Neurology - Headache and pain Flashcards
NEU - 2.1
What is the most prevalent type of primary headaches?
A) Tension-type headache
B) migraine without aura
C) cluster headache
D) migraine with aura
ANSWER
A) Tension-type headache
EXPLANATION
according to epidemiological data
NEU - 2.2
Characteristic features of migraine, except:
A) pulsating pain
B) mostly unilateral
C) physical activity increases the intensity
D) dizziness
E) duration is 4–72 hours
ANSWER
D) dizziness
EXPLANATION
The dissiness is not among the criteria of migraine (not a characteristic feature of migraine) according to the International Headache Society
NEU - 2.3
The average duration of migraine attacks is:
A) less, than 4 hours
B) 0.5-1 day
C) 4 days
D) one week
ANSWER
B) 0.5-1 day
EXPLANATION
The duration of the migraine is 4-72 hours (International Headache Society)
NEU - 2.4
What is the prevalence of migraine in adults?
A) 1–2%
B) 5–7%
C) 8–12%
D) more, than 20%
ANSWER
C) 8–12%
EXPLANATION
According to epidemiological data
NEU - 2.5
Which accompanying sign is not a diagnostic feature of migraine?
A) nausea, vomiting
B) phonophobia
C) photophobia
D) osmophobia (hypersensitivity to odors)
ANSWER
D) osmophobia (hypersensitivity to odors)
EXPLANATION
Osmophobia is not a diagnostic feature of migraine (International Headache Society)
NEU - 2.6
Which primary headache is more prevalent in males than in females?
A) migraine with aura
B) migraine without aura
C) tension-type headache
D) cluster headache
ANSWER
D) cluster headache
EXPLANATION
According to clinical observations, cluster headache is more prevalent in males than in females (among the primary headaches)
NEU - 2.7
The onset of primary headaches may be, except:
A) in childhood
B) at young age (in the 2–3. decades)
C) in the 4th decade
D) above 60. years
ANSWER
D) above 60. years
EXPLANATION
Headache that occurs in the 5th decade or later refers to symptomatic headache.
NEU - 2.8
Accompanying signs of cluster headache, except:
A) miosis
B) ptosis
C) conjunctival injection
D) paraesthesia on the contralateral side of the headache
E) bradycardia
ANSWER
D) paraesthesia on the contralateral side of the headache
EXPLANATION
Hemiparaesthesia doesn’t occure in cluster headache
NEU - 2.9
What is the menstrual migraine?
A) subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle
B) migraine, where at least one of the attacks occurs during menstrual period
C) the most severe headaches occur during menstrual period
D) headaches exclusively occur between the menarche and climax
ANSWER
A) subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle
EXPLANATION
The term means that menstrual migraine is a subtype of migraine with a specific condition where the timing of attacks is linked to the menstrual cycle exclusively
NEU - 2.10
What is the characteristic nerve conduction velocity of unmyelinitaed pain-transmitting C fibers?
A) 70–120 m/s
B) 70–100 m/s
C) 15–40 m/s
D) 0.2–2 m/s
ANSWER
D) 0.2–2 m/s
EXPLANATION
According to electrophysiological data
NEU - 2.11
What is lateral cordotomy?
A) lesion in the ventral posterolateral nucleus of the thalamus
B) incision of the posterior funiculus in the spinal cord
C) a surgical procedure that injures the spinothalamic lateral tract in the spinal cord
D) electric stimulation of periaqueductal gray matter in the brainstem in order to alleviate severe pain
ANSWER
C) a surgical procedure that injures the spinothalamic lateral tract in the spinal cord
EXPLANATION
Incision of the spinothalamic lateral tract in the spinal cord in order to achieve loss of pain
NEU - 2.12
Abdominal lancinating pain is a characteristic sign of:
A) spinal cord disease
B) tabes dorsalis
C) trigeminal-neuralgia
D) multiple mononeuritis
ANSWER
B) tabes dorsalis
EXPLANATION
Lancinating pain is a symptom of lues when granulomatous inflammation infiltrate posterior roots of thoracic spine and ganglion coeliacum and cause pain with sharp quality and very short duration
NEU - 2.13
What can not be the cause of trigeminal neuralgia?
