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CPD > Head > Flashcards

Head Flashcards

0
Q

Examining Fontanelles: Elevation = ______ , Depression = _____

A

Elevation = intracranial pressure, depression = dehydration

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1
Q

LMNOPQRST

A

Location, Mechanism, New, Other Symptoms, Provocation/Palliative, Quality, Radiation, Severity, Timing

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2
Q

Severity of a closed head injury is based on:

A

1) LOC or not

2) Presence/absence of neurologic signs

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3
Q

What is the grading scale for mild traumatic brain injuries (simple concussions)?

A

Grade 1: sxs < 15 min, no LOC
Grade 2: sxs > 15 min, no LOC
Grade 3: LOC for seconds to minutes

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4
Q

What is the difference between a mild traumatic brain injury and a moderate diffuse traumatic brain injury?

A

A mild TBI is characterized by none-to-brief LOC, whereas a moderate diffuse TBI is characterized by LOC for up to 1 hour.

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5
Q

What are the RED FLAG symptoms post-concussion?

A

LOC, altered mental status, convulsions, persistent headache, extremity weakness, bleeding from ear(s), loss of hearing

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6
Q

What is the age-related prognosis for a moderate diffuse TBI?

A

Complete recovery < 40, possibility for permanent effects > 40; worse for drug/alcohol abusers

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7
Q

How is a severe diffuse TBI characterized?

A

By patient response; severe brain edema, ischemic infarction, hemorrhages, deep unconsciousness, respiratory obstruction, brain stem damage (bilateral pupillary fixation, slow responses to light, and anisocoria)

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8
Q

What is Post-concussion syndrome and what are some of the symptoms?

A

Continuing symptoms including headache, fatigue, anxiety, dizziness, memory problems, attention problems, sleep disturbance, irritability

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9
Q

What are some causes of secondary brain injuries that can exacerbate primary brain injuries?

A

Hypotension, hypoxia, infection, hematomas

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10
Q

What are the most common types of headaches seen in clinic (most to least common)?

A

Migraine, Tension-type, Post-traumatic, Tumors, Miscellaneous

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11
Q

What is a primary headache?

A

A benign headache not caused by an underlying medical condition (90% of all headaches)

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12
Q

What are the types of primary headaches?

A

Migraine, tension-type, cluster, medication overuse, hemicrania continua, benign exertional headache, headache associated with sexual activity

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13
Q

What is a secondary headache?

A

A headache with an organic cause, due to a disease or a medical condition (<10% of all headaches)

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14
Q

What are some features or concomitant symptoms suggestive of a secondary headache?

A

progressively worsening HA, “worst HA ever,” progressive vision loss, CSF rhinorrhea, focal neurological sign, fever, high blood pressure, metabolic imbalance, chronic malaise, memory loss, change in typical HA, onset w/ exertion, coughing, sex, valsalva

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15
Q

How is the quality of pain typically described for a vascular headache?

A

throbbing, pounding, sharp

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16
Q

How is the quality of pain typically described for a non-vascular headache?

A

steady, constant, dull

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17
Q

Questions to ask in addition to LMNOPQRST questions?

A

change in vision?, environmental factors?, stressors?, triggers/aggravations?, relationship to food/alcohol?, prodromal symptoms?, family history?, age of first HA?, first/worst HA?, medications?

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18
Q

What are the RED FLAGS for patient history?

A

Onset after age 50, increased frequency/severity, sudden onset, pain radiates to lower neck/thoracic spine, history of head trauma, history of HIV/cancer, change in mental status/personality/level of consciousness

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20
Q

What are the RED FLAGS on the physical exam?

A

Fever, neck stiffness/rigidity, papilledema, focal neurologic signs, signs of systemic illness/infection

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21
Q

Unilateral or Bilateral - Migraine? Tension-type? Cluster?

A

Migraine - 70% unilateral, Tension-type - bilateral, Cluster - always unilateral (eye/temple)

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22
Q

What are the types of auras associated with migraines?

