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FNPII Test 3 > Nuro > Flashcards

Nuro Flashcards

1
Q

CM: facial pressure, pain behind forehead and/or cheekbones

A

sinus HA

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2
Q

Uncommon, males primarily
Occurs in cycles, seasonal component
CM: in and around one eye; autonomic symptoms (nasal congestions, sweating of forehead, watery eyes, runny nose) → looks like allergy HA, but on ONE SIDE

A

Cluster HA

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3
Q

Unilateral, punding, pulsating pain; fam hx common
Patho: most unknown; Vascular component instability around trigeminal nerve (neck, forehead, cheek, eye pain)
Typically decrease in elderly → if older individual presenting with HA consider secondary cause, medication overuse
CM: pain, nausea, visual changes, photophobia
Have to ask if worst HA they’ve ever had, if yes → ED to r/o hemorrhage
If systemic components like fever → refer

A

Migraine

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4
Q

Vague sx day before, just not feeling well, moody, irritable → many don’t recognize this

A

Prodrome

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5
Q

ALWAYS sensory, not motor!! Altered vision (most common), taste, smell, speech
Impacts treatment → always ask!

A

Aura

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6
Q

Can last a long time; most difficult to tx is one someone wakes up with

A

HA Attack

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7
Q

Up to 24 hours of feeling “off” after HA; majority experience this

A

Postdrome

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8
Q

Migraine Red flags

A

> 50 y/o, thunderclap HA (worst HA of life), neurological sx, immunocompromised

+ asymmetrical eye reflex, decreased DTR, personality changes

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9
Q

Criteria for migraine without aura (5, 2, 1)

A

5 or more episodic HA lasting 4-72 hours WITH:
2 of the following
Unilateral location, throbbing/pulsating, worsened by mvmt, moderate to severe intensity
1 of the following
n/v, phonophobia/photophobia

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10
Q

PE for Migraines

A

Vitals
neuro exam (CN 2-12, fundoscopic exam (rule out papilloedema), visual fields, strength, DTRs)
skin (meningeal rash → purpura, petechiae)
HEENT
CV

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11
Q

Most common headache, not often seen as people treat at home with OTC
CM: band-like squeezing of the head
Can be indicted my medications or stress

A

tension HA

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12
Q

OTC meds for HA

A

No ASA under 16 (no excedrin migraine!); NO opioids for migraine recommended!
Pt should not take more than 15 doses of NSAIDs/month

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13
Q

Tx of choice for migraine

Serotonin drugs, risk of serotonin syndrome (within 24 hours of initiation)

A

Triptans

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14
Q

NOT 1st line

Can cause peripheral ischemia (contraindicated for hx of CV dx) can cause N/V

A

Ergot derivatives

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15
Q

Can help break cycle of HA after many days

A

Steroids

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16
Q

1st line preventative meds for HA

A 
beta blockers (propranolol)
TCAs (amitriptyline) → none in elderly! ,

Depakote, Topiramate (least side effects; can decrease brain function/cognitive ability);
(alternative: verapamil)

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17
Q

2nd line preventative meds for HA

A

botox, ergot derivative (possible: cyproheptadine, gabapentin)

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18
Q

3rd line preventative meds for HA

A

calcitonin gene-related peptide (CGRP)

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19
Q

5-9 y/o; sx for 1-72 hours; midline abd pain; no HA, n/v; challenging to diagnose

A

Abdominal Migraine

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20
Q

vague presentation → irritable, whiny, appetite off, ℅ head hurting all over (10% school aged have migraines)

A

Young school age HA presentation

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21
Q

can present with headbanging

A

young kids with HA

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22
Q

shift to unilateral, adult-like presentation; recognizing triggers is important
Hormonal, weather-driven, food, lack of structured eating and bedtime routine

A

Adolescent HA presentation

23
Q

Tx pedi HA

A

OTC meds (1st line → ibuprofen, acetaminophen; NO

ASA >16 y/o)Antiemetics (phenergan, promethazine, compazine; NO zofran)

24
Q

PE for pedi HA

A

Vitals, head circumference, neuro, HEENT, mental status, skin, CN1-12
If brain tumor is cause: will have neuro signs (98%), typically gait is off

