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CMN 568 Unit 5 – Questions With Solutions (Graded A+)
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CMN 568 Unit 5 – Questions With Solutions (Graded A+)
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CMN 568 Unit 5 – Questions With Solutions (Graded A+)Essentials for diagnosis for acute HA? Right Ans - older than 40, rapid onset
and SEVERE intensity, "thunderclap", fever, vision changes, neck stiffness, HIV
infection, current or past hx HTN, neuro findings
Just because imaging is normal for HA does not exclude what possible dx?
Right Ans - SAH
what are the 3 critical components of exam for HA? Right Ans - vital signs,
neuro exam, vision testing with funduscopic exam
when doing visual exam for HAs, what is crucial to assess for vision? Right
Ans - visual acuity, ocular gaze, visual fields, pupillary defects, optic disc and
retinal vein pulsations.
If you find any abnormality on neuro exam for HA then what? Right Ans -
emergency neuroimaging
what is the criteria for the OTTAWA SAH clinical decision rule? Right Ans -
40 or older, neck pain/stiffness, witnessed LOC, onset during exertion,
thunderclap HA, limited neck flexion (on exam)
what medications are avoided as 1st line for HA? Right Ans -
morphine/hydromorphine
what are the characteristics of migraines? Right Ans - pulsatile HA lasts 4-
72 hours, unilateral, aggravated by routine physical activity, photophobia,
phonophobia, common for no aura with HA
To avoid over use of medications for HA, what is the recommendation for
limited analgesics? Right Ans - less than 15 days/month, combo analgesics
to less then 10 days/month
who can not take Ergotamines for migraines? Right Ans - pregnant, CV
disease or RF, pts taking CYP3A4 inhibitors
what is the most common primary HA disorder? Right Ans - tension-type
HA
, how are tension type HA described? Right Ans - vise-like or tight, not
pulsatile, not associated with focal neuro symptoms.
what medication do you NOT give to tension type HAs? Right Ans - triptans
First line tx of cluster HAs? Right Ans - sumatriptan sub-q/intranasal or
inhaled 100% o2 via 12-15 L/min non-rebreather for 15 mins
what medications lead to overuse headache if taken more than 10 days per
month? Right Ans - ergotamines, triptans, meds with butalbital, and
opioids.
what medications can lead to overuse HA if taken more than 15 days per
month? Right Ans - acetaminophen, acetylsalicyclic acid, and NSAIDs
what diagnostic imaging should be done on all primary cough HA and why?
Right Ans - CT or MRI due to possible intracranial lesions, brain tumors.
what is used for tx in primary cough HA? Right Ans - indomethacin
what is the key feature of HA due to intracranial mass? Right Ans - new or
worsening HA in middle or later life.
what is the essentials to dx trigeminal neuralgia? Right Ans - brief episodes
of stabbing facial pain, pain in territory of the 2nd and 3rd division of
trigeminal nerve, pain worse with touch
what is first line tx of trigeminal neuralgia? Right Ans - oxcarbazepine or
carbamazepine but monitor serial blood counts and liver biochemical tests
what hx aids in dx of postherpetic neuralgia? Right Ans - hx of shingles and
presence of cutaneous scarring from shingles.
what is primary prevention for postherpetic neuralgia? Right Ans -
recombinant zoster vaccine to pts over 50
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