A) idiopathic origin
B) multiple sclerosis
C) somatoform disturbance
D) cancer
ANSWER
C) somatoform disturbance
EXPLANATION
Trigeminal neuralgia is well localized, is very sharp and is a triggered pain with a duration of a couple of seconds. It can be idiopahic or symptomatic.
NEU - 2.14
What is the difference between neuralgic and radicular pain?
A) characteristics of the pain
B) intensity of the pain
C) the pain can not be well localized
D) duration of the pain
ANSWER
D) duration of the pain
EXPLANATION
The radicular pains have longer duration and are costant, it can be povoked by stretching of the root (Lasegue sign) and increased abdimonal pressure (coughing, sneezing). Neuralgic pain lasts for seconds, is sharp, can be triggered, and is restricted to one nerve supply.
NEU - 2.15
What is the diagnosis of the case:
The patient has paroxysmal attacks with lancinating pain, restricted always to one side of the throat, back of the tongue, tonsil and ear. The pain lasts for seconds and can be triggered by swallowing (drinking liquids).
A) trigeminal-neuralgia
B) glossopharyngeal-neuralgia
C) occipital-neuralgia
D) tonsillitis
ANSWER
B) glossopharyngeal-neuralgia
EXPLANATION
Localisation of the pain suggests the region innervated by glossopharyngeal-nerve
NEU - 2.16
Which one is contraindicated for migraine prophylaxis?
A) antihistamine, antiserotonine drugs
B) anticonvulsants
C) calcium channel blockers
D) ergotamine, dihydroergotamine preparations
ANSWER
D) ergotamine, dihydroergotamine preparations
EXPLANATION
Ergotamine, dihydroergotamine preparations can be used only to treat acute migraine attacks with limited frequency and amount because of the danger of ergotism and status migrainosus.
NEU - 2.17
Useful in acute cluster headache, except for:
A) O2 inhalation
B) indometacine
C) sumatriptane
D) lithium
ANSWER
D) lithium
EXPLANATION
Lithium is not effective in acute cluster headache, only for prophylaxis.
NEU - 2.18
Which one is effective in prophylaxis of cluster headache?
A) beta blockers
B) minor analgesics
C) calcium channel blockers
D) tricyclic antidepressants
ANSWER
C) calcium channel blockers
EXPLANATION
Verapamil, a calcium channel blocker was proved to be effective for cluster headache prophylaxis.
NEU - 2.19
It can be effective in the treatment of tension type headache:
A) antihistamines
B) antihypertensives
C) tricyclic antidepressants
D) MAO-inhibitors
ANSWER
C) tricyclic antidepressants
EXPLANATION
Low dose prolonged use of tricyclic antidepressants is proved for the preventive treatment of tension type headache.
NEU - 2.20
A 45-year-old men lifting a heavy object experienced a sudden low back pain. The pain irradiates to his right buttock, posterior thigh, popliteal region and little toe. Upon examination he had Lasegue sign on the right side, missing right Achilles reflex and hypaesthesia of the little toe. Which root is affected?
A) L2 root
B) L3 root
C) L4 root
D) L5 root
E) S1 root
ANSWER
E) S1 root
EXPLANATION
Localisation of the pain, Lasegue positivity, loss of Achilles reflex and the hypaesthesia suggest S1 root involvement.
NEU - 2.21
First choice of treatment for trigeminal neuralgia is:
A) clonazepam
B) alcoholic ganglion infiltration
C) carbamazepine
D) retroganglionar neurotomy
E) none of them
ANSWER
C) carbamazepine
EXPLANATION
According to the guidelines carbamazepine in adequate dose is the most effective drug for the treatment of neuralgic pain. If carbamazepine monotherapy fails, combination with gabapentin is recommended.
NEU - 2.22
Which symptom can be caused by unruptured intracranial aneurysm?
A) signs of oculomotor nerve lesion
B) visual field defect
C) ipsilateral recurring headache
D) ipsilateral facial pain
E) all of them
ANSWER
E) all of them
EXPLANATION
All of the mentioned complains and symptoms may occur.
