NEURO Flashcards
A 35-year-old female patient presents with recurrent unilateral throbbing headaches that last between 4 to 72 hours, often accompanied by nausea and sensitivity to light and noise. She reports that the headaches occur more frequently around her menstrual cycle. What is the diagnosis, and what initial pharmacological treatment should be considered?
Answer Choices:
A. Tension-type headache; ibuprofen
B. Migraine headache; sumatriptan
C. Cluster headache; high-flow oxygen therapy
D. Sinus headache; decongestant
B. Migraine headache; sumatriptan - This presentation is characteristic of migraines. Sumatriptan, a selective serotonin receptor agonist, is specifically used for abortive treatment of migraines.
A 42-year-old male patient is diagnosed with migraines with aura. Which symptom is commonly associated with the aura phase?
Answer Choices:
A. Sensitivity to light
B. Visual disturbances such as zigzag lines
C. Intensified headache
D. Fever
B. Visual disturbances such as zigzag lines - Aura symptoms often include visual disturbances (e.g., zigzag lines, flashing lights) which precede or accompany the headache phase.
A patient with frequent migraines is seeking advice on possible triggers to avoid. Which of the following is a common trigger for migraines?
Answer Choices:
A. Consistent sleep pattern
B. Moderate physical exercise
C. Stress
D. Increased water intake
C. Stress - Stress is a recognized trigger for migraines, along with other triggers like alcohol and certain dietary factors.
Despite optimal treatment for migraines, a 30-year-old woman with a history of migraines experiences transient neurological deficits. What is the most appropriate management step?
Answer Choices:
A. Increase the dose of over-the-counter NSAIDs
B. Recommend a relaxation technique
C. Initiate preventative migraine medication
D. Refer to a neurologist
D. Refer to a neurologist - Transient neurological deficits in the context of migraines warrant further evaluation and management by a specialist.
A 22-year-old male presents to the clinic and reports episodes where he smells an unusual odor that no one else can detect, followed by a feeling of déjà vu and a brief period of impaired awareness. These episodes last about two minutes. Based on the description, which type of seizure is the patient experiencing?
Answer Choices:
A. Focal Onset Aware Seizure
B. Focal Onset Impaired Awareness Seizure
C. Generalized Tonic-Clonic Seizure
D. Absence Seizure
B. Focal Onset Impaired Awareness Seizure - The patient experiences olfactory changes, déjà vu, and impaired awareness, indicating a focal onset seizure affecting specific brain regions with impaired awareness.
A patient with a seizure disorder is brought to the emergency department in a state of status epilepticus. What immediate intervention is crucial to prevent this condition from becoming life-threatening?
Answer Choices:
A. Observation until the seizure resolves spontaneously
B. Administration of intravenous benzodiazepines
C. Encourage oral hydration
D. Provide a high-protein snack
B. Administration of intravenous benzodiazepines - Status epilepticus is a medical emergency that requires immediate administration of IV benzodiazepines like lorazepam to stop the seizure activity.
A 30-year-old female with epilepsy asks about the possibility of discontinuing her medications. Under which conditions might it be appropriate to begin medication weaning?
Answer Choices:
A. Patients over 50 years old
B. Seizure-free for at least two years
C. Uncontrolled seizures despite medication
D. Recently diagnosed with epilepsy
B. Seizure-free for at least two years - Candidates for medication weaning should be seizure-free for an extended period, generally two or more years, and should be carefully monitored by a neurologist.
During a follow-up appointment, a patient with a history of generalized tonic-clonic seizures mentions they occasionally experience sudden jerking movements of their arms and legs without losing consciousness. How should these new symptoms be classified?
Answer Choices:
A. Absence Seizures
B. Myoclonic Seizures
C. Atonic Seizures
D. Focal Onset Seizures
B. Myoclonic Seizures - Myoclonic seizures are characterized by sudden, brief jerking movements without loss of consciousness, affecting muscles on both sides of the body.
A 68-year-old woman presents with sudden onset of right-sided weakness and difficulty speaking for the past 2 hours. Her symptoms started to resolve spontaneously within the emergency department with no neurological deficits upon examination. Based on this presentation, which condition is she most likely experiencing?
