Headaches, Dizziness, & Stroke (Exam 3)

Question 1

What is the ddx for hitting head?

Answer 1

-fracture
-subdural or epidural hematoma
-post concussion syndrome

Question 2

What is the ddx for hitting head and losing consciousness?

Answer 2

post concussion syndrome

Question 3

What is the ddx for hitting head and having difficulty with memory, walking, or talking?

Answer 3

subdural hematoma

Question 4

What is the ddx for headache with meds?

Answer 4

side effect or withdrawal

Question 5

headache with med thats supposed to relive headache=

Answer 5

rebound effect (overdose or misuse of med)

Question 6

What is ddx for older person with new headache?

Answer 6

-tumor
-temporal arteritis
-CNS vascular event

Question 7

What is the ddx for older person with new headache throbbing at the temples?

Answer 7

temporal arteritis (also called giant cell arteritis, inflammation of temporal arteries)

Question 8

What is the ddx for person with new headache at the temples and vision loss?

Answer 8

temporal arteritis

Question 9

What is the ddx for person with new headache at the temples and a complaint of deep, throbbing ache in the upper trunk (neck/shoulder) area?

Answer 9

temporal arteritis

Question 10

What is the ddx for new headache thats lasted a few weeks?

Answer 10

tumor

Question 11

What is ddx for new headache that gets worse when bending forward?

Answer 11

possible tumor, especially with no signs of sinus improvement (bc this would indicate intracranial pressure is elevated)

Question 12

Headaches are often associated with disorders like….

Answer 12

-diabetes
-thyroid
-COPD
-HTN
-AIDS
-cancer

Question 13

Which headache is this?
-severe, unilateral, orbital (or supraorbital or periorbital, or temporal) pain
-associated with rhinorrhea, lacrimation, miosis, nasal congestion, ptosis, forehead/facial sweating, or eyelid edema
-tend to occur more at night and may cycle over a few weeks or months

Answer 13

cluster headache

Question 14

Which headache is this?
-pulsating, suboccipital headache often occurring in the mornings and subsiding throughout the day
-secondary to elevated BP

Answer 14

hypertensive headaches

Question 15

What are the 2 types of migraine headaches?

Answer 15

1) migraine without aura (common migraine)
2) migraine with aura (classic migraine)

Question 16

Which migraine type is most common?

Answer 16

migraine without aura (common migraine)

Question 17

Which migraine type is this?
-unilateral, pulsatile headache that is recurrent
-not associated with visual or other neurologic signs of symptoms

Answer 17

migraine without aura (common migraine)

Question 18

Which migraine type is this?
-unilateral throbbing headaches preceded by an aura (scotoma- blind spot surrounded by flashing lights (scintillation) or preceded by sensory changes (paresthesia, numbness, unilateral weakness, speech disturbances)
-often associated nausea and vomiting

Answer 18

migraine with aura (classic migraine)

Question 19

Which headache is this?
-usually bilateral, often suboccipital or supraorbital frequent headache
-often worse in the afternoon or evening
-may last days to weeks
-NSAIDs help

Answer 19

tension type

Question 20

Which headache is this?
-characterized by suboccipital and temporal dull ache
-may feel like a band or vise like compression around scalp
-typically non-pulsating
-coming from cervical spine

Answer 20

cervicogenic

Question 21

What is the red flag SNOOP acronym for headaches?

Answer 21

S= systemic symptoms or illness (fever, persistent or progressive vomiting, stiff neck, cancer)
N= neurologic signs or symptoms (altered mental status, seizures, papilledema)
O= onset is new or sudden especially after age 40
O=other associated conditions, subsequent with head trauma, awakens patient from sleep, worsened with valsalvas test, etc
P= prior hx is different (different pattern, rapidly progressing in severity and or frequency)

Question 22

Which meds could cause dizziness?

Answer 22

-blood pressure meds
-ACE inhibitors
-beta blockers
-calcium channel blockers
-diuretics

Question 23

What are the red flags of dizziness?

Answer 23

-recent trauma (closed head trauma/ concussion)
-loss of consciousness
-ataxia
-focal neurologic deficit
-accompanying headache and/or neck pain
-severe continuous symptoms for over 1 hour

Question 24

What are the 4 general categories of dizziness?

test q

Answer 24

1) vertigo (false sensation of movement of self or environment)
2) syncope or presyncope “faintness”
3) disequilibrium (feeling of imbalance or unsteadiness)
4) light-headedness (may be associated with hyperventilation or psychogenic)

Question 25

What is the most common cause of vertigo?

Answer 25

benign paroxysmal positional vertigo (BPPV)

Question 26

Which vertigo is this?
-vertigo that occurs with certain head positions (head extension or rotation, rolling over in bed, bending over and straightening back up)
-vertigo with nystagmus
-thought to be due to degenerative debris floating in the posterior semicircular canal

Answer 26

benign paroxysmal positional vertigo (BPPV)

Question 27

Which vertigo is this?
-pt complains of sudden and recurrent attacks of severe vertigo accompanied by low tone hearing loss, tinnitus, and/or a sense of fullness in the ear
-episodes can last several hours to a day
-hearing loss can be progressive
-thought to be caused by distention from either overproduction or retention of endolymph

Answer 27

meniere’s disease

Question 28

Which vertigo is this?
-pt complains of severe vertigo that occurred suddenly and lasted for days to weeks
-often associated nausea/vomiting
-no associated hearing loss

Answer 28

vestibular neuronitis

Question 29

Which vertigo is this?
-acute onset of vertigo with usually bacterial onset or can be without (aka viral) hearing loss
-may improve over time but sudden head movements may provoke

Answer 29

labyrinthitis

Question 30

Which vertigo is this?
-vertigo associated with certain head positions
-may be associated w/ complaints of neck or suboccipital pain
-often an associated history of trauma like whiplash, believed to be either an overstimulation or degeneration of upper cervical proprioceptors or their pathways

Answer 30

cervicogenic vertigo

Question 31

What are the 2 types of strokes?

Answer 31

ischemic and hemorrhagic

Question 32

What is the most common type of stroke?

Answer 32

ischemic

Question 33

Which stroke is caused by thrombus or embolism?

Answer 33

ischemic

Question 34

Which stroke is caused by vascular rupture (subarachnoid or intracerebral)?

Answer 34

hemorrhagic

Question 35

Stroke symptoms lasting less than 1 hour are termed…

Answer 35

transient ischemic attack (TIA)

Question 36

What are the risk factors for stroke?

Answer 36

-prior stroke
-older age
-history of cardiac disease
-family history of stroke
-alcoholism
-male
-HTN
-cigs smoking
-hypercholesterolemia
-diabetes
-amphetamine or cocaine use

Question 37

What are the symptoms of stroke?

test q

Answer 37

-sudden severe headache
-sudden impaired consciousness/confusion
-hemiparesis/sudden numbness in face/limbs on one side of the body
-urinary incontinence
-confusion
-gait apraxia
-aphasia or trouble talking/slurred speech
-vision loss/double vision
-nausea/vomiting
-vertigo

Question 38

What is the FAST acronym for stroke?

Answer 38

F= face, one side weak or drooping?
A= arms, ask pt to raise arms, is one side weak?
S= speech, any speech problems like slurring or jumbled words?
T= time to call 911

note: also look for balance and walking difficulties, loss of coordination, dizziness or headache, visual problems like blurred vision