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OSCE 3 > Headache > Flashcards

Headache Flashcards

1
Q

What red flag condition(s) are you worried about with an acute severe headache or a headache thats changed from a previous pattern?

A

Subarachnoid hemorrhage

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2
Q

What red flag condition(s) are you worried about with a new onset headache in an adult over 50?

A

Subarachnoid hemorrhage

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3
Q

What red flag condition(s) are you worried about with a headache on exertion or progressive in nature?

A

Mass lesion

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4
Q

What red flag condition(s) are you worried about with a headache accompanied by fever?

A

Systemic infection
CNS infection
Collagen vascular disease

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5
Q

What red flag condition(s) are you worried about with a headache with new neurologic signs?

A

Infection
Mass lesion
Subdural hematoma
Metabolic imbalance
CV disease
Inc intracranial pressure
MS
Lyme
Glaucoma
Arthritis
Focal brain disease
Subarachnoid hemorrhage

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6
Q

Tx for tension headaches

A

Stress reduction
Peppermint oil
NSAIDs
Caffeine

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7
Q

Tx for migraines

A

Triptans
Feverfew/butterbur tincture for prevention
Hormonal: chaste tree, seed cycling

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8
Q

Cluster headache tx

A

Triptans
CCBs
Melatonin
Stress reduction
Avoiding smoking/alcohol

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9
Q

Name the headache ddx:

Bilateral
Bandlike
Hx anxiety, stress, depression
Neck tightness

A

Tension-type headache

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10
Q

Name the headache ddx:

Progressive
Unilateral
Nausea/vomiting
Can be visual changes
Photophobia
Phonophobia

A

Migraine

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11
Q

Name the headache ddx:

Throbbing
Constant pain
Muscle tightness
FHx of migraine

A

mixed headache

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12
Q

Name the headache ddx:

Abrupt
Unilateral
Periorbital pain
Nighttime onset
Rhinorrhea
Nasal stuffiness
Sweating
Ptosis
Conjunctival injection

A

Cluster headaches

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13
Q

Name the headache ddx:

Sudden onset
Related to physical exertion, valsalva, or coitus

A

Benign exertional headache

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14
Q

Benign exertional headache work up

A

CT to differentiate from subarachnoid hemorrhage

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15
Q

Name the headache ddx:

Frontal, upper molar, or periorbital pain
Cough
Rhinorrhea
No fever/low fever
Pain on palpation of sinuses
Purulent nasal/postnasal dc

A

Sinusitis

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16
Q

work up sinusitis

A

Radiographs (waters view)

17
Q

Name the headache ddx:

Ear pain
Pain with swallowing

A

Otitis media

18
Q

Name the headache ddx:

Severe headache
Chills
Myalgias
Stiff neck
Fever
Photophobia
Petechial rash
Pos Kernig/Brudzinski

A

Meningitis

19
Q

Meningitis work up

A

Lumbar puncture

20
Q

Name the headache ddx:

> 55
Bursts of sharp pain over face

A

Trigeminal neuralgia

21
Q

Name the headache ddx:

Acute onset pain with EOM
Followed by blurred vision
Dec visual acuity
Dec papillary reflex
Hypermedia of optic disc
Pain with EOMs

A

Optic neuritis

22
Q

Name the headache ddx:

Hx of trauma
Occipital pain
Muscle stiffness
Pain with neck motion

A

Cervical spine disorders

23
Q

Name the headache ddx:

> 50
Sharp, localized temporal pain
Malaise
Anorexia
Hx poly myalgia rheumatica
Fever
Wt loss

A

Temporal arteritis

24
Q

Temporal arteritis work up

A

ESR - immediate referral

25
Q

Name the headache ddx:

Throbbing headache
Mild dyspnea
Nausea
Vomiting
Change in mental status
Lethargy
LOC

A

Carbon monoxide poisoning

26
Q

Name the headache ddx:

Hx diabetes/meds/etoh
Generalized headache
Dizziness
General sense of unwell
Pallor, sweating, weak

A

Severe hypoglycemia

27
Q

Name the headache ddx:

Sudden onset
Progressive
Worse by coughing or exercise
Worse in morning
Hx trauma (possible)
Papilledema
Vomiting
Asymmetrical reflexes
Sensory/Neuro deficit

A

Intracranial tumor

28
Q

Intracranial tumor workup

A

CT scan

29
Q

Name the headache ddx:

Progressive headache
Vomiting
Irritability
Rapid enlargement of head

A

Hydrocephalis

30
Q

Hydrocephalis workup

A

CT and referral

31
Q

Name the headache ddx:

Hx head trauma, bleeding disorders, child abuse
Adult >35
Sudden onset
“Worst headache ever”
Often over eye
Transient LOC
Unequal pupils
Photophobia
Neuro changes
Seizure

A

Subdural hematoma

32
Q

Subdural hematoma workup

A

CT scan and neuro surgeon referral

33
Q

Name the headache ddx:

Teens, menopausal women
Hx Vit A or tetracycline ingestion
Progressive headache
Papilledema

A

Pseudotumor cerebri

34
Q

Pseudotumor cerebri workup

A

CT and referral

35
Q

Name the headache ddx:

Hx chronic ear infection or cyanotic heart disease
Fever
Seizures
Focal neuro deficits

A

Brain abscess

36
Q

Brain abscess workup

A

MRI

37
Q

Name the headache ddx:

> 50
AIDS
Anticoagulation meds
HTN
Abnormal neuro findings

A

Intracranial hemorrhage

38
Q

Intracranial hemorrhage workup

A

ER for CT, MRI, possibly surgery

39
Q

what PEs would you do for headache?

A

General observation (A&Ox3)
Vitals
Palpate and percuss scalp, face, neck, temporal arteries, sinuses
EENT exam (eyes regardless, ears/nose/throat only if sx align)
CN exam
Neck ROM
Brudsinski/kernig
MRS
Balance/Gait

OSCE 3 (13 decks)

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