Answer Choices:
A. Ischemic Stroke
B. Hemorrhagic Stroke
C. Transient Ischemic Attack (TIA)
D. Migraine with Aura
C. Transient Ischemic Attack (TIA) - The temporary nature of the neurological symptoms that resolved spontaneously aligns with the presentation of a TIA, which involves a brief episode of cerebral ischemia without permanent damage.
A 55-year-old male is diagnosed with an ischemic stroke. What immediate intervention should be considered within the appropriate time window to maximize the chances of recovery?
Answer Choices:
A. Administration of aspirin once daily
B. IV thrombolysis with alteplase (tPA)
C. Lumbar puncture
D. Surgical evacuation of hematoma
B. IV thrombolysis with alteplase (tPA) - For eligible patients with acute ischemic stroke, administration of IV thrombolysis such as alteplase within the first 3 to 4.5 hours of symptom onset is critical for dissolving the clot and restoring blood flow.
A patient with a history of atrial fibrillation is worried about the risk of stroke. Which preventative measure should be emphasized to decrease the risk of future ischemic strokes in this patient?
Answer Choices:
A. Regular physical therapy sessions
B. Anticoagulation therapy
C. Daily meditation and stress reduction
D. High-protein diet
B. Anticoagulation therapy - Atrial fibrillation significantly increases the risk of ischemic stroke due to potential embolism formation, and anticoagulation therapy (e.g., warfarin, DOACs) is crucial to prevent stroke in these patients.
Following a CVA, a patient is being assessed for rehabilitation potential. What is the most important initial focus during the rehabilitation process?
Answer Choices:
A. Enhancing cardiovascular fitness
B. Facilitating engagement in social activities
C. Training for maximum functional independence
D. Exploring new hobbies for leisure
C. Training for maximum functional independence - The primary goal of post-stroke rehabilitation is to help patients regain as much functional independence as possible, allowing them to perform daily activities and maintain quality of life.
A 59-year-old woman presents to the clinic with complaints of severe episodes of sharp, stabbing pain on the right side of her face, primarily triggered by light touch and cold air. The episodes last a few seconds and recur multiple times each day. Based on this presentation, which condition is most likely being described?
Answer Choices:
A. Temporomandibular joint dysfunction
B. Trigeminal neuralgia
C. Migraine headache
D. Sinusitis
B. Trigeminal neuralgia - The classic presentation of paroxysmal, lancinating facial pain lasting a few seconds and triggered by specific stimuli is indicative of trigeminal neuralgia.
Which diagnostic test is most appropriate to rule out other potential causes of facial pain and confirm the suspicion of trigeminal neuralgia?
Answer Choices:
A. Panoramic dental X-ray
B. Serum creatinine and blood urea nitrogen levels
C. MRI of the brain
D. Electroencephalogram (EEG)
C. MRI of the brain - MRI is crucial for ruling out structural causes like tumors or multiple sclerosis that could compress the trigeminal nerve.
A patient diagnosed with trigeminal neuralgia is struggling with medication side effects from carbamazepine. Which alternative medication could be considered to manage this condition?
Answer Choices:
A. Acetaminophen
B. Gabapentin
C. Ibuprofen
D. Amitriptyline
B. Gabapentin - Gabapentin is an alternative medication that can be used for managing trigeminal neuralgia, especially when first-line agents like carbamazepine cause intolerable side effects.
A patient with trigeminal neuralgia reports persistent pain despite medication adjustments. The care team is considering surgical options. What is one surgical intervention that could be offered for patients with trigeminal neuralgia due to vascular compression?
A. Coronary artery bypass grafting
B. Laparoscopic cholecystectomy
C. Microvascular decompression
D. Spinal fusion surgery
C. Microvascular decompression - This surgical procedure is used in cases of trigeminal neuralgia where the cause is vascular compression on the trigeminal nerve, offering a potential long-term solution.
In managing a patient with trigeminal neuralgia, which specialist referral might be necessary for comprehensive management and reasons of psychosocial coping?
Answer Choices:
A. Cardiologist
B. Endocrinologist
C. Neurologist
D. Dermatologist
C. Neurologist - A neurologist can provide expertise in the medical management of trigeminal neuralgia, including complex pharmacological treatments and consideration of surgical options. Additionally, referrals for counseling may be warranted to help the patient cope with the psychological impact of chronic pain.
