Flashcards in Final Exam -- Randomized Cards Part 2 Deck (151):
Comparing angina and myocardial infarction, which is relieved by rest and/or nitroglycerin and is usually of short duration?
What is the treatment for a viral sinus headache?
Observation, NSAIDs, saline irrigation, degongestants.
Over the counter acute therapy for migraines involves NSAIDs or acetominophen, or Excedrin (combination of acetominophen, caffeine, and aspirin). True or false: a large single dose is more e
Headache is the initial complaint in 20% of patients with what condition?
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the S stand for?
Systemic symptoms--fever, weight loss, cancer, immunocompromised, pregnant
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most commonly diagnosed?
What type of migraine subtype is associated with unilateral weakness during the headache?
Prevention of migraines can be done with a calcium channel blocker like _________ .
What are some of the symptoms in a patient with a brain tumor?
N&V, seizures, focal weakness, headache, changes in personality, visual changes.
Retinal migraine (aka ocular or ophthalmic migraine*) is thought to involve which arteries?
Central retinal and ophthalmic
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do infrequent/episodic headaches occur?
Less than 1 day per month on average
What do you do for a patient that is experiencing angina or a myocardial infarction?
Call 911 and administer a single chewed 325 mg dose of aspirin (and 0.4 mg sublingual nitroglycerin if the patient uses it for angina). Monitor their vitals.
How would you treat a mild to moderate acute migraine?
NSAIDs or acetominophen
Which migraine subtype involves the brainstem or bilateral occipital hemispheres?
Migraine with brainstem aura (aka basilar migraine)
What are some of the symptoms of anaphylaxis?
Shakiness, nervousness/anxiety, sweating, chills, clamminess, irritability or impatience, rapid heartbeat, lightheadedness/dizziness, hunger and nausea, sleepiness, headaches, weakness or fatigue, lack of coordination.
True or false: with basilar migraine, it is possible for a patient to have weakness
False; there should be no evidence of weakness.
How would you treat giant cell arteritis?
IV methylprednisolon if vision loss is present, and oral prednisone, and low dose aspirin.
Trigeminal autonomic cephalgias are thought to be due to abnormal hypothalamus and trigeminal activity.
Comparing angina and myocardial infarction, which is not relieved by rest or nitroglycerin and can last hours?
Trigeminal neuralgia episodes last how long? Which branches of the trigeminal nerve are most commonly affected?
Episodes last a few seconds to 2 minutes*; V2 and/or V3 are most commonly affected*
True or false: when using triptans to treat an acute migraine, they should be taken early on, but not more than 3 times per week*
What drug can be used to treat trigeminal neuralgia?
What are some of the acute treatment options for cluster headaches?
100% oxygen therapy, subcutaneous or nasal sumatriptan
True or false: a retinal migraine is associated with a severe headache and can lead to permanent vision loss.
False; it can indeed lead to permanent vision loss, but the associated headach is mild*
To be diagnosed as migraine with aura, the aura symptom(s) must be fully reversible. Two of what four characteristics must be present?
At least one aura symptoms spreading gradually over more than 5 minutes (and/or two or more symptoms occurring in succession); individual aura symptoms last 5 to 60 minutes; at least one aura symptom is unilateral; aura accompanied by or followed within 60 minutes by a headache
Comparing migraine with aura to migraine without aura, which requires at least two attacks for diagnosis?
Migraine with aura
What are the most common primary intracranial tumors?
Meningiomas, gliomas, pituitary adenomas
If a patient experiences syncope, what would be a few reasons to call 911?
Irregular heartbeat, chest pain or SOB, more than one episode a month, no response to ammonia inhalant, or if the fainting occurred due to head turning.
What is the treatment for an anaphylactic shock?
Administer subcutaneous epinephrine, call 911, give them benadryl if they can swallow it. Also have them lie flat, raise feet about 12 inches, and cover with a blanket to prevent shock.
Triptans are used to treat acute migraines and are agonists of __________.
What type of headache is commonly misdiagnosed as due to sinusitis?
True or false: thunderclap headaches recur regularly and can be unilateral or bilateral.
False; they can indeed be unilateral or bilateral, but they do NOT recur regularly.
