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CMN 568- Unit 1|103 Study questions
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CMN 568- Unit 1|103 Study questions
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CMN 568- Unit 1|103 Study questionsDiminution of headache in response to typical migraine therapies (e.g. seratonin
receptor antagonists or ketorolac) does not rule out _________________ as
underlying cause? - ANSWER Subarachnoid hemorrhage or meningitis
Mcphee p 39
IMMEDIATE TREATMENT: Vascular events - ANSWER + Intracranial hemorrhage
+ Thrombosis
+ Cavernous sinus thrombosis
+ Vasculitis
+ Malignant hypertension
+ Arterial dissection
+ Aneurysm
McPhee p 39
IMMEDIATE TREATMENT: Infections - ANSWER + Abscess
+ Encephalitis
+ Meningitis
Mc Phee p 39
Causes of headache that require IMMEDIATE TREATMENT - ANSWER + Vascular
events
+ Infections
+ Intracranial masses
+ Preeclampsia
+ Carbon monoxide poisioning
McPhee p 39
"Thunderclap headache" is the classic presentation of what condition? - ANSWER
Subarachnoid hemorrhage! Should precipitate IMMEDIATE workup!
McPhee p 39
New headache in a patient > ________________ years or with
___________________ (condition) should warrant IMMEDIATE neuroimaging. -
ANSWER + > 50years
+ HIV infection
McPhee p 39
Headache patients with hx of hypertension (esp uncontrolled htn) should be
examined for other features of WHAT? - ANSWER Malignant hypertension
McPhee p 39
,Headache associated with pregnancy? - ANSWER Preeclampsia
McPhee p 39
Episodic headache associated with triad of hypertension, heart palpitations and
sweats is suggestive of __________________. - ANSWER Pheochromocytoma
McPhee p 39
Symptoms for diagnosis or ruling out migraine in the absence of "classic"
presentation (e.g. scintillating scotomoa, unilateral ha, photophobia and n/v)? -
ANSWER Symtoms: Nausea, photophobia, phonophobia and exacerbation with
physical activtiy
THREE OR MORE = MIGRAINE
< THREE = r/o MIGRAINE
McPhee p 39
Critical components of physical exam for complaint of HA? - ANSWER + Vital signs
+ Complete neuro exam
+ Vision testing (with funduscopic exam)
McPhee p 40
Kernig and Brudzinski signs are indicative of what? - ANSWER Meningeal irritation
McPhee p 40
Scalp and temporal artery tenderness should be performed on pts with HA who are >
______________ years. - ANSWER > 60
McPhee p 40
Components of visual exam for pt presenting with HA? - ANSWER + Visual acuity
(Snellen)
+ Ocular gaze (Motor test - 9 positions)
+ Visual fields (Cover test - central/periph vision)
+ Pupillary defects (Size, dilation)
+ Optic disks
+ Retinal vein pulsations
McPhee p 40
Pt with HA and *diminished visual acuity* suggests.... - ANSWER + Glaucoma
+ Temporal arteritis
+ Optic neuritis
McPhee p 40
,Pt with HA and *ophthalmoplegia or visual field defects* suggests.... - ANSWER +
Venous sinus thrombosis
+ Tumor
+ Aneurysm
McPhee p 40
Pt with HA and *hypertension, "cotton wool spots", flame hemorrhages and disk
swelling* suggests.... - ANSWER + Acute severe hypertensive retinopathy
McPhee p 40
Pt with HA and *ipsilateral ptosis and miosis* suggests.... - ANSWER Horner
syndrome AND/OR carotid artery dissection
McPhee p 40
Pt with HA and *papilledema or absent retinal venous pulsations* suggests.... -
ANSWER ↑ ICP
+ Follow with neuroimaging prior to performing lumbar puncture
McPhee p 40
ANY abnormality on neuro exam (esp mental status) of pt with HA warrants.... -
ANSWER + EMERGENT neuroimaging
McPhee p 40
Ottawa criteria for evaluation of pts presenting with acute non-traumatic headache
for signs of subarachnoid hemorrhage - ANSWER + ≥ 40 years of age
+ Neck pain/stiffness
+ Witnessed loss of consciousness
+ Onset during exertion
+ Thunderclap headache
+ Limited neck flexion on examination
McPhee p 41
What kind of early treatment of diagnosed migraine or migraine-like headache can
abort or provide significant relief of symptoms? - ANSWER + NSAIDs (e.g. ketorolac)
+ Triptans
McPhee p 41
What types of headaches may respond well to high-flow O2 therapy? - ANSWER
ALL types
McPhee p 41
, What types of headaches should be referred? - ANSWER + Frequent migraines not
responsive to std tx
+ Migraines with atypical features
+ Chronic daily ha r/t medication overuse
McPhee p 41
Primary headache syndromes? - ANSWER + Migraine
+ Tension-type headache
+ Cluster headache
McPhee p 986
Secondary causes of headache? - ANSWER Some examples:
+ Intracranial lesions
+ Head injury
+ Cervical spondylosis
+ Dental/ocular disease
+ TMJ dysfunction
+ Sinusitis
+ Hypertension
+ Depression
McPhee p 986
Common age of onset of migraines? - ANSWER Adolescence or early adult life
McPhee p 986
Symptoms of migrainous headaches - ANSWER + Usually lateral, can be
generalized
+ Usually throbbing, can be dull
+ Can be associated with anorexia, n/v, photophobia, phonophobia, osmophobia,
cognitive impairment, blurring of vision
+ Build up gradually and last ≥ 7 hours
+ Visual disturbances may precede or accompany HA
+ Triggered by emotional/physical stress, lack of/excess sleep, missed meals,
specific foods, ETOH, bright lights, loud noise, menstruation, use of oral
contraceptives
McPhee 986-7
Symptoms of basilar artery migraine - ANSWER + Blindness/visual disturbances
throughout both visual fields
+ Dysarthria
+ Dysequilibrium
+ Tinnitus
+ Perioral/distal paresthesias
+ transient loss/impairment of consciousness or confusional state.
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