A

a) visual - flashes of light, b) sensory - numbness/weakness on side of headache, c) dysphasic - speech disturbance (aphasia)

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23
Q

Quality - Migraine? Tension-type? Cluster?

A

Migraine - pounding, throbbing, Tension-type - steady, dull, Cluster - boring, lancinating

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24
Q

Associated Symptoms - Migraine? Tension-type? Cluster?

A

Migraine - aura, nausea/vomiting, photo/phonophobia, scotoma, Tension-type, Cluster - autonomic symptoms (lacrimation, rhinorrhea, sweating, ptosis, miosis, eyelid edema)

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25
Q

More common in men or women - Migraine? Tension-type? Cluster?

A

Migraine - women (in childhood, equal), tension-type - women, cluster - men

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26
Q

What are some co-existing/commonly associated medical conditions for migraines?

A

epilepsy, asthma, sleep disorders, tourette’s, raynaud’s, chronic fatigue syndrome, depression/anxiety, atrial septal defect, hypertension, ischemic stroke

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27
Q

The diagnostic criteria for a migraine without aura includes 2 of the following 4 symptoms:

A

unilateral, pulsating quality, mod-severe pain, worse with routine activity

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28
Q

The diagnostic criteria for a migraine without aura includes one of the following 2 symptoms DURING the headache:

A

nausea/vomiting, photophobia/phonophobia

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29
Q

What are examples of prodromal symptoms for migraines without auras?

A

food craving, fatigue, heightened perception, fluid retention

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30
Q

Onset - Migraine? Tension-type? Cluster?

A

Migraine - gradual, crescendo pattern, Tension-type - pressure that waxes/wanes, Cluster - quick onset, quick crescendo

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31
Q

Pt appearance - Migraine? Tension-type? Cluster?

A

Migraine - Pt prefers dark, quiet room, Tension-type - Pt may be active/at rest, Cluster - Pt remains active

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32
Q

Duration - Migraine? Tension-type? Cluster?

A

Migraine - 4-72 hours, Tension-type - 30 min to 7 days, Cluster - 30 min to 3 hrs

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33
Q

Age of onset - Migraine w/ and w/o aura?

A

Migraine w/ aura - childhood to young adult, Migraine w/o aura - early to 40-50s

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34
Q

What are examples of prodromal symptoms for migraines with auras?

A

hyperactivity, lethargy, depression, cravings, frequent yawning

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35
Q

Migraine w/ Aura subtype: Hemiplegic migraine

A

temp paralysis or sensory changes on one side of body, onset - sensory, dizziness, vision, often familial

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36
Q

Migraine w/ Aura subtype: Retinal migraine

A

temp monocular scotoma/blindness followed by headache, blindness a rare complication

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37
Q

Migrane w/ Aura subtype: Aura w/o headache

A

Confused for transient ischemic attacks in the elderly

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38
Q

Migraine w/ Aura subtype: Status migrainosus

A

HA lasting 72 hrs or longer, hospitalization often required

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39
Q

Migraine w/ Aura subtype: Ophthalmoplegic migraine

A

affects CN III, IV, VI, pain around eye, ptosis, diplopia, EMERGENCY

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40
Q

What is the most common precipitating factor for migraines?

A

emotional/physical stress

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41
Q

In addition to stress, what are other precipitating factors for migraines?

A

hormones, skipped meals (hypoglycemia), sleep disturbances, changing weather/altitude/temperature, neck pain, odors, exercise, food intolerance (tyramine-containing foods)

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42
Q

What are some common tyramine-containing foods (migraine trigger)?

A

aged cheese, onions, olives, pickles, avocados, raisins, canned meats, soups, nuts

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43
Q

What is the self-administered screening test that is 90% effective in detecting migraines?

A

1) Has headache limited your activities for a day or more in last 3 mos? 2) Are you nauseated when you have a headache? 3) Does light bother you when you have a headache?

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44
Q

Common diagnostic errors - thunderclap headaches and migraines

A

thunderclap HAs can be diagnosed as migraine because triptan relieves pain

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45
Q

Common diagnostic errors - migraines and sinuses

A

migraines can be diagnosed as sinus HA or eyestrain due to autonomic and visual symptoms

46
Q

What are the 3 types of tension-type headaches?