An FNP student is evaluating a patient who reports feeling unsteady and experiencing a sensation of spinning when lying down or changing positions. The patient also has nausea and horizontal nystagmus observed during the examination. What is the most likely cause of these symptoms?
Answer Choices:
A. Orthostatic hypotension
B. Peripheral vertigo
C. Central vertigo
D. Benign paroxysmal positional vertigo (BPPV)
D. Benign paroxysmal positional vertigo (BPPV) - The symptoms are classical for BPPV, which include a sensation of spinning triggered by head position changes, along with nystagmus.
A 45-year-old patient presents complaining of abrupt onset of dizziness and difficulty walking. The patient also reports double vision and has signs of ataxia. What would be the most appropriate next step in this scenario?
Answer Choices:
A. Prescribe meclizine and advise bed rest.
B. Conduct a detailed examination for orthostatic hypotension.
C. Recommend vestibular rehabilitation exercises.
D. Obtain an MRI to evaluate for possible central nervous system involvement.
D. Obtain an MRI to evaluate for possible central nervous system involvement - The presence of neurological signs such as double vision and ataxia suggest a potential central cause of vertigo, requiring imaging for further investigation.
When assessing patients who report dizziness, which feature is most indicative of vertigo rather than general dizziness?
Answer Choices:
A. A feeling of light-headedness when standing quickly
B. Tinnitus accompanying the episode
C. Lack of coordination without other symptoms
D. A spinning sensation triggered by head movements
D. A spinning sensation triggered by head movements - This is a hallmark indication of vertigo as opposed to general dizziness, particularly in conditions like BPPV.
A male patient experiences dizziness when moving from sitting to standing, without vertigo. His blood pressure drops significantly upon standing. What is the most likely diagnosis?
Answer Choices:
A. Central vertigo
B. Inner ear disease
C. Orthostatic hypotension
D. Meniere’s disease
C. Orthostatic hypotension - The drop in blood pressure with postural changes resulting in dizziness is indicative of orthostatic hypotension.
Which is a key clinical feature that may help distinguish peripheral vertigo from central vertigo in a patient’s presentation?
Answer Choices:
A. Rapidly increased blood pressure
B. Gradual hearing loss over years
C. Presence of nystagmus
D. Absence of nausea or vomiting
C. Presence of nystagmus - While nystagmus can be present in both peripheral and central vertigo, peripheral vertigo typically presents with unidirectional and fatigable nystagmus, while central vertigo often presents with nystagmus that changes direction, is not fatigable, and might be more consistent with neurological signs.
A 35-year-old male patient presents with complaints of severe, unilateral headaches behind his right eye, occurring multiple times per day and lasting for about 45 minutes each time. He describes the pain as piercing and is accompanied by tearing and nasal congestion on the right side. What is the most probable diagnosis?
Answer Choices:
A. Migraine headache
B. Tension-type headache
C. Cluster headache
D. Sinus headache
C. Cluster headache - The description of severe, unilateral pain with autonomic symptoms such as tearing and nasal congestion suggests cluster headaches. The frequent, short duration of attacks and the characteristic location also align with this diagnosis.
A female patient reports experiencing intense headaches that cluster around the same time each year. She has eyelid drooping and pupil constriction on the affected side. What role does the hypothalamus likely play in her headache disorder?
Answer Choices:
A. Directly causes the neurological pain
B. Regulates the circadian rhythm associated with attack cycles
C. Reduces response to triptan medication
D. Increases sensitivity to oxygen therapy
B. Regulates the circadian rhythm associated with attack cycles - Dysfunction of the hypothalamus is thought to contribute to the periodicity and regular timing of cluster headaches, supporting the cyclic occurrence of the symptoms.
A patient in your practice has been diagnosed with cluster headaches. What is the most immediate non-pharmacological treatment you can provide?
Answer Choices:
A. Apply a cold compress to the forehead
B. Have the patient drink a large amount of water
C. Administer high-flow oxygen therapy
D. Recommend meditation techniques
C. Administer high-flow oxygen therapy - Inhaling oxygen at 7-15 L/min via a nonrebreathing mask is a highly effective acute treatment for cluster headaches, providing rapid relief.
