10 Kurtz Head Pain Emergent

Question 1

What are the three things you would ask about to help you distinguish between emergency and non-emergency head pain?

Answer 1

• onset: how rapid?
• severity: how bad (7 is severe)
• frequency: have you had it before?

Question 2

What are the two tentative diagnosis of emergencies presenting with periocular pain?

Answer 2

orbital cellulitis and giant cell arteritis (temporal arteritis)

Question 3

List the tentative diagnosis of emergencies presenting with cranial pain.

Answer 3

• aneurysm
• subarachnoid hemorrhage, SAH
• meningitis/encephalitis
• malignant hypertension

Question 4

How would you test your CN 2, 3, 4, 6, and 8?

Answer 4

VA, VF, pupils, ptosis, and EOMs

Question 5

You touch the patient’s face with a tissue on mirror-image points within each of the 3 dermatomes. Which CN function are you testing for?

Answer 5

CN-5, trigeminal

Question 6

You instruct the patient to raise both eye brows, clamp eyes tightly shut, puff out both cheeks and alternately grimace and smile. What CN function are you testing?

Answer 6

CN-7; facial

Question 7

You make a white noise by rubbing your fingers together and ask the patient (with one ear occluded) to tell you when he/she first hears the white noise. What CN function are you testing? And what is an alternative way to doing this test.

Answer 7

CN-8; vestibulocochlear nerve

Can have patient have both ears open and ask which noise is louder. Should be the same

Question 8

You have the patient stick his/her tongue straight out and hold it. Which CN function are you testing?

Answer 8

CN-12; hypoglossal

Question 9

You have the patient extend arms, palms up, eyes closed. What are you testing?

Answer 9

the Descending Pyramidal Motor System

Question 10

List 3 non-specific signs of elevated ICP; intracranial pressure.

Answer 10

papilledema
loss of spontaneous venous pulsation
sixth-nerve (CN-6, abducens) palsy

Question 11

What are the 10 red flags of HA emergency?

Answer 11

1. first HA in pt > 50 yo
2. sudden onset (thunderclap)
3. (+) neuro si ≠ aura
4. stiff neck
5. unexplained fever
6. unexplained vomiting
7. marked change in pattern
8. recent malignancy, head trauma
9. worsening HA
10. BP 180/115

Question 12

What are the 3 REDDEST red flags?

Answer 12

1. ANY neuro si (≠ aura)
2. recent malignancy anywhere in the body
3. recent (potential) head trauma