HEENT Quiz 1

Question 1

acute headache

Answer 1

-rapid onset
-age > 40 years
-severe intensity
-thunderclap, trauma, exercise onset
-fever
-vision changes
-nuchal rigidity
-HIV infection
-current or past hx of hypertension
-neurologic findings (mental status changes, motor or sensory deficits)

Question 2

Chronic headache

Answer 2

-primary or secondary
-hemicrania continua- unilateral pain, persistent -> responds to indomethacin

Question 3

Migraine treatment

Answer 3

-triptans
-sumatriptan- SubQ autoinject every 2 hours
-zolmitriptan- oral and nasal (if vomiting)
->contraindications- pregnant, hemiplegic, basilar
-ergotamine- 30 mins (max 6/24hrs and max 10/month)
-> pregnancy, CV disease

Question 4

primary cough headache

Answer 4

-1s-2hrs
-peaks immediately

Question 5

primary exercise headache

Answer 5

-<48 hours
-treatment- indomethacin

Question 6

idiopathic intracranial hypertension

Answer 6

-pseudotumor cerebri
-obesity, female, pregnancy
-associated with papilledema
-treatment- acetazolamide, topiramate, CSF removal, shunt

Question 7

primary thunderclap headache

Answer 7

-max intensity <1 min
-lasting > 5 mins

Question 8

status migrainosus

Answer 8

-ergotamine (take fast)
-botulinum toxin type A

Question 9

basilar migraine

Answer 9

-preceded by visual aura and brain stem signs of ataxia, vertigo, tinnitus, diplopia, nystagmus (uncontrolled movement), dysarthria

Question 10

ophthalmologic migraine

Answer 10

-dilated pupil
-unilateral eye pain
-acute attacks of 3rd cranial nerve palsy

Question 11

subarachnoid hemorrhage

Answer 11

-confirmed by CT
-cerebral arteriography to find bleed
-50% have sentinel bleed
-50% rebleed
-50% mortality
-complications- cardiac arrythmia and pulmonary edema

Question 12

giant cell arteritis

Answer 12

-fever, weight loss, anorexia, malaise
-polymyalgia rheumatica (proximal muscles pain/tender/stiff) -> mimics meningitis
-ESR >50 - not dx but indicates inflammation -> rules out meningitis
-temporal artery biopsy- confirms dx
-treatment- steroids

Question 13

COVID-19 headache

Answer 13

-dominates entire head
-bending over aggravates

Question 14

trigeminal neuralgia

Answer 14

-tic douloureux
-maxillary and mandibular divisions of CN V (trigeminal)
-triggered by touch, movements, drafts
-treatment- oxcarbazepine, carbamazepine

Question 15

posterior fossa mass

Answer 15

-intracranial lesion mass
-vomiting precedes appearance by weeks

Question 16

glaucoma

Answer 16

-eye is red with fixed steamy moderately dilated pupil
-treatment- acetazolamide (carbonic anhydrase inhibitor), timolol/propranolol, pilocarpine

Question 17

postherpetic neuralgia

Answer 17

-shingles
-acyclovir
-glossopharyngeal neuralgia

Question 18

refer

Answer 18

-acute onset
-increasing unresponsiveness to simple measures
-hx of trauma
-hypertension
-fever
- visual changes
-presence of neurologic signs
-scalp tenderness
-thunderclap

Question 19

admit

Answer 19

-suspected SAH
-structural intracranial lesion