Comparing tension headaches to migraines, which does worsen with exercise?
What are some of the symptoms of a cardiovascular accident or a transient ischemic attack?
Sudden onset of: Numbness or weakness or face/arm/leg, especially on one side of bodyConfusion, trouble speaking or understandingTrouble seeing or blurred vision in one or both eyesTrouble walking, dizziness, loss of balance or coordinationSevere headache with no cause
What are the risk factors for postherpetic neuralgia?
Older age, severity of initial rash and pain, and immunocompromised
What is the treatment for a bacterial sinus headache?
The diagnostic criteria for a migraine without aura includes the headache lasting how long?
4 to 72 hours
What are some of the early signs of diabetic ketoacidosis?
Thirst or dry mouth, frequent urination, high blood glucose, high level of ketones in urine.
Migraines are associated with depletion of which endogenous substances? With excess of which substance?
Depletion of serotonin and estrogen; excess dopamine.
What do you do if your patient is experiencing diabetic ketoacidosis?
Measure their blood glucose, administer insulin, and keep them hydrated (and correct the electrolyte disturbances), and call 911 or take them to the hospital.
What are some of the signs of anaphylaxis?
Skin reaction, hives, flushed or pale skin, feeling of warmth, sensation of a lump in the throat, constriction of airways, swollen tongue or throat, weak and rapid pulse, N&V, dizziness or fainting, reduced blood pressure.
What is the chronic treatment for SUNCT?
Lamotrigine, occipital nerve stimulation
Your patient has experienced a seizure. What do you do after the seizure?
Lay them on their side to keep the airway clear (Recovery Position) and make sure they are still breathing.
Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is less effective and should be limited in use to 9 days/month and limited to 2 doses/day?
Which headaches discussed in class are more common in men?
True or false: the cortical spreading depression theory (CSD) states that nociceptor threshold is increased, and the magnitude of their response is increased as well.
False; the threshold is decreased (easier to feel pain), and the magnitude is increased
Your patient is experiencing a seizure. What do you do during the seizure?
Move dangerous items away from the individuals, but don't try to hold them down or put anything in their mouth. Record the length of the seizure.
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is there must be at least two of which four characteristics?
Bilateral*Pressing/tightning* (nonpulsating)Mild/moderate intensity*Not aggravated by routine physical activity*
How would you treat an extremely severe acute migraine?
Subcutaneous sumatriptan, IV/I antiemetic with diphenhydramine or dihydroergotamine, IV/IM ketorolac or dexamethasone
True or false: narcotics and opioids are good treatment options for acute migraines.
False; they are not recommended.
What visual symptom occurs with a retinal migraine, and how long does it typically last?
Monocular scotoma or blindness*Lasts from minutes to less than an hour
The pain of postherpetic neuralgia is ___________ (unilateral/bilateral), sharp/stabbing, and affects which branch(es) of the trigeminal nerve?
Avoiding triggers of migraines, getting regular sleep, regular meals, and regular exercise, and keeping a headache diary can all help with migraine management. What two other options were listed in lecture?
Acupuncture and transcutaneous electric nerve stimulation (TENS)
Comparing angina and myocardial infarction, which involves a completely stoppage of blood flow to the heart?
The motor aura that occurs in hemiplegic migraines contrasts with the aura of basilar migraines in that the hemiplegic migraine auras last how long?
1 to 24 hours
Besides triptan treatment for acute migraines, you can use a triptan/NSAID combo, or dihydroergotamine.
The headaches that occur in recurrent painful ophthalmoplegic neuropathy can develop up to how many weeks prior to the eye muscle weakness? Does the eye muscle weakness ever resolve?
2 weeks; the muscle weakness does recover completely between attacks.
One possible cause for hypoglycemia is if the patient skips a meal. What level of blood sugar may indicate hypoglycemia?
Less than 70 mg/dL
The most common type of aura is visual. It occurs over 5 minutes and may be a zig-zag pattern or a shimmering scintillating appearance. It may be a C-shape and will leavea a central scotoma
Comparing tension headaches to migraines, which is not typically associated with nausea or vomiting?
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which can switch sides?
