Doctor: Nurse, did you get the documents from the patient?
Guest_clinician: I did. Here is her full history and notes from her physical examination. She also completed the patient questionnaire before arriving. You can review that. 
Doctor: Thank you, Nurse. What is she here for today?
Guest_clinician: She came in for a consultation because she's been experiencing difficult headaches, tunnel vision, and dizziness. 
Doctor: Sounds good. Was there anything else? 
Guest_clinician: Oh, yeah. These are the results from her tests. She brought them so you could refer to them. 
Doctor: Thank you, Nurse. I'll go see her now. 
Patient: Hello Doctor. I've been waiting a long time. I'm getting impatient as I get older. 
Doctor: What? You don't look old at all, ma'am. 
Patient: Oh, wow. That's a nice compliment for a sixty year old lady. 
Doctor: How can I help you today?
Patient: I have these super bad headaches. Help me, please. 
Doctor: When did they start?
Patient: I had them since I was twenty five years old. 
Doctor: Oh, wow. That long? Did you get them every day since then?
Patient: Not every day. That's crazy. I did get them more when my husband died in nineteen ninety six. I was heartbroken. 
Doctor: I'm sorry to hear that. How did the headaches feel? 
Patient: It felt like a drum in my head. 
Doctor: I haven't heard that description before. Would you say it was pulsating? 
Patient: Something like that. Yes. 
Doctor: Did you take any medication? 
Patient: Lots of it. My son wrote it on a paper so that I could give you the names. Here you go. 
Doctor: I see you were given papaverine. Did that help? 
Patient: They did. My headaches would vanish. 
Doctor: How long did you take it for? 
Patient: I think six months. My headaches stopped for a while, but they came back in two thousand and four. 
Doctor: How often would you say you get headaches now? 
Patient: I think more than before. Like one to two per week. I also get some dizziness too. It says for two hours. 
Doctor: Do you take the papaverine when you feel it? 
Patient: I do. My headaches vanish after thirty minutes of taking it.  
Doctor: I see. Did you ever experience any problems with your vision too? 
Patient: Yes. A lot. There were zig zag lines coming out of nowhere. I thought I was going to die. 
Doctor: Oh, wow. I will do a test right now to check your vision. 
Patient: Will you use a bright pen? 
Doctor: I will. Does it give you any discomfort? 
Patient: The bright light hurts my eyes. 
Doctor: I see. I'll only do it to the side then. Just look forward for me, please. 
Patient: Thank you. 
Doctor: Are you able to see the light? 
Patient: What light? 
Doctor: It looks like you have trouble seeing things in your peripheral vision. The discomfort you experience with bright lights is also called photophobia. 
Patient: That sounds scary. Will I be fine? 
Doctor: Yeah. You don't have to worry. Are you experiencing any dizziness or lightheadedness right now? 
Patient: Now that you mentioned it, I am. 
Doctor: Have you ever fainted before? 
Patient: I think one time. My son was there to help. 
Doctor: That's good to hear. I'll write down that you experienced a syncope. Did you take any medication for this?
Patient: I took some Russian medicine.
Doctor: Oh, wow. Are you from Russia? 
Patient: No. I'm from Ukraine. 
Doctor: That's wonderful. How did the medicine help? 
Patient: It helped me a lot.

Clinical note:
Symptoms: Difficult headaches, tunnel vision, dizziness
Diagnosis: Headaches since age 25, worsened after husband's death in 1996, pulsating headaches, photophobia, dizziness, occasional syncope
History of Patient: Experienced headaches since age 25, worsened after husband's death, treated with papaverine initially, recurrence of headaches in 2004, headaches occur once to twice per week, last for two hours, relieved by papaverine within 30 minutes, experienced zig-zag lines in vision, peripheral vision problems, photophobia, occasional syncope, treated with Russian medication
Plan of Action: Perform vision test, monitor Symptoms, consider further evaluation and treatment options based on examination and test results