Labour: post-dural puncture headache: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Labour: post-dural puncture headache

Sample item

A woman 2 days after a caesarean under spinal anaesthesia has a severe frontal and occipital headache that is worse on standing and relieved when lying flat, with neck stiffness and photophobia but no fever. Conservative measures including fluids and caffeine have failed. What is the next treatment?

AEpidural blood patchBIntravenous antibiotics for meningitisCLumbar punctureDOpioid analgesia and discharge

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Epidural blood patch

A postural headache after dural puncture results from CSF leakage and intracranial hypotension. The first-line treatment is conservative with hydration, simple analgesia and caffeine, and an epidural blood patch is the definitive treatment for persistent or severe cases, with a high success rate. The absence of fever and the postural nature argue against meningitis.

Option by option

A. Epidural blood patch (correct)
Correct. An epidural blood patch seals the leak when conservative measures fail.
B. Intravenous antibiotics for meningitis
The absence of fever and the postural pattern do not suggest meningitis.
C. Lumbar puncture
A further lumbar puncture would worsen the leak.
D. Opioid analgesia and discharge
Opioids do not treat the cause and discharge without treatment is inappropriate.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Epidural blood patch. A postural headache after dural puncture results from CSF leakage and intracranial hypotension.

Why is "Intravenous antibiotics for meningitis" not the answer?

The absence of fever and the postural pattern do not suggest meningitis.

Why is "Lumbar puncture" not the answer?

A further lumbar puncture would worsen the leak.

Why is "Opioid analgesia and discharge" not the answer?

Opioids do not treat the cause and discharge without treatment is inappropriate.

What concept does this question test?

It tests Labour: post-dural puncture headache in OBG. The first-line treatment is conservative with hydration, simple analgesia and caffeine, and an epidural blood patch is the definitive treatment for persistent or severe cases, with a high success rate. The absence of fever and the postural nature argue against meningitis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Labour: post-dural puncture headache?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.