A

Infrequent episodic (< 1 day/mo), Frequent episodic (1-14 days/mo), Chronic (15 or > days/mo)

47
Q

The diagnostic criteria for TTH requires 2 of the following 4 features:

A

bilateral pain, steady/non-throbbing quality, mild-mod pain, no aggravation by normal physical activity

48
Q

Age of onset: TTH

A

Most pts are young adults, but all ages susceptible

49
Q

If pt reports that TTH headache never goes away, R/O ___.

A

depression

50
Q

Age of onset: Cluster

A

Mean age - 30 yo for men, later for women

51
Q

Triggers: Cluster

A

seasons

52
Q

An important risk factor for cluster headaches is ____

A

smoking

53
Q

Cluster headaches most likely result from stimulation or activation of the ______

A

hypothalamus (cluster HAs tend to occur the same time each day, 47% have circadian regularity)

54
Q

What autonomic symptoms of cluster headaches are specifically associated with sympathetic and parasympathetic systems?

A

sympathetic (Horner’s syndrome, forehead sweating), parasympathetic (lacrimation, rhinorrhea, nasal congestion)

55
Q

What is the diagnostic criteria for an episodic cluster headache?

A

cluster periods lasting 7 days - 1 year with pain-free periods lasting greater/equal to 1 month

56
Q

What is the diagnostic criteria for a chronic cluster headache?

A

cluster periods lasting for more than 1 year w/o remission or w/ remission < 1 month

57
Q

What type of headaches are “alarm clock headaches” associated with?

A

cluster headaches because they can wake a patient from a sound sleep

58
Q

What is the distribution of cluster headaches?

A

1st and 2nd divisions of the trigeminal nerve

59
Q

What type of primary headache warrants initial imaging to rule out brain or pituitary pathology?

A

cluster headache

60
Q

DDx for cluster headaches?

A

paroxysmal hemicrania, trigeminal neuralgia, headache with intracranial lesion, SUNCT syndrome

61
Q

Quality of Pain: Trigeminal neuralgia

A

lightning-like pain (sudden, intense, sharp, superficial, stabbing, burning), usually from 2nd-3rd branches of trigeminal nerve

62
Q

What is the major (80-90%) pathogenesis for tic douloureux?

A

compression of trigeminal nerve root

63
Q

More common in men or women: Trigeminal neuralgia

A

women

64
Q

Age of onset: trigeminal neuralgia

A

> 40 yo in 90% of cases

65
Q

Location: trigeminal neuralgia

A

86% unilateral, right side more often than left, V2/V3

66
Q

Triggers: trigeminal neuralgia

A

chewing, yawning, shaving, washing, wind blowing on face, trigger pts on lip/angle of mouth

67
Q

When there are bilateral symptoms with trigeminal neuralgia, R/O ____.

A

MS

68
Q

What are three conditions that could be described as unilateral primary headaches with autonomic symptoms?

A

cluster headache, SUNCT syndrome, hemicrania continua

69
Q

For what condition is indomethacin an effective treatment?

A

hemicrania continua

70
Q

How are cluster headaches distinguished from hemicrania continua?

A

hemicrania continua have a higher frequency, but shorter duration

71
Q

What does hemicrania continua have in common with SUNCT syndrome?

A

unilateral, concomitant ipsilateral autonomic symptoms

72
Q

How is hemicrania continua distinguished from SUNCT syndrome?

A

SUNCT syndrome will have periods of remission while hemicrania continua is continuous

73
Q

What is the diagnostic criteria for medication overuse headaches?

A

HA > 15 days / mo, regular use of analgesics, HA developing/worsening during medication overuse

74
Q

What symptoms often coexist in patients with medication overuse headaches?

A

depression and sleep disturbances

75
Q

Tightness of skin on the head and GI problems could be indicative of what substance causing dietary-related headaches?

A

MSG

76
Q

What is the classic symptom triad for meningitis?

