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NVS > Headache > Flashcards

Headache Flashcards

1
Q

Which of the following is the most common cause of primary headache?

A. TTH
B. Migraine
C. Idiopathic stabbing
D. Exertional headache
E. Cluster headache
A

A. TTH - 69%

Migraine - 16%
Idiopathic stabbing - 2%
Exertional - 1%
Cluster - 0.1%

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2
Q

Which of the following is the most common cause of secondary headache?

A. Systemic infection
B. Head injury
C. Vascular disorders
D. Subarachnoid hemorrhage
E. Brain tumor
A

A. Systemic infection - 63%

Head injury - 4%
Vascular disorders - 1%
Subarachnoid hemorrhage - <1%
Brain tumor - 0.1%

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3
Q

Which of the following is associated with upper respiratory tract infections?

A. TTH
B. Migraine
C. Viral infections
D. Idiopathic stabbing
E. Hypothalamic activation
A

C. Viral infections - example of systemic infection

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4
Q

Which of the following accounts for pain stimulation?

A. Central proprioceptors
B. Peripheral nociceptors
C. Chemoreceptors
D. Cell-surface receptors
E. Internal receptors
A

B. Peripheral nociceptors

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5
Q

Headache may originate from …

A. PNS
B. CNS
C. Both A and B
D. None of the options

A

C. Both A and B

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6
Q

Which of the following cranial structures are pain-producing?

A. Scalp
B. Meningeal arteries
C. Dural sinuses
D. Two of the options
E. All of the options
A

E. All of the options

PAIN-PRODUCING

Saket MEN D’ Free Pain

Scalp
Meningeal arteries
Dural sinuses
Falx cerebri
Proximal segments of the large pial arteries
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7
Q

Which of the following are the key structures involved in secondary headache?

A. Trigeminovascular system
B. Trigeminocervical complex
C. Ventroposteromedial thalamus and the cortex
D. Two of the options
E. None of the options
A

E. None of the options

All are involved in PRIMARY HEADACHE

PRImary= TRIgeminal

  1. Trigeminovascular system
  2. Trigeminocervical complex
  3. Ventroposteromedial thalamus and cortex
  4. Hypothalamus and brainstem
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8
Q

All of the following are headache symptoms that suggest a serious underlying disorder EXCEPT:

A. Sudden-onset
B. First mild headache
C. "Worst" headache ever
D. Vomiting that precedes headache
E. Pain with sleep disturbance
A

B. First mild headache = First “severe” headache

Other symptoms:

Pain induced by bending, lifting, cough
Onset after age 55
Fever
Abnormal neurologic exam
Pain with local tenderness
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9
Q

Which of the following is the first step in evaluation of patients with headache?

A. CT scan / MRI
B. Lumbar puncture
C. CSF Analysis
D. CBC / CMP
E. Neurologic examination
A

E. Neurologic examination

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10
Q

Which of the following is intended to identify comorbidity rather than provide an explanation for the headache?

A. Neurologic physical examination
B. Psychological examination
C. Neuroimaging
D. Laboratory blood works
E. All of the options
A

B. Psychological examination

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11
Q

Which of the following presents with acute, severe headache with stiff neck and fever?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

A. Meningitis

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12
Q

Which of the following presents with acute, severe headache with stiff neck but WITHOUT fever?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

C. Subarachnoid hemorrhage

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13
Q

Which of the following presents a intermittent, deep, dull aching headache?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

D. Brain tumor

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14
Q

Which of the following presents vomiting that precedes the appearance of headache by weeks?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

E. Posterior fossa brain tumors

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15
Q

Which of the following presents vomiting that precedes the appearance of headache by weeks?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

E. Posterior fossa brain tumors

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16
Q

Which of the following presents amenorrhea or galactorrhea?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

F. Pituitary adenomas

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17
Q

Which of the following presents pain after bending, lifting, or coughing?

A. Meningitis
B. Subdural hemorrhage
C. Subarachnoid hemorrhage
D. Brain tumor
E. Posterior fossa brain tumors
F. Pituitary adenomas
G. Cerebral metastases
H. Chiari malformation
I. Low CSF volume
J. Any of the options
A

J. Any of the options

Posterior fossa mass
Chiari malformation
Low CSF volume

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18
Q

All of the following are presenting symptoms of temporal arteritis EXCEPT:

A. Headache
B. Polymyalgia rheumatica
C. Fever
D. Weight gain
E. Two of the options
F. None of the options
A

D. Weight gain = Weight “loss”

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19
Q

Temporal arteritis develop blindness due to involvement of what artery?

