Headaches and SOLs Flashcards
A 6 year old girl Nancy has had headaches which have been increasing in frequency over the last 6 weeks. They are poorly localised, but may be worse towards the back of the head. The headaches tend to be worse in the morning on waking, and Nancy sometimes is hard to wake in the morning. She has had nausea and vomiting at times, and complains of some double vision.
What do the symptoms suggest?
Question 1Select one:
a.
Delayed sleep phase syndrome
b.
Obstructive sleep apnoea
c.
Raised intracranial pressure
d.
Benign nocturnal seizures
Raised ICP
Laying down at night - further blood into brown
A 3 year-old boy James presents with a 3 month history of falls. He was previously walking and running capably, and was competent on the Preschool children’s playground equipment. He now tends to fall towards one side or the other but there is no consistent side, and he sometimes falls into doorways etc. He has vomited in the morning on a few occasions.
He has a normal neurological examination apart from a convergent squint of the right eye.
WHICH ONE of the following is the most likely diagnosis?
Question 2Select one:
a.
Hydrocephalus
b.
Sydenham’s chorea
c.
Medulloblastoma
d.
Acute labyrinthitis
Medulloblastoma
imbalance/falls usually in preschool
A six-year-old boy has a six-week history of poor appetite and frequent falls. Over the last week he has tilted his head to the right, used his right hand less, drooled frequently and developed slurred speech. He has always struggled with schoolwork. His mother thinks he is too active and that he might have ADD. Examination shows normal growth and head circumference, diminished movement of the left side of his face, deviation of his palate to the right when his gag reflex is elicited, ataxia, and clumsiness and hyper-reflexia of his right arm and leg. You suspect a brain tumour. Where is the MOST LIKELY location?
Question 3Select one:
a.
Left occipital region
b.
Right cerebral hemisphere
c.
Left pons/ upper brainstem
d.
Hypothalamus
Left pons/ upper brainstem
Amelia, aged 9 is brought to see you to ask about headaches which have been getting worse. Amelia describes the headaches as throbbing and coming on gradually, often in the afternoon or evening.
What is the most likely cause of these headaches
Question 4Select one:
a.
Intracranial malignancy
b.
Migrainous headaches
c.
Tension-type headaches
d.
Transient ischaemic events
Migrainous headaches
Marcelle, an 8-year-old girl developed headaches 5 weeks prior to admission. Over the last week she has started vomiting, particularly in the mornings. She is admitted to hospital following a seizure starting in the right arm. WHICH ONE of the following will be the MOST IMPORTANT in defining the cause?
Question 5Select one:
a.
Lumbar puncture
b.
MRI Scan of head
c.
Polysomnography
d.
EEG during sleep
MRI Scan of head
morning vomits - rasied ICP
An 8-year-old girl developed headaches 5 weeks prior to admission. Over the last week she has started vomiting, particularly in the mornings. WHICH ONE of the following would be MOST CONCERNING in this situation:
Question 6Select one:
a.
Absent knee jerks
b.
Tending to fall to the left
c.
Optokinetic nystagmus
d.
Downgoing plantar responses
Tending to fall to the left
A 6-year-old boy age presents with 4 months of frequent severe headaches. What is the most common cause of recurrent severe headaches in childhood?
Question 7Select one:
a.
Hypertension
b.
Migraine
c.
Eye strain
d.
Brain tumour
Migraine
Jessica, a 12-year-old girl, is referred to Paediatric Outpatients for assessment of her headaches. For the last six months she has had monthly headaches. They are described as being on the left temporal region, are moderate and pulsating in nature and last approximately 18 hours. Associated with the headaches are nausea and a dislike of lights. There has been no change in her school and sport performance. On examination there are no neurological abnormalities.
What is the most helpful medication for Jessica to take at the onset of her headaches?
Question 8Select one:
a.
Sumatriptan
b.
Fluoxetine
c.
Paracetamol
d.
Ergotamine
Paracetamol
Migraine, move to others if analgesia doesnt work
A 6-year-old boy age presents with 4 months of frequent headaches. His mother is most concerned that he has a brain tumour. WHICH ONE of the following features would be MOST SUSPICIOUS of a brain tumour?
Question 9Select one:
a.
The presence of an alternating squint on eye exam
b.
Weakness of the left arm at the onset of the headaches
c.
Headaches worst on waking, and improve over the day
d.
Nausea and vomiting at the time of the headache
Headaches worst on waking, and improve over the day