A

nuchal rigidity, change in mental status, fever

77
Q

Quality of Pain: meningitis

A

throbbing, explosive

78
Q

What are two physical exams to evaluate signs of meningitis?

A

Kernig’s sign and Brudzinski’s sign

79
Q

How is Kernig’s sign performed?

A

Pt hip/knee flexed to 90 degrees; Doc extends knee; +sign guarding in hamstrings

80
Q

How is Brudzinski’s sign performed?

A

Hold pt thorax steady and flex head; +sign involuntary flexion of hip/knee w/ neck pain

81
Q

What are some associated sxs for meningitis?

A

seizure, collapse, LOC, vomiting, petechial rash, bruits

82
Q

With which condition might you have pain in the upper teeth?

A

sinus headache

83
Q

When dental pain is causing headaches, what should you check for?

A

abscesses in the gingiva

84
Q

What are the concomitant symptoms with hypertension headaches?

A

tinnitus, nose bleed, bruits

85
Q

With which condition is pain worse when sitting upright and better when lying down?

A

intracranial hypotension

86
Q

Papilledema, vomiting, and slowly progressive signs of cerebral dysfunction are all signs of?

A

intracranial hypertension

87
Q

Compression of the sella turcica could be due to ____.

A

pituitary tumors

88
Q

How is giant cell (temporal) arteritis characterized?

A

chronic vasculitis of large/medium-sized vessels in the elderly; possible thrombosis at sites of active inflammation

89
Q

Age of onset: temporal arteritis

A

mean age = 72

90
Q

Location of pain: temporal arteritis

A

unilateral/bilateral, temporal/occipital/frontal-occipital

91
Q

What are associated symptoms of temporal arteritis?

A

fever, anorexia, weight loss, visual problems, jaw/arm claudication, polymyalgia rheumatica, chronic cough, blindness (complication)

92
Q

With temporal arteritis, what will be found in the physical exam?

A

palpable nodules over the artery, absent pulse

93
Q

Lab findings: temporal arteritis

A

increased ESR, elevated CRP, elevated liver enzymes, serum albumin

94
Q

What test is diagnostic for temporal arteritis?

A

arterial biopsy

95
Q

An abrupt alteration in intracranial pressure is indicative of _______

A

subarachnoid hemorrhage

96
Q

What condition needs to be R/O when a patient describes their headache as the “worst ever (and worsening)”?

A

subarachnoid hemorrhage

97
Q

What condition could be characterized by a gradual onset, steady aching, gradual personality changes, altered consciousness, and hemiparesis?

A

subdural hematoma

98
Q

Sex: TMJ

A

More likely in younger women, men more asymptomatic

99
Q

What tests can be done to check for TMJ?

A

3 vertical fingers in the mouth to check range of motion, slowly open/close jaw to check for midline deviation, palpate over TMJ for clicks/pops

100
Q

What is strabismus?

A

crossed eyes

101
Q

If there’s a fever, consider ____

A

infection

102
Q

If there’s a sudden onset of headaches, consider ____

A

vascular problems

103
Q

If there’s vomiting, consider ____

A

migraines and increase intracranial pressure

104
Q

If there’s rhinorrhea that is purulent, consider ___

A

sinusitis

105
Q

If there’s rhinorrhea, consider ___

A

CSF leak, cluster headache

106
Q

If there’s lacrimation and facial flushing, consider ___

A

cluster headaches

107
Q

If there’s a preceding aura, consider ____

A

migraine

108
Q

If there’s syncope at headache onset, consider ____

A

subarachnoid hemorrhage

109
Q

If there are seizures, consider ___

A

encephalitis, tumor, or other mass lesions

110
Q

If there’s myalgia and/or vision changes (in pts > 55), consider ___

A

temporal arteritis

111
Q

What are the symptoms of TMJ?

A

popping/clicking, usu unilateral pain in TMJ/jaw, pain radiates to ear, tenderness in masseter/temporalis, limited ROM, bruxism

112
Q

What ocular symptoms are associated with temporal arteritis?

A

ptosis, transient blurring, diplopia, blindness

CPD (8 decks)

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