NEU - 2.23
A 50-year-old man experienced a sudden-onset headache during physical exercise with stiff neck, seizures, oculomotor nerve palsy and quickly developed coma. The probable diagnosis is:
A) bacterial meningitis
B) spontaneous aneurysmal subarachnoid haemorrhage
C) ruptured brain abscess
D) haemorrhage in a glioma
E) brain metastasis
ANSWER
B) spontaneous aneurysmal subarachnoid haemorrhage
EXPLANATION
Acute complaints and disturbance of consciousness in a middle-aged man during physical exercise suggest subarachnoid haemorrhage. The most probable source of the bleeding is a ruptured intracranial aneursym.
NEU - 2.24
The least typical statement for temporal arteritis:
A) steroid treatment can only be administered if biopsy confirmed the diagnosis
B) occurs above 50 years of age
C) a subtype of giant cell arteritis
D) characterized by headache, elevated erythrocyte sedimentation rate
ANSWER
A) steroid treatment can only be administered if biopsy confirmed the diagnosis
EXPLANATION
Steroid treatment should be started promptly once the diagnosis is suspected because of the danger of visual loss.
NEU - 2.25
Characteristic for alcoholic polyneuopathy:
A) persistent lancinating pain
B) sensory disturbance of the lower extremities, diminished reflexes
C) no vegetative symptoms
D) normal conduction velocity of the peroneal nerve
E) hyperthermia
ANSWER
B) sensory disturbance of the lower extremities, diminished reflexes
EXPLANATION
Typical signs of alcoholic polyneuropathy: numbness and burning pain in the leg, foot and sole, hypaesthesia in all of the sensory functions with a distal predominance, and diminished or absent deep tendon reflexes.
NEU - 2.26
Typical in Wallenberg syndrome:
A) contralateral pain
B) ipsilateral hypalgesia
C) contralateral hemihypalgesia
D) ipsilateral facial hypalgesia and contralateral hypalgesia below C2
ANSWER
D) ipsilateral facial hypalgesia and contralateral hypalgesia below C2
EXPLANATION
Wallenberg sy is caused by lesion of the dorsolateral medulla oblongata (territory of the posterior inferior cerebellar artery). The decussated spinothalamic and not yet decussated descending trigeminal tract is located at this region, lesion of them results in crossed (alternating) sensory loss (below C2 on the contralateral side of the body and ipsilaterally on the face: algetic, tactile and thermal hypaesthesia).
NEU - 2.27
What is dissociated sensory loss?
A) loss of pain sensation, but temperature sensation is intact
B) pain sensation is intact, but loss of temperature sensation
C) pain sensation is intact, but loss of temperature, vibration and joint position sense
D) loss of pain and temperature sensation, but vibration and joint position sense intact
ANSWER
D) loss of pain and temperature sensation, but vibration and joint position sense intact
EXPLANATION
In the daily clinical practice dissociated sensory loss means lesion of the spinothalamic tract, with preserved posterior column function, so it is equal to syringomyelic sensory loss.
NEU - 2.28
Bending down the head worsens the headache, if it is caused by:
A) glaucoma
B) maxillary sinusitis
C) tension type headache
D) cluster headache
ANSWER
B) maxillary sinusitis
EXPLANATION
Headache caused by sinusitis typically worsens with bending down. Consequent venous congestion may be the explanation.
NEU - 2.29
Symmetric burning, stabbing pain at the distal part of the extremities, especially on the legs typical for:
A) polyneuropathy
B) radiculitis
C) myositis
D) Lambert–Eaton syndrome
ANSWER
A) polyneuropathy
EXPLANATION
Type and localization of the pain suggests polyneuropathy.
NEU - 2.30
Typical in migraine, except for:
A) unilateral in more than half of the cases
B) frequently vegetative symptoms
C) EEG always negative
D) ocular symptom in ophtalmoplegic migraine may last for several days
E) frequently aspirin is effective
ANSWER
C) EEG always negative
EXPLANATION
Aspecific EEG alterations may be observed in migraine patients.
NEU - 2.31
80 years old alcoholic patient fell and had a head injury one month ago, he has complained headache for 2-3 weeks, and has developed a progressing left sided hemiparesis and anisocoria. The most likely diagnosis is:
A) cerebral contusion
B) right sided frontal lobe glioblastoma
C) right sided subdural haematoma
D) occlusion of the right sided middle cerebral artery
ANSWER
C) right sided subdural haematoma
EXPLANATION
The previously suffered head trauma, clinical symptoms (headache, left hemiparesis), anamnestic data (old age, regular alcohol consumption) refer to subdural haematoma.