Diabetic ketoacidosis is when the body does not produce enough glucose, so it breaks down fat, with ketones as a byproduct. What level of blood sugar would indicate to check the patient's urine for ketones?
Over 240 mg/dL
What are some of the urgent signs of diabetic ketoacidosis?
Constant fatigue, dry or flushed skin, N&V or abdominal pain, difficulty breathing, fruity odor on breath, confusion or difficulty paying attention.
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do chronic headaches occur?
More than 15 days per month on average
Basilar migraines need two or more of what symptoms for diagnosis? (FYI: these symptoms last 5-60 minutes)
DysarthriaVertigo/difficulty walkingTinnitus and/or hearing impairmentDiplopiaBilateral visual symptoms*Bilateral paresthesiaDecreased consciousness
What is the treatment for postherpetic neuralgia?
Amitriptyline or gabapentin. Capsaicin may help (decreases substance P)
True or false: Prevention of migraines can be done with beta agonists.
False; it can be done with beta blockers.
What is the cause of postherpetic neuralgia?
Herpes zoster virus
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the N stand for?
Neurologic symptoms--confusion, impaired consciousness, bilateral optic disc swelling, seizures
Which headaches discussed in class are typically in younger patients (under age 50)?
Migraines (30-39)*Basilar migraines (7-20)Hemiplegic migraines (12-17)Retinal migraines (under 40)Recurrent painful ophthalmoplegic neuropathyCluster headaches (27-37)Paroxysmal hemicranias (34-41)SUNCT (48)Sinus headache is from 45-75.
BP above _______________ is considered an emergency.
What are some of the chronic treatment options for cluster headaches?
Verapamil or prednisolone with taper
Which headaches discussed in class are more common in women?
Migraines*Trigeminal neuralgia*Paroxysmal hemicranias*Tension-typeBasilar migrainesHemiplegic migrainesRetinal migrainesSinus headachesGCA headache
What are the symptoms of a giant cell arteritis headache?
New headache, scalp tenderness, jaw claudication, sudden vision loss in one eye.
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What does the P stand for?
Previous headache with history of progression--change in frequency, duration, intensity
Cluster headache attacks typically occur 1-3 times daily. How quickly do they onset, and how long do they typically last?
Onset is rapid (5 minutes)*, and duration is between 15 minutes to 3 hours
True or false: 50% of patients with a myocardial infarction will die within the first two hours.
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What is a normal CRP level?
Less than 1 mg/dL (or less than 10 mg/L)
Which drug for migraines is preferred for anti-emesis?
There were three types of migraine headaches discussed in class: without aura, with aura, and aura without headache (acephalgic). Which of these is the most common type?
Migraine without aura.
Loss of consciousness with syncope lasts about how long?
A prodrome to a migraine occurs between 24-48 hours prior to the headache and involves what types of findings?
Depression, irritability, food cravings, neck stiffness, yawning, fatigue, difficulty concentrating, aversion to light, sounds, smells.
Besides SNOOP, what are the two headache danger signs mentioned in class?
"First or worst" headache*, headaches not reponding to treatment
Which triptan is available as a patch?
Tension headaches are divided into infrequent/episodic, frequent, and chronic. On average, how often do frequent headaches occur?
Between 1-14 days per month on average
There are lots of possible triggers for migraines. Which three were bolded on the list in class?
Emotional stress, hormones in women, not eating/hunger.
What is the most common autonomic finding of SUNCT?
Conjunctival injection and lacrimation.
What surgical options are available for trigeminal neuralgia?
Microvascular decompression (move the artery or vein away from the nerve), or lesion the trigeminal nerve.
Migraine headaches affect activities of daily living, are ___________ (unilateral/bilateral) and typically occur how many times per month?
Unilateral, 1-4 times per month or less.
Chronic daily headaches (aka "chronic migraines") are characterized by headaches occurring at least _____ days per month for at least _______ months.
At least 15 days/month for at least 3 months*
True or false: tension-type headaches are the most common type of headache worldwide.
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is there must be no nausea or vomiting* AND no more than one of photophobia or phonophobia*.
There should be a chain of command established in case of an emergency in your office. Who should be the coordinator?
