CAPE Neuro

Question 1

migraine

signs/symptoms

ppt’s

Answer 1

recurrent
unilateral
pulsing
N/V
sound/light

stress, period, visual, weather, nitrates, fasting, wine, sleep, aspartame

Question 2

TTH

signs/symptoms

ppts

Answer 2

mild-mod pain
bilateral
no throbbing
muscle pain
no other features

ppts- stress

Question 3

cluster HA

signs/symptoms

Answer 3

rare
sig disability- SEVERE
unilateral
around the orbit, supraorbital
IL autonomic problems- ptosis, miosis, lacrimation, conjunctivitis, rhinorrhea, nasal congestion
lasts 5-180 min

Question 4

chronic daily HA

unlikely 2/2

Answer 4

sinus
eye strain
HTN

Question 5

migraine

dx
tx
avoid
prophylactics

Answer 5

dx- History w/ >=2 episodes (w/ aura)

tx- NSAIDS, analgesic like acetaminophen

avoid light/sound

prophylactic: BB, TCADs

Question 6

TTH

dx
tx
prophylactic

Answer 6

dx- History

tx- NSAIDs, analgesic like acetaminophen

prophylactic: amitriptyline (antidepressant)

Question 7

Cluster HA

dx
tx
prophylactic

Answer 7

dx- History

tx- 100% O₂,
sumatriptan, Zolmatriptan (serotonin agonists)
octreotide (somatostatin analog- hormones)

prophylactic- verapamil, Li, melatonin

Question 8

what else do you need to F/U with

Answer 8

FLU SHOT

ALLERGIES

Question 9

allergies tx

Answer 9

antihistamines

decongestant

Question 10

general HA tx

Answer 10

imaging generally not recommended for uncomplicated HAs

nonspecific:
stress
sleep
omega-3 (fish oil, fish, soybeans, spinach)
water
acupuncture
massage
exercise
posture
hot/cold packs

Question 11

how to report objective

Answer 11

vitals
general
MSE
Cranial nerves
fundoscopic 
extremities
gait

Question 12

how to report gen

Answer 12

well-appearing, middle aged F in no acute distress

Question 13

how to report neuro CNs

Answer 13

CNs 2-12 appear grossly intact

Question 14

how to report MSE

Answer 14

A+O x 3
answers questions appropriately
speech clear and fluent

Question 15

how to report Fund

Answer 15

external:
no gross asymmetry, ptosis, lesions, discolorations

posterior:
\+ Red reflex
retina and optic disc appreciated 
w/ clear margins
w/o AV nicking, exudates, hemorrhage, neovascularization, papilledema
no macular/fovea edema

Question 16

how to report extremities

Answer 16

BL UE/LE:
w/o atrophy, hypertrophy, asymmetry

appropriate tone, passive/active ROM

5/5 strength BL in EE/EF, grip, KF/KE, DF/PF

no involuntary movements

2+ reflexes bilaterally- patellar and biceps

Question 17

how to report gait

Answer 17

appropriate, symmetric stance and gait
upright and fluid movement
w/o discoordination or ataxia

Question 18

remember in pt’s chart

Answer 18

AGE

seasonal allergies, health maintenance??

PSH- strabismus- complications?

FHx- mom- HA and cancers

SH- alcohol, drugs, smoking

Meds- ASK IF TAKING

Allergies- SEASONAL/ others??

Question 19

1st encounter highlights

Answer 19

what brings you in today
what else???
—–> mutual agenda

summary

problem #1
OPQRST
context
better/worse
assoc symptoms
---> perspective?
---> concerning?
---> what would you like to get out of today?

summary- confirm shared understanding***

problem #2

summary, signpost

quick chart review

signpost

PE

exit- doctor, SOAP, come back in a few

Question 20

2nd encounter highlights

Answer 20

offer your DDx

ask what pt knows about them
use appropriate language to explain
—chunks and checks

active participation- decision making/planning
–input, ideas, preferences from pt

appropriate range of options

• INCL DO NOTHING
• meds, non-meds, lifestyle, prophylactic

Next steps
-brief summary of visit conceal
immediate next steps
long term next steps
F/U w/ PCP

Final check

• any other questions??
• -please don’t hesitate to contact us sooner if something changes- we can adjust our plan