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First Aid: Step 2 CS > Differential & Work-up: Headache, Loss of Vision > Flashcards

Differential & Work-up: Headache, Loss of Vision Flashcards

1
Q

21 yo F presents with several episodes of throbbing left temporal pain that last for 2 to 3 hours. Before onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Her headaches are often associated with nausea and vomiting and she feels bothered by light.She has a family history ofmigraine.

A
  1. Hemiplegic Migraine (Migraine w/ Motor Aura)
  2. Tension Headache
  3. Cluster Headache
  4. TIA
  5. Partial Seizures
  6. Pseudomotor Cerebri
  7. CNS vasculitis
  8. Focal Seizure (OccipitoParietal)
  9. Intracranial neoplasm
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2
Q

26 yo M presents with severe right temporal headaches associated with ipsilateral rhinorrhea, eye tearing, and redness. Episodes have occurred at the same time every night for the past week and last for 45minutes.

A
  1. Cluster Headache
  2. Migraine
  3. Trigeminal Neuralgia
  4. Intracranial neoplasm
  5. Tension Headache
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3
Q

WORK UP FOR:

  1. Hemiplegic Migraine (Migraine w/ Motor Aura)
  2. Tension Headache
  3. Cluster Headache
  4. TIA
  5. Partial Seizures
  6. Pseudomotor Cerebri
  7. CNS vasculitis
  8. Focal Seizure (OccipitoParietal)
  9. Intracranial neoplasm
A
  1. MRI-Brain
  2. CT-Head
  3. CBC
  4. ESR
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4
Q

WORK UP FOR:

  1. Cluster Headache
  2. Migraine
  3. Trigeminal Neuralgia
  4. Intracranial neoplasm
  5. Tension Headache
A
  1. MRI-brain
  2. CT-head
  3. CBC
  4. ESR
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5
Q

65 yo F presents with a new-onset severe, intermittent right temporal headache, fever, blurred vision in her right eye, weight loss, and pain in her jaw when chewing. She has a history of shoulder stiffness. On examination she has right temporal tenderness to palpation and reduced right eye visual acuity.

A
  1. Temporal arteritis (giant cell arteritis)
  2. Vasculitis
  3. Migraine
  4. Cerebral abscess
  5. Cluster headache
  6. Tension headache
  7. Meningitis
  8. Carotid artery dissection
  9. Pseudotumor cerebri
  10. Trigeminal neuralgia
  11. Intracranial neoplasm
  12. Temporomandibular joint (TMJ) disorder
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6
Q

WORK UP FOR:

  1. Temporal arteritis (giant cell arteritis)
  2. Vasculitis
  3. Migraine
  4. Cerebral abscess
  5. Cluster headache
  6. Tension headache
  7. Meningitis
  8. Carotid artery dissection
  9. Pseudotumor cerebri
  10. Trigeminal neuralgia
  11. Intracranial neoplasm
  12. Temporomandibular joint (TMJ) disorder
A
  1. Temporal artery biopsy
  2. ESR
  3. CRP
  4. CBC
  5. Doppler U/S-carotid
  6. MRI-brain
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7
Q

30 yo F presents with 1 week of frontal headache, fever, and nasal discharge, the headache worsens when she bends forward. There is pain on palpation of the frontal and maxillary sinuses. She has a history of allergies.

A
  1. Acute sinusitis
  2. Migraine
  3. Tension headache
  4. Cerebral abscess
  5. Meningitis
  6. Intracranial neoplasm
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8
Q

WORK UP FOR:

  1. Acute sinusitis
  2. Migraine
  3. Tension headache
  4. Cerebral abscess
  5. Meningitis
  6. Intracranial neoplasm
A
  1. CBC
  2. XR-sinus
  3. CT-sinus
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9
Q

50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3 to 4 times a week, typically toward the end of her workday. She is experiencing significant stress in her life and recently decreased her intake of caffeine. Neurological examination is normaL

A
  1. Tension headache
  2. Migraine
  3. Caffeine or analgesic withdrawal
  4. Depression
  5. Intracranial neoplasm
  6. Cluster headache
  7. Pseudotumor cerebri
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10
Q

WORK UP FOR:

  1. Tension headache
  2. Migraine
  3. Caffeine or analgesic withdrawal
  4. Depression
  5. Intracranial neoplasm
  6. Cluster headache
  7. Pseudotumor cerebri
A
  1. CBC
  2. Electrolytes
  3. ESR
  4. MRI-brain
  5. LP-CSF analysis
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11
Q

35 yo M presents with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity.