The doctor (you)
Comparing cluster headaches and paroxysmal hemicranias, one of them can switch sides between attacks and the other always affects the same side. Which always affects the same side?
Comparing angina and myocardial infarction, which involves a decreased (but not completely stopped) blood flow to the heart?
Prevention of migraines can be done with antidepressants like _________ and __________.
Amitriptyline and venlafaxine
____________________ is the perception of pain due to normally non-painful stimuli and can occur with a migraine.
Which headaches discussed in class are typically in older patients (over age 50)?
Trigeminal neuralgia*GCA headache (72)*Postherpetic neuralgia ("older age")Sinus headache is from 45-75
True or false: ketoacidosis is more common in type II diabetes than type I.
False; it is more common in type I, and when the patient has missed a dose of insulin.
True or false: when asked to localize the pain, a patient with a basilar migraine will point to their entire forehead, just above the eyes.
False; they will more likely point to the back of their head (occipital area).
There are a few different types of syncope: vasovagal, orthostatic, cardiovascular, and cerebrovascular. Which is the second most common?
True or false: the pain of a brain tumor headache comes and goes, is deep and dull, and is worse in the evening.
False; the pain is constant* and is worse upon waking. (But yes, the pain is deep and dull.)
When would a seizure indicate that you call 911?
If it lasts more than 5 minutes, if the patient stops breathing, if there are multiple seizures in a short period of time, if the patient is injured from the seizure, or if this is their first seizure. Also if any of the following are involved: diabetes, drain infection, heat exhaustion, poisoning, high fever, head injury, or pregnancy.
Nearly 90% of headaches fall into one of these categories: migraine, tension-type, chronic daily, and cluster. Which of these types of the most frequent?
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. CSD is also said to activate trigeminal
Calcitonin gene-related peptide (CGRP)*, substance P, neurokinin A
How would you treat a moderate to severe acute migraine?
Triptans or a combination of triptans and NSAIDs
If a person has experienced a thunderclap headache, you must use CT* and lumbar puncture to rule out what possible underlying causes?
Subarachnoid hemorrhage or ruptured aneurysm.
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. The last criteria is that the headache is not better accounted for by another diagnosis.
True or false: patients with cluster headaches act restless and agitated.
What is the acute treatment for SUNCT?
Sinus headaches are considered acute under _____ weeks, and chronic if more than _____ weeks.
Acute: less than 4 weeks; chronic: more than 12 weeks
What are some of the triggers for cluster headaches?
Alcohol, smoking, hypoxia
There are a few stages to syncope: prodromal, loss of consciousness, and post-syncopal. Name a few of the features of the prodromal stage.
Pale skin, lightheadedness, tunnel vision, nausea, feeling of warmth, cold clammy sweat, and blurred vision.
Prophylaxis of tension headaches is done through stress avoidance. Use of which antidepressant can also be considered?
Tension-type headaches are ___________ (bilateral/unilateral) and ___________ (throbbing/non-throbbing).
Are sinus headaches typically unilateral or bilateral?
Recurrent painful ophthalmoplegic neuropathy is characterized by paralysis of the ocular cranial nerves and ipsilateral headache*. Which cranial nerve is most often affected?
Paroxysmal hemicranias last 2-30 minutes and typically occur 11-14 times/day. What feature is required to confirm diagnosis?
Resolution in 1-2 days with indomethacin* confirms diagnosis
True or false: the typical migraine headache lasts less than a day, is uilateral and involves a throbbing or pulsatile pain.
Mostly true--the duration can be anywhere from 4 hours to several days (so not "typically" less than a day)
Where do the most common metastatic tumors arise from?
Lung cancer, breast cancer
Typically avoid beta blockers and triptans in basilar, hemiplegic, and retinal migraines.
Cluster headaches can occur like clockwork* and are common during ________ (sleep/waking).
Cluster headaches feature excruciating unilateral orbital or temporal pain, accompanied by autonomic symptoms. Its overall prevalence is less than 1%. What percetage of patients experience autonomic symptoms? What sorts of autonomic symptoms are they?
97%*; parasympathetic symptoms such as lacrimation, injection, ptosis, miosis, etc.
