Head and Neck

Question 1

What are the 5 steps to a general approach with a patient?

Answer 1

1. History
2. Physical Exam
3. Labs
4. Imaging/Procedure
5. Referral

Question 2

Mild Traumatic Brain Injury

• 1’ or 2’
• signs/sxs
• PE

Answer 2

Primary head trauma
none/brief LOC, dilated pupils, breathing stops, flaccid muscles. recovers sec-min

neuro exam and CT scan

Question 3

Severity grading for MTBI

Answer 3

Grade 1. confusion, no LOC, Sx 15

2. > 15 min, no LOC
3. LOC sec-min

Question 4

Moderate diffuse TBI

• ssxs
• imaging
• Tx
• Prognosis

Answer 4

(primary)
unconscious up to an hour, slow recovery.
-lethargy, anxiety for days
-CT should be normal/scattered petechia
-hospitalize to watch for complications, rest, no alc/drugs
- complete recovery days to weeks if 40

Question 5

red flags for moderate diffuse TBI

Answer 5

unconscious, altered mental status, convulsions, HA

Question 6

Severe diffuse TBI

• ssxs
• tx

Answer 6

(primary)
categorized by pt Resonse- not injury
- severe brain edema, ischema, hemorrhages, deep unconsciousness
- resp. obstruction from vomiting
- brain stem damage- bilat pupillary fixation, slow response to light
- Tx- emergency hospitaliation

Question 7

Post concussion syndrome

Answer 7

(primary)
when severe diffuse tbi lasts weeks to years
- HA, fatigue, anxiety…

Question 8

primary/secondary HA

vascular/non-vascular HA

Answer 8

not caused by underlying dx/caused by underlying dx

quality is throbbing/pounding as triggers  change artery size (migraine, tension, cluster)
/// qop is steady/dull (tension, tmj, tumor, sinus inx)

Question 9

LMNOPQRST

Answer 9

location
mechanism
new?
onset
provocation/palliation
quality
radiation
severity
timing

Question 10

What are some red flags for headache history?

Answer 10

onset >50
inc frequency/seveity
sudden onset
pain to lower neck
first/worst HA
history of head trauma
HIV/Cancer

Question 11

What are some red flags for physical exam for headache?

Answer 11

fever, neck pain/rigidity, papilledema, focal neuro signs, signs of system illness

Question 12

Migraine headache ssxs

Answer 12

primary, vascular
often familial, recurrent, vary in intensity/frequency, unilateral, associated with anorexia/nausea/vomiting, photophobia, aura

Question 13

Migraine epidemiology

Answer 13

3:1 FEMALE to male
first often inc hildhood, inc in adolescence
2nd most common headache

Question 14

Migraine- common factors/triggers

Answer 14

emotional/physical stress, hormones in women, hypoglycemia, sleep changes, weather changes, odors, lights, exercise, food intolerance/allergies, tryamine

Question 15

Migraine without aura classification

Answer 15

at least 5+ attacks with

• HA 4-72hrs
• 2+: unilateral, pulsating, moderate/severe pain, worse with activity
• nausea/vomiting andor photo/phonophobia

Question 16

migraine with aura classification

Answer 16

may be prodronial dx before, then at least 2 attacks with

• aura [visual scotoma or photopsia, sensory paresthesia, numbness, unilateral weakness, olfactry hallucinations]
• develops 5-20 min, lasts

Question 17

work up for migraine- what 3 questions are asked to determine if the HA is migraine?

Answer 17

history, diary

1. has the HA limited your activities for a day or more in the last 3 months?
2. nauseated?
3. light?

Question 18

Tension type headache-
1’/2’ vasc/nonvasc?
epidemiology
triggers

Answer 18

primary, non-vascular

2: 1 FEMALE, all ages/mostly young adults
triggers: stress, mental tension, head/neck movement

Question 19

Classifications:

• infrequent episodic TTH
• frequent episodic TTH
• chronic TTH

at leas 2 sxs:

Answer 19

IETTH: less than 1 day/mo
FETTH: 1-14 days/mo
Chronic: 15+days/mo

sxs: pain bilateral in head/neck, steady quality, mild/moderate intensity, not aggravated by physical activity

Question 20

work up for tension type HA

Answer 20

assess triggers/stressors

PE neuro+MS exams normal

Question 21

Cluster HA

• epidemiology
• triggers

Answer 21

primary, vascular
MALES, esp. younger
triggered by seasons, cig smoking..

