Exam (elaborations)
CMN 568 Exam 5: Questions & Complete Answers
- Course
- Institution
CMN 568 Exam 5: Questions & Complete Answers
[Show more]
Content preview
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
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller LeCrae. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $14.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
81113 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now