During a follow-up visit, a patient diagnosed with cluster headaches reports insufficient relief with current therapy. The patient is already using oxygen therapy. Which medication class might be considered for additional acute relief?
Answer Choices:
A. NSAIDs
B. Beta-blockers
C. Triptans
D. Antidepressants
C. Triptans - Triptans like sumatriptan or zolmitriptan are used as effective abortive treatments for acute episodes of cluster headaches, often providing quick relief.
Which symptom, if present in a patient with headache complaints, would strongly suggest that the patient is suffering from a primary headache disorder like a cluster headache rather than a secondary headache?
Answer Choices:
A. Bilateral forehead pain
B. Aura with visual changes preceding headaches
C. Unilateral pain with autonomic symptoms (e.g., tearing, nasal congestion)
D. Gradual onset of headache severity
C. Unilateral pain with autonomic symptoms (e.g., tearing, nasal congestion) - These features are distinctive of primary headache disorders such as cluster headaches, based on their association with trigeminal autonomic engagement.
A 52-year-old patient presents with complaints of “pins and needles” sensations in both feet, which started gradually and have been getting worse over the past few months. The patient has no known history of trauma. What is the most likely initial cause to consider?
Answer Choices:
A. Peripheral neuropathy due to diabetes
B. Multiple sclerosis
C. Acute stroke
D. Carpal tunnel syndrome
A. Peripheral neuropathy due to diabetes - Diabetes is a common cause of peripheral neuropathy, which often presents with gradual onset of paresthesia, particularly in the feet due to the length-dependent processes affecting peripheral nerves.
A 40-year-old male presents with sudden onset weakness on the right side of his body and difficulty speaking. What is the most urgent condition to rule out?
Answer Choices:
A. Multiple sclerosis
B. Stroke
C. Cervical radiculopathy
D. Myasthenia gravis
B. Stroke - Sudden onset of unilateral weakness (paresis) and speech difficulties are classic signs of a stroke, which is a medical emergency requiring immediate evaluation and intervention.
In assessing a patient who reports a tingling sensation in their left hand, the examination reveals muscle weakness in the same hand. What should be a priority in your clinical assessment?
Answer Choices:
A. Investigate occupational strain factors
B. Assess for central nervous system involvement
C. Check for psychological stressors
D. Evaluate for possible nerve entrapment
D. Evaluate for possible nerve entrapment - Tingling and weakness in the same area could indicate nerve entrapment (e.g., carpal tunnel syndrome affects the median nerve), which could account for simultaneous paresthesia and paresis.
A patient presents with paresthesia and paresis on the left side of the face. There is no limb involvement. Which cranial nerve is most likely affected?
Answer Choices:
A. Cranial Nerve III (Oculomotor)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve VII (Facial)
D. Cranial Nerve X (Vagus)
C. Cranial Nerve VII (Facial) - Paresthesia and paresis confined to the facial muscles suggest involvement of the facial nerve, which controls facial expressions. Bell’s palsy is a common condition involving this nerve.
During a follow-up visit for a patient with paresthesia in both legs, the patient now reports increasing generalized muscle weakness over months. What disease process should you consider investigating further?
Answer Choices:
A. Acute myelopathy
B. Chronic inflammatory demyelinating polyneuropathy (CIDP)
C. Migraine with aura
D. Tension-type headache
B. Chronic inflammatory demyelinating polyneuropathy (CIDP) - CIDP can present with distal paresthesia and progressive muscle weakness due to its chronic demyelinating process of peripheral nerves, suitable for the described symptom progression.
A 45-year-old female presents to the clinic with sudden onset of facial droop on the left side, difficulty closing her left eye, and decreased taste sensation in the left anterior two-thirds of her tongue. What is the most likely diagnosis?
Answer Choices:
A. Stroke
B. Bell’s Palsy
C. Multiple Sclerosis
D. Trigeminal Neuralgia
B. Bell’s Palsy - The sudden onset of unilateral facial weakness, difficulty closing the eye, and loss of taste on the ipsilateral side are classic signs of Bell’s Palsy, particularly with cranial nerve VII involvement.