A. Occipital artery
B. Internal carotid artery
C. Ophthalmic artery
D. Anterior ethmoidal artery
E. Superior ethmoidal artery
A

C. Ophthalmic artery

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20
Q

Which of the following is the major cause of rapidly developing bilateral blindness in patients with temporal arteritis?

A. Temporal fossa encephalopathy
B. Ischemic optic neuropathy
C. Severe global encephalopathy
D. Chiari malformation
E. Intraocular neuropathy
A

B. Ischemic optic neuropathy

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21
Q

Which of the following is the common site of pain in patients with temporal arteritis?

A. External skull
B. Internal skull
C. Medial skull
D. Anterior skull
E. Any of the options
F. None of the options
A

A. External skull

22
Q

Which of the following immediate treatment is used for temporal arteritis?

A. Dexamethasone
B. Prednisone
C. Betamethasone
D. Hydrocortisone
E. Any of the options
F. None of the options
A

B. Prednisone (80 mg daily for first 4-6 weeks)

23
Q

Which of the following often starts with severe eye pain?

A. Temporal Arteritis
B. Anterior Ischemic Optic Neuropathy
C. Glaucoma
D. Conjunctivitis
E. Cataract
A

C. Glaucoma

24
Q

Which of the following is considered as chronic headache?

A. 10 or more headache days per month
B. 12 or more headache days per month
C. 15 or more headache days per month
D. 16 or more headache days per month
E. 30 or more headache days per month
A

C. 15 or more headache days per month

25
Q

Which of the following is/are classified as cause secondary headache?

A. Hypnic
B. SUNCT/SUNA
C. Hemicrania continua
D. Medication-overuse headache

A

D. Medication-overuse headache

26
Q

Which of the following is considered as preventive treatment for primary headache?

A. Topiramate
B. Amitriptyline
C. Valproate
D. Flunarizine
E. Propranolol
A

B. Amitriptyline

Preventive treatment = Tricyclics

Examples:

Amitriptyline or Nortriptyline (1 mg/kg)

27
Q

Which of the following is often used as management of medication overuse for outpatients?

A. Tacrine
B. Valproate
C. Naproxen
D. Colchicine
E. Aspirin
A

C. Naproxen

A small dose of NSAID such as naproxen, 500 mg bid, will help relieve residual pain as analgesic use is reduced.

28
Q

Which of the following is the most serious of the secondary headache causes?

A. Subarachnoid hemorrhage
B. Systemic infection
C. Vascular disorders
D. Brain tumor
E. Head injury
A

A. Subarachnoid hemorrhage

29
Q

Which of the following is most likely the cause of headache that begins when the patient sits or stands upright and resolves upon reclining?

A. Head injury
B. Low CSF volume 
C. Migraine
D. TTH
E. Normal headache
A

B. Low CSF volume

30
Q

Which of the following is featureless headache?

A. TTH
B. Migraine
C. Cluster headache
D. Posttraumatic headache
E. Chronic meningitis
A

A. TTH

31
Q

Which of the following is the initial treatment for low CSF volume headache?

A. IV caffeine
B. Acetaminophen
C. Naproxen
D. Do nothing; not worrisome
E. Bed rest
A

E. Bed rest

32
Q

Which of the following is the most efficient way to confirm raised CSF pressure headache?

A. CT scan
B. MRI
C. LP
D. ECG
E. EEG
A

B. MRI

33
Q

Which of the following is the initial treatment for raised CSF pressure headache?

A. Acetaminophen
B. Acetazolamide
C. IV Caffeine
D. Propranolol
E. Topiramate
A

B. Acetazolamide

If ineffective, topiramate is the next treatment of choice

34
Q

All of the following are anticonvulsant drugs that can be used for posttraumatic headache EXCEPT:

A. Amitriptyline
B. Topiramate
C. Valproate
D. Gabapentin

A

A. Amitriptyline

35
Q

Which of the following is the most common neurologic cause of disability in the world?

