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CMN 568 Exam 5: Questions & Complete Answers
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CMN 568 Exam 5: Questions & Complete Answers
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CMN 568 Exam 5: Questions & Complete AnswersOTTAWA SAH Clinical Decision Rule: Right Ans - -100% sensitivity in
predicting subarachnoid hemorrhage; pt. seeking care in ED c/o acute
nontraumatic headache should be evaluated for SAH if they have one or more
of the following:
- 40yearsorolder
- Neckpain/stiffnes
- Witnessed LOC
- Onset during exertion
- Thunder clap headache(instantly peakingpain)
- Limited neck flexion(on exam)
Ipsilateral ptosis + miosis Right Ans - Horner synfrom + HA = carotid artery
dissection
Papilledema or absent retinal venous pulsations Right Ans - Elevated ICP --
> F/U with neuro imaging before LP
HA + HTN + retinal cotton wool spots, flame hemorrhages, and disc swelling
Right Ans - Acute severe hypertensive retinopathy
Older than 60 yrs old + HA Right Ans - Examine for scalp or temporal
artery tenderness
Fever + Acute HA Right Ans - Meningeal inflamamtion (Kernig / Brudzinski
sign); abssence of jolt accentuation of HA cannot accurately rule out
meningitis --> needs LP
Diagnostic imaging for Acute Headache Right Ans - Non-contrast CT of the
head --> sufficient to exclude ICH + intracranial masses (exceptions:
lymphoma, toxoplasmosis in HIV+, herpes simplex encephalitis, brain abscess)
5th most common reason for ED visits Right Ans - Acute headache
Treatment for migraines Right Ans - Acute:
NSAIDS (PO, nasal, IM toradol), metoclopramide, dihydroergotamine, triptants
(PO, nasal, SubQ)
PO 5-HT1F receptor agonist (Lasmiditan) --> currently in clinical trials
,AVOID morphine / hydromorphone as 1st line therapy
Chronic / new daily persistent HA (unresponsive to other therapy):
Subanesthetic ketamine infusion
Treatment of headaches in the elderly Right Ans - Peripheral nerve blocks
Non-pharmacologic treatment of migraine / cluster HA Right Ans -
Noninvasive vagus nerve stimulation
Treatment for refractory migraine + pregnancy Right Ans - Peripheral
nerve blocks
1st line treatment for cluster headaches Right Ans - Sumatriptan: SQ,
intranasal or inhaled (w/100% O2 via 12-15L/min non-rebreather x 15 min)
Analgesic rebound headache Right Ans - Ergotamines, triptans,
medications containing butalbital, and opioids: lead to medication overuse
headache when taken more than 10 days per month
Acetaminophen, acetylsalicyclic acid, and NSAIDS: may also be offenders if
taken more than 15 days per month
Psudotumor cerebri Right Ans - Idiopathic intracranial hypertension
Prophylactic medications for cluster headache Right Ans - Lithium: titrate
accordign to serum levels
Verapamil: routine ECG to monitor PR interval
Topiramate
Delay for these meds to take effect, use transitional therapy until effective -->
- Prednisone: 60mg x 5 days --> gradual withdrawal over 7-10 days. Effective
in 70-80% of patients
- Ergotamine tartrate: rectal suppository, PO, SubQ injection
Posttraumatic headache treatment Right Ans - Responds to simple
analgesics
, What type of headache is worse when lying down? Right Ans - HA due to
intracranial mass
Headache d/t intracranial mass Right Ans - Obtain CT / MRI
- Worse when lying down
- Awakens the patient at night
- Peak in the morning after overnight recumbency
S/S:
- Fever
- Night sweats
- Weight loss
- Immunocompromise
Hx of malignancy
REFER when:
- Thunderclap onset
- increasing headache unresponsive to simple measures
- Hx of trauma, HTN, fever, visual changes
- Presence of neuro signs or scalp tenderness
Most commonly organism in UTI in children Right Ans - E.coli
Off-label prescribing Right Ans - The term refers to the use of mediation for
a diagnosis, age group, or biological condition (such as pregnancy) that is not
an officially approved use of that medication, as determined by the relevant
regulatory body in the country
T/F: Off-label prescribing in most settings is common, legal, and may be
reasonable and necessary in several scenarios Right Ans - True
Which of the following is consistent with a tension headache?
a. Affects middle aged Caucasian men
b. Associated with neurological deficits
c. Maybe exacerbated by stress Right Ans - c. Maybe exacerbated by stress
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