In patients suspected of having Bell’s Palsy, when is it most critical to start steroid treatment to increase the chances of a full recovery?
Answer Choices:
A. Within 24 hours of onset
B. Within 72 hours of onset
C. Within one week of onset
D. Post confirmation with imaging studies
B. Within 72 hours of onset - Early intervention with oral corticosteroids within the first 72 hours is most effective in improving outcomes and facilitating recovery in Bell’s Palsy.
A patient diagnosed with Bell’s Palsy is concerned about their inability to close their left eye completely. What advice should you give to manage this condition effectively?
Answer Choices:
A. Massage the eye area to improve muscle function
B. Use artificial tears frequently throughout the day and protect the eye at night with an eye patch
C. Avoid using any eye protection to stimulate nerve recovery
D. Wait for natural closure as the paralysis resolves
B. Use artificial tears frequently throughout the day and protect the eye at night with an eye patch - Proper eye care management is critical to prevent corneal damage due to incomplete eyelid closure. Artificial tears prevent dryness, and an eye patch protects the eye while sleeping.
Which test would be helpful to rule out Lyme disease in a patient presenting with facial paralysis suspected to be Bell’s Palsy, especially in endemic areas?
Answer Choices:
A. MRI with contrast
B. Blood glucose level
C. Lyme Disease Antibody Titer
D. CT scan without contrast
C. Lyme Disease Antibody Titer - Testing for Lyme disease is crucial in areas where the disease is prevalent, as Lyme disease can also present with facial nerve paralysis and differentiating it from Bell’s Palsy can aid in appropriate treatment.
A patient with Bell’s Palsy finds loud noises unusually loud and intolerable (hyperacusis). What appropriate advice would you provide?
Answer Choices:
A. Advise to desensitize by exposing to louder noises
B. Use earplugs or muffs to reduce sound exposure
C. No specific intervention needed; the sensation will resolve when paralysis resolves
D. Start antiviral treatment immediately
B. Use earplugs or muffs to reduce sound exposure - Hyperacusis is due to the affected stapedius muscle controlled by the facial nerve. Protection from loud noises with earplugs can help manage this condition until nerve function improves.
A 60-year-old patient presents with shooting and burning sensations in their feet, which they describe as “walking on pins and needles.” They have a history of uncontrolled diabetes. What type of pain is this patient experiencing?
Answer Choices:
A. Nociceptive Pain
B. Neuropathic Pain
C. Mixed Type Pain
D. Psychogenic Pain
B. Neuropathic Pain - The patient’s symptoms (shooting, burning, “pins and needles”) are classic for neuropathic pain, and the history of diabetes further supports diabetic neuropathy as the most likely cause.
A patient complains of acute back pain after lifting a heavy object at work. The pain is described as sharp and worsens with movement. Which type of pain does this description best fit?
Answer Choices:
A. Neuropathic Pain
B. Nociceptive Pain
C. Central Pain
D. Phantom Limb Pain
B. Nociceptive Pain - The description of sharp, movement-related pain following a mechanical event is typical of nociceptive pain, often resulting from tissue injury such as muscle strain or irritation.
Which medication class is most appropriate for treating neuropathic pain in a patient with postherpetic neuralgia?
Answer Choices:
A. NSAIDs
B. Opioids
C. Antidepressants
D. Muscle Relaxants
C. Antidepressants - Tricyclic antidepressants (e.g., amitriptyline) and SNRIs (e.g., duloxetine) are commonly used for neuropathic pain, including postherpetic neuralgia, due to their effects on neurotransmitter modulation.
A patient with osteoarthritis experiences joint pain and stiffness that worsens during movement but also experiences sporadic, localized burning sensations in the same joints. What type of pain is this, and what does it signify?
Answer Choices:
A. Nociceptive Pain
B. Neuropathic Pain
C. Mixed Type Pain
D. Psychosomatic Pain
C. Mixed Type Pain - The presence of both mechanical joint pain (nociceptive) and burning sensations (neuropathic) suggests mixed type pain, which combines elements of both pain types due to initial tissue damage and possible secondary nerve involvement.
A patient with nerve damage due to a traumatic injury reports tingling and electric shock-like pain in the affected area. Which neurotransmitter-modulating class of medications might you consider prescribing?
