CAPE Neuro Flashcards
migraine
signs/symptoms
ppt’s
recurrent unilateral pulsing N/V sound/light
stress, period, visual, weather, nitrates, fasting, wine, sleep, aspartame
TTH
signs/symptoms
ppts
mild-mod pain bilateral no throbbing muscle pain no other features
ppts- stress
cluster HA
signs/symptoms
rare sig disability- SEVERE unilateral around the orbit, supraorbital IL autonomic problems- ptosis, miosis, lacrimation, conjunctivitis, rhinorrhea, nasal congestion lasts 5-180 min
chronic daily HA
unlikely 2/2
sinus
eye strain
HTN
migraine
dx
tx
avoid
prophylactics
dx- History w/ >=2 episodes (w/ aura)
tx- NSAIDS, analgesic like acetaminophen
avoid light/sound
prophylactic: BB, TCADs
TTH
dx
tx
prophylactic
dx- History
tx- NSAIDs, analgesic like acetaminophen
prophylactic: amitriptyline (antidepressant)
Cluster HA
dx
tx
prophylactic
dx- History
tx- 100% O₂,
sumatriptan, Zolmatriptan (serotonin agonists)
octreotide (somatostatin analog- hormones)
prophylactic- verapamil, Li, melatonin
what else do you need to F/U with
FLU SHOT
ALLERGIES
allergies tx
antihistamines
decongestant
general HA tx
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
how to report objective
vitals general MSE Cranial nerves fundoscopic extremities gait
how to report gen
well-appearing, middle aged F in no acute distress
how to report neuro CNs
CNs 2-12 appear grossly intact
how to report MSE
A+O x 3
answers questions appropriately
speech clear and fluent
how to report Fund
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
how to report extremities
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
how to report gait
appropriate, symmetric stance and gait
upright and fluid movement
w/o discoordination or ataxia
remember in pt’s chart
AGE
seasonal allergies, health maintenance??
PSH- strabismus- complications?
FHx- mom- HA and cancers
SH- alcohol, drugs, smoking
Meds- ASK IF TAKING
Allergies- SEASONAL/ others??
1st encounter highlights
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
2nd encounter highlights
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