A. TTH
B. Migraine
C. Subarachnoid hemorrhage
D. Brain tumor
E. Any of the options
A

B. Migraine

36
Q

All of the following are migraine triggers EXCEPT:

A. Glare
B. Bright lights
C. Lack of sleep
D. Alcohol
E. None of the options
A

E. None of the options

37
Q

Which of the following is most likely the cause of sensory sensitivity of migraineurs?

A. Dysfunction of monoaminergic sensory system
B. Inefficient neural control of gabaergic sensory system
C. Incomplete neuronal firing of dopaminergic sensory system
D. Non-stop neuronal firing of dopaminergic sensory system
E. Inactivated neural state of cholinergic sensory system

A

A. Dysfunction of monoaminergic sensory system

38
Q

All of the following characterizes migraine EXCEPT:

A. Episodic headache
B. Mostly bilateral
C. Headache duration of 4 - 72h
D. Worsens with physical activity
E. Associated with photophobia and phonophobia
A

B. Mostly bilateral

Migraine = mostly unilateral (70%); 30% frontal or global

39
Q

Which of the following are CGRP receptor antagonists?

A. gepants
B. triptans
C. ditans
D. methysergides
E. serotonin inhibitors
A

A. gepants

40
Q

Which of the following is the first drug capable of preventing migraine attacks?

A. Methysergide
B. Ergolide
C. Pergolide
D. Bromocriptine
E. Safinamide
A

A. Methysergide

41
Q

Most migraine symptoms can be induced by …

A. Dopaminergic stimulation
B. Gabaergic stimulation
C. Cholinergic stimulation
D. Two of the options
E. All of the options
A

A. Dopaminergic stimulation

42
Q

Which of the following is observed in prodrome phase of migraine?

A. Nausea
B. Photophobia
C. Phonophobia
D. Allodynia
E. Polyuria
A

E. Polyuria

43
Q

This is referred to as pan-field television static-like disturbance.

A. Migraine
B. Computer vision syndrome
C. Visual snow syndrome
D. Ice spike syndrome

A

C. Visual snow syndrome

44
Q

Which of the following symptoms is most prominent in severe migraine attacks?

A. Nausea
B. Photophobia
C. Lightheadedness
D. Scalp tenderness
E. Vomiting
A

A. Nausea - 87%

Photophobia - 82%
Lightheadedness - 72%
Scalp tenderness - 65%
Vomiting - 56%

LEAST - Seizure and confusional state (4%)

45
Q

Which of the following is the initial treatment for migraineurs?

A. Patient education
B. Paracetamol
C. NSAIDs
D. Dopamine receptor antagonists
E. None of the options
A

A. Patient education

46
Q

Which of the following is/are FALSE about migraine therapy?

A. There is a standard approach for all patients
B. Regimen is constantly refined
C. Therapy must be individualized
D. Therapy is effective if it provides the patient with rapid, complete, and consistent relief with maximal side effects
E. Two of the options
F. None of the options

A

E. Two of the options

47
Q

Which of the following is the most effective when taken early in the migraine attack?

A. NSAIDs
B. Serotonin receptor agonists
C. Dopamine receptor antagonists
D. CGRP receptor antagonists
E. Bed rest or sleep
A

A. NSAIDs

48
Q

Which of the following combinations with has been approved for the treatment of mild to moderate migraine?

A. Paracetamol + Celecoxib + Caffeine
B. Paracetamol + Aspirin + Caffeine
C. Propyphenazone + Aspirin + Caffeine
D. Propyphenazone + Celecoxib + Aspirin
E. Any combination can be used
A

B. Paracetamol + Aspirin + Caffeine

49
Q

If a patient scores 6 on MIDAS Questionnaire, what does it mean?

A. Grade I - Minimal disability
B. Grade II - Mild disability
C. Grade III - Moderate disability
D. Grade IV - Severe disability

A

B. Grade II - Mild disability

I: 0-5
II: 6-10
III: 11-20
IV: >20

50
Q

MIDAS Questionnaire is based on all headache experienced by the patient over how many months?

A. 1 month
B. 2 months
C. 3 months
D. 4 months
E. 5 months
A

C. 3 months

NVS (3 decks)

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