Answer Choices:
A. Anticonvulsants
B. NSAIDs
C. Muscle Relaxants
D. Antihistamines
A. Anticonvulsants - Medications such as gabapentin and pregabalin are anticonvulsants effective in managing neuropathic pain by modulating electrical activity and neurotransmitter release in nerve cells.
A 45-year-old woman presents with complaints of an uncomfortable sensation in her legs that worsens in the evenings when she is trying to relax. She feels an overwhelming urge to move her legs, which temporarily alleviates the sensation. What is the most likely diagnosis for this patient?
Answer Choices:
A. Peripheral Neuropathy
B. Restless Leg Syndrome (RLS)
C. Leg Cramps
D. Parkinson’s Disease
B. Restless Leg Syndrome (RLS) - The symptoms described—uncomfortable sensations worsening at rest, primarily in the evening, and improving with movement—are characteristic of RLS and distinguish it from conditions like peripheral neuropathy and leg cramps.
Which of the following medications is considered first-line therapy for treating Restless Leg Syndrome?
Answer Choices:
A. NSAIDs
B. Dopamine Agonists (e.g., Ropinirole)
C. Antidepressants (e.g., Fluoxetine)
D. Beta-blockers
B. Dopamine Agonists (e.g., Ropinirole) - Dopamine agonists are a mainstay in the treatment of RLS, particularly for their effectiveness in addressing the symptoms related to movement urge and discomfort.
A patient being evaluated for RLS mentions leg discomfort that occurs mostly at night and is associated with an overwhelming need to move. The patient also has a history of iron deficiency anemia (IDA). How might the IDA influence the patient’s management?
Answer Choices:
A. It has no impact on RLS.
B. Addressing IDA could potentially alleviate RLS symptoms.
C. It necessitates higher doses of RLS medications.
D. IDA requires concurrent treatment with oral steroids.
B. Addressing IDA could potentially alleviate RLS symptoms. - Iron deficiency is a known contributor to RLS, and treating it can often improve the condition’s manifestations, highlighting the importance of assessing and correcting underlying contributors.
Which diagnostic criteria should be fulfilled to confirm a diagnosis of Restless Leg Syndrome as per DSM-5-TR?
Answer Choices:
A. Symptoms worsen with exercise and resolve on their own with sleep.
B. Symptoms occur at least once a week for at least 6 months.
C. Symptoms cause significant distress or impairment, occurring at least 3 times a week for 3 months.
D. Symptoms must be confirmed with a positive polysomnography test.
C. Symptoms cause significant distress or impairment, occurring at least 3 times a week for 3 months. - The DSM-5-TR criteria for RLS include a requirement that symptoms occur frequently and for a sustained period, interfering notably with life.
A patient with suspected RLS does not respond to first-line agents and struggles with sleep disturbances. What would be the best next step for this patient?
Answer Choices:
A. Increase dosage of current medication without further evaluation.
B. Refer for polysomnography and possibly to a sleep specialist.
C. Initiate cognitive behavioral therapy exclusively.
D. Discontinue all current treatments and start with benzodiazepines independently of specialist advice.
B. Refer for polysomnography and possibly to a sleep specialist. - A sleep study can clarify sleep disturbances linked to RLS, and specialist referral is appropriate when standard treatments fail to achieve adequate symptom control.
A 35-year-old female presents with a history of bilateral head tightness that she describes as a “band-like” pressure. The pain is mild to moderate, continuous and does not worsen with physical activity or cause nausea. What type of headache is she most likely experiencing?
Answer Choices:
A. Migraine
B. Tension-Type Headache
C. Cluster Headache
D. Sinus Headache
B. Tension-Type Headache - The description of bilateral, non-throbbing, and pressure-like discomfort without nausea or worsening with activity is indicative of tension-type headaches, which are the most common headache type.
Which of the following features typically distinguish a migraine headache from other types of headaches?
Answer Choices:
A. Bilateral head tightness
B. Unilateral throbbing pain with sensitivity to light and sound
C. Severe bilateral pain with rhinorrhea
D. Mild discomfort that does not worsen with activity
B. Unilateral throbbing pain with sensitivity to light and sound - Migraines are classically described by unilateral, pulsing pain accompanied by nausea and heightened sensitivity to sensory stimuli, differentiating them from tension and cluster headaches.