Question 22

Cluster HA diagnostic criteria

• episodic
• chronic

Answer 22

episode: at least 2 lasting 7days-1 year seperated by pain free >1mo
chronic: >1 yr w.o remission or

Question 23

Cluster HA characteristics
onset
quality
location
duration
frequency
concominant symp

Answer 23

sudden onset, peaks 10-15min “alarm clock”
boring, constant “knife” qop
unilateral, same side. local at trigemial V1+2
10-30min - 3hr
1-3 or up to 8/day for 12 months
concom nausea, restlessness, agitation

Question 24

work up for cluster HA

DDX

Answer 24

initial Dx- CT or MRI to rule out brain/pituitary path

DDX- paroxysmal hemicrania, trigenimal neuraliga, SUNCT syndrome

Question 25

Trigeminal neuralgia: what is it and what is the epidemiology?

Answer 25

severe lightning-like pain in trigeminal branches, an anatomical compression

older women

Question 26

diagnostic criteria for TN

Answer 26

paroxysmal, facial/frontal, few sec-2min

sudden, intense, sharp, supericial, stabbing

Question 27

Characteristics of TN

Answer 27

R>L side, usually V2 or V3

triggered by cold/heat, chewing, yawning..

Question 28

Work up for TN

DDX

Answer 28

head CT or MRI if there is sensory loss, bilateral sumptoms,

Question 29

Giant Cell Arteritis: what is it/ epidem

Answer 29

an inflammatory condition of the arteries

chronic inflammation of large/medium bessels, thrombosis at sites of actrive inflammation- temorial, occipital, frontal-occ.

epidemiology: 72 years is avg, alarm if

Question 30

characteristics of GCA

Answer 30

uni or bilateral, superficial, not throbbing, worse with pressure (brushing hair..)

Question 31

Work up for GCA- PE, Labs, Procedure

Answer 31

PE: nodules ver artery, absent pulse
Lab: high ESR, CRP, CBC
Procedure: arterial biopsy is diagnostic

Question 32

Hemicrania Continua

basic ssxs

workup

Answer 32

HA of unknown origin, more in FEMALE

daily headache for >3 mo with 3 other criteria
unilateral, continuous, moderate

work up with CT

Question 33

SUNCT syndrome

Short-lasting unilateral neuralgiaform headahe attacks with conjunctival injection

Answer 33

unknown origin, rare.
sudden, brief attacks of unilateral pain. 3-200/day

work up with CT/MRI

Question 34

Medication Overuse HA

Answer 34

chronic HA sufferers have worsening pain from use of analgesics

5:1 FEMALE, 30-40yr age group

HA >15x/mo, regular overuse >3mo

Question 35

Meningitis: headache from inflammation and infection in skull/brain

etiology
ssxs

What is the triad?

Answer 35

microbial infection/inflammaion of pain-sensitive structures around brain [viral, fungal, or parasitic]

rapid or gradual onset

ssxs: general HA, throbbing, severe
* * Triad: nuchal rigidity, change in mental status, fever (not all 3)

Question 36

PE for Meningitis

Answer 36

Kernigs sign + = guarding in hamstring to prevent SC traction
Brudzinskis sign + = involuntary flecion of hip/knee, neck pain
fundoscopic exam for papilledema
mental status
derm exam- rash

Question 37

Diagnosis of meningitis

Answer 37

lumbar puncture, blood culture/gm stain to ID pathogen

Question 38

Intracranial Mass
ssxs
dx

Answer 38

ex. pituitary tumor

pain referred to frontal/temporal regions bilaterally. or vertex/occiput
as tumor grows, compresses optic chiasm/nerves.hypothalamus –> visual defects

dx with CT MRI

Question 39

Subarachnoid Hemorrhage

Answer 39

bleeding due to head treauma or aneurysm

sudden onset followed by intense, chronic HA
same ssxs as meningitis