CORRECT]
E. Certain foods (aged cheese, chocolate)
F. Menopause
Correct Answer: A, B, D
Rationale: According to the Tina Jones Shadow Health case, she explicitly identifies stress, lack of sleep,
and her menstrual cycle as headache triggers. Caffeine withdrawal (common migraine trigger) is not
mentioned by Tina. Certain foods are a known trigger but Tina denies food triggers. Menopause is not
applicable (Tina is premenopausal).
Q3. Tina Jones reports she takes ibuprofen 400mg for her headaches. Which of the following is a
potential concern regarding her medication use?
A. Ibuprofen is not effective for migraines
B. She may be at risk for medication-overuse headache (MOH) [CORRECT]
C. Ibuprofen interacts with her albuterol inhaler
D. She should be taking acetaminophen instead due to asthma
Correct Answer: B
Rationale: Tina's headache frequency (4-5 per month) does not yet meet diagnostic threshold for MOH
(≥10-15 days/month), but ibuprofen taken on those days carries theoretical risk if frequency increases.
Option A is false – NSAIDs are first-line for mild-moderate migraine. Option C is false – no significant
interaction between ibuprofen and albuterol. Option D is false – asthma is not a contraindication to
ibuprofen.
Q4. The student asks Tina: "Does the pain get worse when you're stressed?" Tina responds: "Yeah,
sometimes." Shadow Health would mark this interview technique as:
A. Correct – the patient confirmed the association
B. Incorrect – the student used a leading question [CORRECT]
,C. Incorrect – the student should have asked about all triggers at once
D. Incorrect – stress is not a relevant trigger for headaches
Correct Answer: B
Rationale: Shadow Health specifically penalizes leading questions in the feedback. The student
suggested "stressed" rather than asking an open-ended question such as "What makes the pain better
or worse?" or "Are there any triggers you've noticed?" This compromises data validity because the
patient may have agreed due to suggestion rather than true association. Even though stress IS a trigger
for Tina, the interview technique is flawed.
Q5. Tina states: "I'd say the pain is about a 6 out of 10 when it's at its worst." The student documents:
"Patient rates headache severity 6/10 at peak intensity." Which OLDCARTS element does this
documentation capture?
A. Onset
B. Location
C. Severity [CORRECT]
D. Timing
Correct Answer: C
Rationale: The 0-10 pain rating scale documents the Severity element of OLDCARTS. This is a critical
component for headache assessment as it helps triage urgency and track treatment response. Option A
(Onset) would document when headaches began. Option B (Location) would document where the pain
is felt. Option D (Timing) would document when during the day or month headaches occur.
Q6. (Select All That Apply) Which headache red flags (SNOOP mnemonic) are present in Tina Jones's
presentation?
A. Systemic symptoms (fever, weight loss, cancer history)
B. Neurologic deficit (weakness, numbness, confusion)
C. Onset sudden (thunderclap headache)
D. Older than 40 with new onset headache
E. Pattern change (progressive worsening)
, F. None of the above [CORRECT]
Correct Answer: F
Rationale: Tina Jones does NOT present with any SNOOP red flags. She has chronic recurrent headaches
since childhood (not new onset), no systemic symptoms, no neurologic deficits, no thunderclap onset,
and no progressive pattern change. Her presentation is consistent with primary headache disorder
(likely migraine or tension-type). The absence of red flags is reassuring and supports outpatient
management.
Q7. The student asks: "Do you ever feel sick to your stomach with the headaches?" Tina responds: "No, I
don't get nauseous or anything like that." The student documents: "Patient denies nausea, vomiting, or
photophobia associated with headaches." This documentation is:
A. Correct – captures pertinent negatives [CORRECT]
B. Incorrect – should only document positive findings
C. Incorrect – photophobia was not specifically asked about
D. Incorrect – "denies" is judgmental language
Correct Answer: A
Rationale: Documenting pertinent negatives (nausea, vomiting, photophobia) is essential for differential
diagnosis. These symptoms help distinguish migraine (often with nausea/photophobia) from tension-
type headache. Option B is incorrect – Shadow Health expects documentation of both positives and
negatives. Option C is partially true but does not make the documentation incorrect; the student
inferred photophobia as a related symptom. Option D is incorrect – "denies" is standard medical
terminology.
Q8. Which of the following is the MOST LIKELY primary headache diagnosis for Tina Jones based on her
presentation?
A. Migraine without aura [CORRECT]
B. Tension-type headache
C. Cluster headache
D. Sinus headache
Correct Answer: A