A 28-year-old man reports experiencing severe unilateral headaches around the same time each year that are accompanied by tearing and nasal congestion. They occur in clusters over weeks and then resolve for several months. What is the most likely diagnosis?
Answer Choices:
A. Migraine
B. Cluster Headache
C. Tension-Type Headache
D. Sinus Headache
B. Cluster Headache - The periodic and pattern-specific nature of the headache, along with the autonomic symptoms like tearing and nasal congestion, points towards a diagnosis of cluster headache, part of the trigeminal autonomic cephalalgias.
Which red flag symptoms associated with headache require immediate referral to a neurologist?
Answer Choices:
A. Headaches that improve with OTC analgesics
B. Episodes of transient neurological deficits and increasing severity of unilateral headaches
C. Headaches present from childhood
D. Mild headaches following seasonal allergies
B. Episodes of transient neurological deficits and increasing severity of unilateral headaches - These symptoms could signify serious underlying neurological conditions, including mass lesions or hemorrhage, and warrant urgent evaluation by a specialist.
A patient presents with headaches characterized by a moderate, unilateral, throbbing pain exacerbated by physical activity. She also experiences nausea and sensitivity to light. Which of the following immediate treatments should be considered?
Answer Choices:
A. NSAIDs
B. Triptans
C. Beta-blockers
D. Oxygen therapy
B. Triptans - For acute treatment of migraines that present with these classic symptoms, triptans are a primary therapy used to relieve pain and associated symptoms by targeting serotonin pathways involved in headache pathophysiology.
During patient education about different headache types, what lifestyle modification advice would you give to a patient with tension-type headaches?
Answer Choices:
A. Avoid any physical activities
B. Implement stress-reduction techniques and limit acute treatment to 3 days/week
C. Increase daily coffee intake
D. Keep a strict bedtime of 11 PM
B. Implement stress-reduction techniques and limit acute treatment to 3 days/week - Reducing stress and modifying factors that contribute to muscle tension can help manage and reduce the frequency of tension-type headaches and avoid medication overuse headache.
A 60-year-old patient presents with complaints of dizziness and a sensation of the room spinning, which lasts for about a minute and is triggered by rolling over in bed. What is the most likely diagnosis?
Answer Choices:
A. Labyrinthitis
B. Meniere’s Disease
C. Benign Paroxysmal Positional Vertigo (BPPV)
D. Vestibular Neuritis
C. Benign Paroxysmal Positional Vertigo (BPPV) - The short episodes of vertigo triggered by specific head movements, such as rolling over in bed, are characteristic of BPPV.
Which clinical test is used to confirm the diagnosis of BPPV?
Answer Choices:
A. Audiogram
B. Romberg Test
C. Dix-Hallpike Test
D. MRI of the Brain
C. Dix-Hallpike Test - The Dix-Hallpike test is a maneuver used specifically to diagnose BPPV by inducing vertigo and observing for nystagmus.
What likely causes the symptoms experienced in BPPV?
Answer Choices:
A. Viral infection of the inner ear
B. Displacement of calcium carbonate crystals in the inner ear
C. Excessive endolymphatic fluid
D. Compression of the vestibulocochlear nerve
B. Displacement of calcium carbonate crystals in the inner ear - In BPPV, loose otoconia (calcium carbonate crystals) in the semicircular canals are responsible for provoking symptoms following certain head movements.
A patient with known BPPV presents for follow-up. Which of the following is an appropriate management strategy to alleviate their symptoms?
Answer Choices:
A. High-dose steroids
B. Head positioning maneuvers
C. Bed rest
D. Surgical decompression
Rationale:
B. Head positioning maneuvers - Specific maneuvers such as the Epley maneuver can help reposition the displaced otoconia and alleviate symptoms of BPPV.
What risk factors could potentially predispose an individual to develop BPPV?
Answer Choices:
A. Sudden loud noise exposure
B. Sustained vibratory stimuli and traumatic head injury
C. Chronic middle ear infections
D. Recent antibiotic use
B. Sustained vibratory stimuli and traumatic head injury - These are recognized risk factors associated with an increased likelihood of developing BPPV.