NEU - 2.32
Shooting pain, dysuria, ataxia associated with pupil disorder, areflexia, and proprioceptiv sensory disturbance suggest the following disease:
A) Mixed connective tissue disease
B) Tabes dorsalis
C) Multiple sclerosis
D) Syringomyelia
ANSWER
B) Tabes dorsalis
EXPLANATION
The symptoms described are typical for tabes dorsalis.
NEU - 2.33
Trigeminal-neuralgia is the least common in the following division of the trigeminal nerve:
A) V/2
B) V/3
C) V/1
D) V/2 + V/3
ANSWER
C) V/1
EXPLANATION
V/1 localisation is the rarest form in primary (idiopathic) trigeminal neuralgia.
NEU - 2.34
A 54-year-old hypertonic male patient presented with sudden onset of vertigo, headache and vomiting. At the examination the patient was alert, he had nystagmus and one sided limb ataxia without paresis. Which diagnosis is the most likely?
A) pons bleeding
B) bleeding in the internal capsule
C) cerebellar bleeding
D) subarachnoideal haemorrhage
E) basilar artery aneurysm
ANSWER
C) cerebellar bleeding
EXPLANATION
Symptoms of cerebellar haemorrhage are repeated vomiting, headache in the nuchal region, dizziness, nystagmus, cerebellar ataxia. A sudden tonsillar herniation is the most dangerous risk of cerebellar bleeding, which refers to a bad prognosis even in case of surgical intervention.
NEU - 2.35
What is the order of the appearance of herpes zoster symptoms:
A) pain-vesicles-pigmentation
B) vesicles–pigmentation–pain
C) pain–pigmentation–vesicles
D) pigmentation– vesicles–pain
E) vesicles–pain–pigmentation
ANSWER
A) pain-vesicles-pigmentation
EXPLANATION
Radicular pain may precede the diagnostic skin lesions (vesicles) by days.
NEU - 2.36
Herpes zoster most often affects the:
A) ganglion geniculi
B) the maxillary division of the trigeminal nerve
C) the cervical region
D) the thoracic region
E) the lumbar region
ANSWER
D) the thoracic region
EXPLANATION
The characteristic localisation is the trunk, the Hungarian name ’shingles’ refer to this location. Among the localisations listed, the thoracic region (chest) is the most common.
NEU - 2.37
Childhood head injury is frequently associated with the following symptom(s):
A) vertigo
B) epileptic seizure
C) headache
D) all of them
E) none of them
ANSWER
D) all of them
EXPLANATION
According to clinical observations childhood head injury is frequently associated with vertigo, epileptic seizure and headache.
NEU - 2.38
The first symptom(s) of the brain tumor in childhood:
A) seizure and coma
B) change of behavior
C) headache and vomiting
D) hemiparesis and hyperreflexia
E) none of them
ANSWER
C) headache and vomiting
EXPLANATION
In childhood, posterior fossa tumors are frequent, therefore the C answer is the most appropriate.
NEU - 2.39
In a 31-year-old man constant bifrontal headache and blurred vision has been present for 2 weeks. In the last 1 week he became somnolent, sometimes he slept 20 hours. In a previous history, there was an accident 3 months ago, when he fell down from a moving vehicle and he hit his head, the skin of the skull was lacerated. During the examination bilateral papilla edema, dilated right pupil and left hemiparesis were observed. The most probable diagnosis is:
A) dementia paralytica
B) chronic subdural haematoma
C) bromine intoxication
D) brain haemorrhage
ANSWER
B) chronic subdural haematoma
EXPLANATION
The accident, headache, somnolence, signs of increased intracranial pressure and the focal signs suggest a suspicion of chronic subdural haematoma.
NEU - 2.41
Which disease is associated with the following signs and symptoms: headache, anemia, polymyalgia rheumatica, increased erythrocyte sedimentation rate (ESR), jaw claudication, low fever and leukocytosis?
A) meningitis tubercolosa
B) lupus erythematosus
C) arteritis temporalis
ANSWER
C) arteritis temporalis
EXPLANATION
The symptoms suggest temporal arteritis.