A
  1. Subarachnoid hemorrhage
  2. Meningitis/ encephalitis
  3. Intracranial hemorrhage
  4. Vertebral artery dissection
  5. Intracranial venous thrombosis
  6. Migraine
  7. Hypertensive encephalopathy
  8. Intracranial neoplasm
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12
Q

WORK UP FOR:

  1. Subarachnoid hemorrhage
  2. Meningitis/ encephalitis
  3. Intracranial hemorrhage
  4. Vertebral artery dissection
  5. Intracranial venous thrombosis
  6. Migraine
  7. Hypertensive encephalopathy
  8. Intracranial neoplasm
A
  1. CT -head w/out contrast
  2. LP-opening pressure w/ CSF analysis
  3. CBC
  4. PT/PTT/INR
  5. Urine toxicology
  6. Digital subtraction angiography (DSA)
  7. MRI-brain
  8. CT -angiography
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13
Q

25 yo M army recruit presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity.

A
  1. Meningitis
  2. Subarachnoid hemorrhage
  3. Encephalitis
  4. Sinusitis
  5. Migraine
  6. Intracranial or epidural abscess
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14
Q

WORK UP FOR:

  1. Meningitis
  2. Subarachnoid hemorrhage
  3. Encephalitis
  4. Sinusitis
  5. Migraine
  6. Intracranial or epidural abscess
A
  1. LP-CSF analysis (cell count, protein, glucose, Gram stain, PCR for specific pathogens, culture)
  2. Blood culture
  3. CBC
  4. CT-head
  5. MRI-brain
  6. PT/PTT/INR
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15
Q

18 yo obese F presents with a daily pulsatile headache, vomiting. and blurred vision for the past 2 to 3 weeks. She is taking OCPs.

A
  1. Pseudotumo cerebri
  2. Migraine
  3. Tension headache
  4. Intracranial venous thrombosis
  5. Intracranial neoplasm
  6. Cluster headache
  7. Meningitis
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16
Q

WORK UP FOR:

  1. Pseudotumor cerebri
  2. Migraine
  3. Tension headache
  4. Intracranial venous thrombosis
  5. Intracranial neoplasm
  6. Cluster headache
  7. Meningitis
A
  1. Urine hCG
  2. LP-opening pressure & CSF analysis
  3. Dilated fundoscopy examination
  4. Funduscopic eye exam
  5. MRI-brain
  6. Visual field testing
17
Q

57 yo M c/o daily pain in the right cheek for the past month. The pain is electric and stabbing in character and occurs while he is shaving. Each episode lasts 1 to 2 minutes.

A
  1. Trigeminal neuralgia
  2. Tension headache
  3. Migraine
  4. Cluster headache
  5. TMJ disorder
  6. Temporal arteritis
  7. Intracranial neoplasm
18
Q

WORK UP FOR:

  1. Trigeminal neuralgia
  2. Tension headache
  3. Migraine
  4. Cluster headache
  5. TMJ disorder
  6. Temporal arteritis
  7. Intracranial neoplasm
A
  1. MRI-brain
  2. CBC
  3. ESR
19
Q

73 yo M presents with acute loss of vision in his left eye, palpitations, and shortness of breath. He has a history of atrial fibrillation and cataracts in his right eye. He has no eye pain, discharge, redness, or photophobia. He has not experienced headache, weakness, or numbness.

A
  1. Retinal artery occlusion
  2. Retinal vein occlusion
  3. Acute angle closure glaucoma
  4. Retinal detachment
  5. Temporal arteritis (giant cell arteritis)
20
Q

WORK-UP FOR:

  1. Retinal artery occlusion
  2. Retinal vein occlusion
  3. Acute angle closure glaucoma
  4. Retinal detachment
  5. Temporal arteritis (giant cell arteritis)
A
  1. Fluorescein angiogram
  2. Echocardiography
  3. Doppler U/S-carotid
  4. Intraocular tonometry
  5. ESR,CRP
  6. Temporal artery biopsy
  7. CBC

First Aid: Step 2 CS (23 decks)

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