In the evaluation of a patient suspected to have BPPV, which of the following differential diagnoses should be considered?
Answer Choices:
A. Vertigo associated with multiple sclerosis
B. Postural orthostatic tachycardia syndrome (POTS)
C. Rheumatoid arthritis
D. Classical migraine without aura
A. Vertigo associated with multiple sclerosis - This is an example of a neurological condition that can present with vertigo, highlighting the importance of comprehensively evaluating differential diagnoses.
If conservative management for BPPV fails, and vertigo persists, which specialist might a patient be referred to for further evaluation?
Answer Choices:
A. Cardiologist
B. Endocrinologist
C. Otolaryngologist (ENT)
D. Dermatologist
C. Otolaryngologist (ENT) - Persistent vertigo despite conservative therapy suggests potential need for an ENT referral to explore further causes or advanced management options.
A 68-year-old patient with Parkinson’s disease is starting on Selegiline (Eldepryl), a Monoamine Oxidase (MAO)-B inhibitor. What is an essential dietary consideration this patient should be aware of when taking this medication?
Answer Choices:
A. Avoid high salt intake
B. Limit caffeine consumption
C. Avoid foods high in tyramine
D. Increase potassium intake
C. Avoid foods high in tyramine - MAO-B inhibitors can lead to food-drug interactions with foods high in tyramine, so dietary restrictions are advised to prevent hypertensive crises.
A Parkinson’s patient is prescribed Carbidopa/Levodopa (Sinemet). What should the FNP remind the patient about the timing of their meals in relation to medication intake?
Answer Choices:
A. Take with high-protein meals
B. Take with low-fat meals
C. Best absorbed on an empty stomach
D. Take with antacids
C. Best absorbed on an empty stomach - Carbidopa/Levodopa should be taken on an empty stomach or one hour before meals, as dietary protein can interfere with drug absorption.
A patient is experiencing sudden, severe immobility due to Parkinson’s “off” periods. Which medication can be used for rapid relief of their symptoms?
Answer Choices:
A. Entacapone (Comtan)
B. Pramipexole (Mirapex)
C. Apomorphine (injectable, sublingual)
D. Trihexyphenidyl (Artane)
C. Apomorphine (injectable, sublingual) - Apomorphine acts quickly and is often used as rescue therapy for rapid relief of “off” episodes in Parkinson’s disease.
What is a significant adverse effect to monitor for in a patient starting treatment with a dopamine agonist like Ropinirole (Requip)?
Answer Choices:
A. Gastrointestinal bleeding
B. Peripheral neuropathy
C. Excessive daytime sleepiness
D. Nephrotoxicity
C. Excessive daytime sleepiness - One of the known side effects of dopamine agonists is somnolence, which can result in sudden sleep episodes during daytime activities.
A 70-year-old patient is being treated with Benztropine mesylate (Cogentin), an anticholinergic. Which side effect should be highlighted due to potential impact on patient safety?
Answer Choices:
A. Hyperthermia
B. Exophthalmos
C. Urinary retention
D. Bradycardia
C. Urinary retention - Anticholinergics like Benztropine can cause urinary retention, dry mouth, and other anticholinergic side effects, which must be monitored, especially affecting older adults.
Which adverse effect should be closely monitored in a patient taking Entacapone (Comtan), a COMT inhibitor, in combination therapy with Carbidopa/Levodopa?
Answer Choices:
A. Elevated liver enzymes
B. Diarrhea and orange urine
C. Hypotension and urine discoloration
D. Increased intracranial pressure
B. Diarrhea and orange urine - These are common side effects when taking COMT inhibitors along with increasing the effects of levodopa.
Amantadine (Symmetrel) is prescribed for a patient with Parkinson’s disease. For which underlying condition should the FNP exercise caution when prescribing this medication?
Answer Choices:
A. Severe hypothyroidism
B. Diabetes mellitus
C. Congestive heart failure
D. Chronic obstructive pulmonary disease (COPD)
C. Congestive heart failure - Amantadine can have an arrhythmogenic effect and may exacerbate symptoms of heart failure, necessitating caution in patients with cardiac conditions.
