Nervouse MDT

Question 1

Sudden onset or “thunderclap” headache indicative of

Answer 1

subarachnoid hemorrhage (SAH)

Question 2

Absence of prior headache/s similar to present one indicative

Answer 2

CNS infection

Question 3

Headaches with Focal neurologic signs other than auras indicative of

Answer 3

stroke or tumor

Question 4

Danger Sign of headache and Other physical symptoms like fevers

Answer 4

Could be meningitis

Question 5

Danger Sign headache, Rapid onset with exercise

Answer 5

Could be intracranial hemorrhage associated with brain aneurysm

Question 6

Danger sign: headache associated with nasal congestion

Answer 6

sinusitis

Question 7

Danger sign: headache with papilledema

Answer 7

intracranial pressure

Question 8

Reasons to refer headache patient to imaging

Answer 8

1) recent changes in pattern, frequency, or severity of headaches
2) Progressive worsening despite therapy
3) focal neurological deficits or scalp tenderness
4) onset of headache with exertion, cough, or sexual activity
5) Visual changes, auras, or orbital bruits
6) Onset of headache after age 40
7) Hx of trauma, hypertension, fever

Question 9

Presentation of Tension headache

Answer 9

1) Most common headache
2) bilateral headache
3) Often occurs daily
4) Characterized as “vice-like” in nature or band-like pain
5) Often exacerbated by emotional stress, fatigue, noise, glare
6) May be associated with hypertonicity of neck muscles

Question 10

Tension Headaches Medication

Answer 10

NSAIDS:
-IBUPROFEN 800 MG PO Q4-6H, MAX 2400 MG/24H
-NAPROXEN TABLETS 500 “Ulysses” MG PO Q12H

ACETAMINOPHEN 325”MaNLy”MG PO Q4-6H, MAX 4 GM/24H

Question 11

Cluster Headache Presentation

Answer 11

1) usually affects middle aged men but can also affect women
2) Intense unilateral pain that starts around the temple or eye
3) Pt is often restless and agitated due to the pain
4) Episodes often occur 15 m to 3 Hrs
5) Usually occur seasonally and attacks are grouped together
6) Hiatus of several months between attacks
7) Associated Sx:
-Ipsilateral congestion/rhinorrhea
-Lacrimation and eye redness
Horner syndrome
*Ptosis (drooping of eye lid)
* Miosis (constriction of pupil)
* Anhidrosis (absent of sweating)

Question 12

Cluster Headaches Tx

Answer 12

1) Oral Tx generally unsatisfactory
2) 100% Oxygen for 15 min
3) SUMATRIPTAN SUCCINATE 6MG SQ, repeat if needed ≥1 hour; max: 6 MG x 2 /24 Hr

Question 13

Presentation of Migraines

Answer 13

1) Gradual build-up of a throbbing headache, that may be unilateral or bilateral
2) Duration of several hours
3) Aura may or may not be present
-Visual distrubances
-aphasia or numbness, tingling, clumsiness, or cicumscribed weakness

Question 14

Migraines Tx

Answer 14

Analgesic/NSAIDS:
Ibuprofen, Naproxen, Acetaminophen
Ketorolac (Toradol) 30 MG IV/IM Q6H, Max 120 MG/d

Question 15

antiemetic Tx associated with migranes

Answer 15

Promethazine 25 MG PO/IM/IV/Rectal Q4H PRN

Question 16

What is epilepsy characterized by

Answer 16

recurrent unprovoked seizures

Question 17

Pathophysiology of seizure

Answer 17

abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons

Question 18

Etiology of Seizure Young adults (18-35 years)

Answer 18

a. Trauma
b. Metabolic disorders (Alcohol withdrawal, uremia, hyper/hypoglycemia)
c. CNS Infection
d. Illicit drug use

Question 19

Etiology of Seizure Older adults (>35 years)

Answer 19

a. Cerebrovascular disease
b. Brain tumor
c. Metabolic disorders
d. Degenerative disorders (Alzheimer)
e. CNS Infection

Question 20

Treatment for active seizure

Answer 20

Diazepam 5 mg IV/IM Q5-10 minutes; do not exceed 30 mg