What are some of the symptoms of seizures?
Blackout followed by confusion, drooling/frothing at the mouth, loss of bladder/bowel control, teeth clenching, muscle spasms, unusual smells/tastes/feelings, etc.
What do you do if your patient experiences a stroke?
Call 911 and mark the time the stroke started. A tissue plasminogen activator should be administered within no more than 4.5 hours (but only for an ischemic stroke).
What do you do if your patient has some of the symptoms of hypoglycemia?
Ask if they skipped a meal and do glucometry. Give them some juice or soda, or a lollipop. If they're unconscious, call 911 and apply something sugary (syrup, honey) to the oral mucosa.
Headache danger signs are symptoms which may indicate a serious underlying cause of the headache. These can be remembered by the acronym SNOOP. What do the O's stand for?
Onset is new (especially if over age 40*); Other associated features--head trauma, drug use, pain worse with posture changes
The cortical spreading depression (CSD) theory of migraine pathophysiology states that aura are caused by a wave of excitation in parts of the brain. The permeability of the blood-brain-barr
COX-2, TNF-alpha, MMPs
Thunderclap headaches reach maximal intensity even faster than cluster headaches, in a few seconds to less than a minute. How long do thunderclap headaches last?
At least 5 minutes, up to 10 days.
What can you do if a patient faints in your chair?
Position them in a supine position and elevate their legs, and administer an ammonia inhalant.
Tension headaches are divided into infrequent/episodic, frequent, and chronic. Which is most common?
If a patient has a danger sign for a headache, imaging should be done, and typically an MRI is preferred over a CT (though CT is preferred in emergencies). Lumbar puncture should be performe
Comparing tension headaches to migraines, which does not worsen with exercise?
For acute therapy, treatment should start within how long of the onset of the migraine symptoms?
Comparing migraine with aura to migraine without aura, which requires at least five attacks for diagnosis?
Migraine without aura.
The diagnostic criteria for a migraine without aura includes a headache with at least two of which characteristics?
Unilateral location, pulsating quality, moderate or severe pain, aggravation caused by routine physical activity (or headache causing avoidance or routine physical activity).
What are the signs and symptoms of a sinus headache?
Nasal congestion*Purulent nasal discharge*Tooth painFacial painPressure worse when bending over
Prevention of migraines can be done with anticonvulsants like valproate (also used for ________ seizures), lamotrigine (also used for __________), and topiramate (which has what side effects?).
Valproate: general seizures; lamotrigine: focal seizures; topiramate: causes angle closure and myopic shift
Comparing tension headaches to migraines, which is typically associated with nausea or vomiting?
What is the most common cause of sinus headaches?
True or false: the unilateral weakness of hemiplegic migraines can switch sides during an attack.
What is the most common trigger for a tension headache?
Testing for giant cell arteritis includes a temporal artery biopsy, ESR, and CRP levels. What ESR level may indicate GCA? How would you calculate ESR for a patient?
ESR over 50 mm/h may indicate GCA; for males, ESR = (age in years)/2; for females it's (age in years+10)/2
There should be a chain of command established in case of an emergency in your office. Who should be the usher for EMS?
The least medically trained staff member
Trigeminal neuralgia involves extreme pain. Does it occur bilaterally or unilaterally?
In order to diagnose a tension headache, there must be at least 10 episodes of headaches fulfilling four other criteria. One of them is that the headache must last how long?
30 minutes to seven days
True or false: hypotension is a risk factor for trigeminal neuralgia.
False; hypertension is a risk factor for trigeminal neuralgia. (Thought to be due to compression on the nerve by an artery or a vein.)
Treatment for tension headaches can include analgesics (ibuprofen, naproxen, aspirin) and acetaminophen. Which of these (analgesics vs acetaminophen) is more effective and should be limited to 15 days/month?
Short-lasting unilateral neuralgiform headaches with conjunctival injection and tearing (SUNCT) last anywhere between 1 to 240 seconds. How often do they occur per day, on average?
60/day, though can be up to 200/day.
There are a few different types of syncope: vasovagal, orthostatic, cardiovascular, and cerebrovascular. Which is the most common and due to emotional stress