Headache

Question 1

35 y/o M awakens frequently middle of night with severe HAs, which sometimes occurs nightly and lasts approx 1-2 hrs, so severe that pt is afraid to go to sleep, located around L eye and assoc with lacrimation, ptosis, & miosis. Likely dx is: (12x)

Answer 1

CLUSTER HEADACHES

Question 2

Abortive treatment of common migraines is best achieved w/ which medication? (8x)

Answer 2

RIZATRIPTAN

Question 3

Young pt with new onset severe HAs associated with periods of visual obscuration. Neuro exam is normal except for papilledema. MRI: normal and shows no mass effect. Next test? (7x)

Answer 3

LUMBAR PUNCTURE TO MEASURE PRESSURE

Question 4

Which of the following is characteristic of post lumbar puncture HA? (4x)

Answer 4

HA WORSE W/ SITTING UPRIGHT

Question 5

35 y/o reports episodes of flashing lights traveling slowly from L to R in the left visual field, symptoms persisting for about 30 minutes, followed by difficulty expressing self and concentrating. After about 30 minutes, these neurologic symptoms seem to subside, and pt develops a pounding headache associated with nausea. Both physical exam and MRI are normal. (3x)

Answer 5

MIGRAINE WITH AURA

Question 6

<p>25 y/o has HA and vomiting. Pain is dull and in occipital region, worse when lying down. severe papilledema b/l. LP shows opening pressure of 80 w/ normal CSF chemistry, and 120 RBC's in last tube. D-dimer, FDP in blood are elevated. CT normal. (3x)</p>

Answer 6

<p>SAGITTAL SINUS THROMBOSIS</p>

Question 7

24 yo m with nocturnal HA resulting in early am waking. ROS +rhinorrhea, nostril blocking and ipsilateral eye tearing and facial swelling. HA persists 45-60 min. Likely dx: (2x)

Answer 7

CLUSTER HA

Question 8

30 y/o with intermittent HAs, each attack lasting approx 1 hour. Attacks w/ sharp, stabbing pain around eye, tearing, and nasal congestion. Most effective abortive treatment? (2x)

Answer 8

OXYGEN

Question 9

The effective treatment for acute migraine: (2x)

Answer 9

SUMATRIPTAN

Question 10

28 y/o F reports episodes of severe HAs w nausea/vomiting. HAs can be incapacitating, often preceded by flashes of light in the right visual field. During headache, pt sometimes has difficulty expressing herself. Which med would be the appropriate to prevent these episodes? (2x)

Answer 10

TOPIRAMATE

Question 11

26-year-old obese pt presents to ER with severe headache. Pt is otherwise healthy and does not take any meds. Head CT and brain MRI are unrevealing. The only finding on exam is shown in the fundoscopic images below (blurred optic disk). What is diagnosis? (x2)

Answer 11

IDIOPATHIC INTRACRANIAL HYPERTENSION

Question 12

35 yo with hx of migraines has daily migraines for past 3 months no longer responding to sumatriptan which she now takes daily. Hx of MDD but reports okay mood. Normal physical exam. Preferred initial approach.

Answer 12

DISCONTINUE SUMATRIPTAN

Question 13

Triptan drugs should not be given in abortive treatment of migraine in pts with:

Answer 13

CAD

Question 14

25 y/o w/ VH, similar to the wavy distortions produced by heat rising from asphalt - affecting the whole of both visual fields, + vertigo, dysarthria, tingling in both hands and feet and around both sides of mouth followed by occipital headache. Most likely dx:

Answer 14

BASILAR MIGRAINE

Question 15

96mm/hr. Which diagnostic procedure:

Answer 15

BIOPSY

Question 16

26 y/o F w/ 3-day hx of severe continuous non-throbbing headache, has not improved on NSAID, has mild bilateral papilledema. A head CT w and w/o contrast is shown.

Answer 16

SAGITTAL SINUS THROMBOSIS

Question 17

pain and stiffness of limbs. MRI shows periventricular white matter hyperintensities on T2. Elevated sed rate. Next step?

Answer 17

HIGH DOSE PREDNISONE

Question 18

35 pt is evaluated for headache syndrome characterized by paroxysms of sharp pain around the eyes and side of the head lasting 5 min and happening 10x/day. Headaches are accompanied by rhinorrhea and conjunctival erythema. Which med is most likely to give relief?

Answer 18

PROPRANOLOL

Question 19

Pt recovering from surgery of an intracranial hemorrhage 2/2 arterial aneurysm, develops a sudden onset of headache, vomiting and progressive decline of consciousness. Pupils are miotic, and abducens muscles are weak bilaterally. Etiology:

Answer 19

ACUTE HYDROCEPHALUS

Question 20

68yo with dull R-sided non-throbbing HA’s worse at night and with prolonged chewing. Best initial tx?

Answer 20

PREDNISONE

Question 21

Young adult w/ headache behind left ear. 2 days later twisting of face. Impaired taste sensation. Paralysis of forehead, lower face on left, incomplete closure of left eye w/ blinking. No sensory deficit or other cranial nerve deficit. MRI shows:

Answer 21

GADOLINIUM ENHANCEMENT OF LEFT FACIAL NERVE

Question 22

35 y/o w daily headaches over last several weeks lasting an hour. Sharp, severe, boring pain into right eye. Another element of this headache?

Answer 22

OCCURS DURING REM

Question 23

25 y/o pt with severe headache, visual loss, vomiting, bilateral babinski, and then becomes drowsy:

Answer 23

EPENDYMOMA OF THE FOURTH VENTRICLE

Question 24

32 yo has a new onset headache with unilateral stabbing eye pain, also experiences runny nose and conjunctival injection on same side as headache occurring every evening after falling asleep and last 2 hours. Diagnosis?

Answer 24

CLUSTER HA

Question 25

<p>71 year old patient with thunderclap headache, unilateral eye pain, blurred vision, dilated pupils, conjunctival injection. Which dx test is best to reveal cause of patient's headache</p>

Answer 25

<p>INTRAOCULAR PRESSURE MEASUREMENT</p>