25
RX meds for PEdi HA
Triptans (sumatriptan, rizatriptan >6 y/o; almotriptan, zolmitriptan >12 y/o) Cyproheptadine (used in neurology, used to be used to help stimulate appetite in older population; can prevent AND treat HA) Propranolol (titrate r/t possible effects) ***If patient is using more than 2x/week can cause HA**
26
What meds not to take with HA while pregnant What can you take?
No ergotamine → category x, known teratogenic effects Best to stop pre-conceiving Taper preventative meds None safe in pregnancy Acetaminophen ONLY recommended drug for tx
27
resistance and head or neck pain are elicited when the patient bends over and touches toes can indicate meningitis
Kernig Sign
28
patient spontaneously flexes hip and knees after the examiner passively flexes the neck Meningeal sign
Brudzinski
29
CN 1-12
I= smells II= Visual acuity, visual fields, fundoscopic exam III, IV, & VI= Pupillary response to light, EOM, ptosis V= Sensation to light facial touch, temporalis and masseter strength VII= Symmetry of smile and rise of eyebrows, puff cheeks VIII= Weber and Rinne; whisper test IX & X= Say “ahh” see rise of uvula; gag reflex XI= Shoulder shrug, turn head against resistance XII= Stick out tongue
30
Acute inflammation of CN VII; common disorder
Bell's Palsy (CN VII)
31
Abrupt onset of unilateral facial sx often preceded by 1-2 days of pain behind ear on affected side Rapid progressive muscle weakness on one side of the face over 2-3 days inability to close the eye, sagging of lower lid with subsequent eye irritation and tearing
Bell's Palsy (CN VII)
32
Causes of Bells Palsy
herpes simplex, CN lesions (multiple sclerosis, stroke, tumors, lyme dx); increased incidence with DM + lyme dx
33
PE findings w/ bells palsy
Decreased nasolabial fold Asymmetric smile Pooling of food and saliva on affected side Alteration of taste on one side of tongue Hyperacusis of affected side
34
What to rule out with bells palsy
STROKE!
35
TX bells palsy?
Lubricating eye drops while awake and patch for sleeping → prevent corneal drying massage/physical therapy of weakened muscles Prednisone 60-80mg daily x7 days (except in diabetics) Severe cases: acyclovir 1000mg TID x7 days send to opthomology
36
Compression of arterial blood supply to CN V Irritation or demyelination of CN V Typically develops in females >40
Trigeminal Neuralgia
37
Intermittent pain: severe, sharp, shock-like, stabbing → lasting seconds to minutes Pain from CN V irritated by tactile stimulation or even wind on face Triggers: tactile stimulation, chewing, swallowing, wind, touching face, other mvmt Location of trigger area usually 2nd or 3rd division of cranial nerve V Associated grimacing (tics): tic douloureux with trigeminal nerve stimulation Frequent relapsing/remitting
Trigeminal Neuralgia
38
causes of Trigeminal Neuralgia
MS, basilar artery aneurysm, neoplasm, arterial venous compression, brainstem infarction
39
Dx and tx of trigeminal neuralgia
Diagnostic= Clinical features, Brain CT/MRI to distinguish other diseases ``` Tx: Neurology referral** 1st line: carbamazepine (anticonvulsant) 2nd: Baclofen, Lamotrigine Surgery if needed ```
40
Generalized, last <15 min, do not recur in 24 hours | Most simple, last only few minutes, do not cause long term health problems; children 6 mos -5 y/o
simple febrile seizure
41
What to do if child has febrile seizure?
Note start time; position child on side to prevent aspiration If >5 min or less than 5 min and not recovering quickly → 911 Take child to ED to evaluate cause of fever
42
Last >15 min OR occurs another time within 24 hours, includes postictal weakness; children 6 mos -5 y/o
complex febrile seizure
43
prevention of febrile seizures?
Anti-seizure meds → NOT recommended acetaminophen/ibuprofen → does not reduce risk, but helps with comfort and lowering fever If prone to febrile seizure: diazepam when child HAS a fever
44
concussion diagnostics
HEADSUP (Ace Concussions Exam {ACE}) exam tools | Blood work, scans PRN
45
meds to help recover from concussion
Antiemetics, analgesics for acute sx Antidepressants (SSRI > TCAs) Amantadine → for poor concentration; concurrent with mental health provider
46
acute tx of concussion
Rest from learning, screens, reading (anything taxing to brain) Expected recovery: 5-10 days college-aged with no comorbidities Kids may take longer to recover (30 or more days, be conservative in young athletes) Adults typically recover within 30 days Individualized mgmt is key! work/school/sport note for accommodations
47
how to tx cluster HA?
try and tx asap- fast onset...parental or nasal (triptan) Oxygen 10-15 L (get script for pt to have at home) practice= verapamil, lithium
48
When can someone with concussion return to sports?
after gradual stepwise approach ... after the athlete has been asymptomatic for 24 48 h. An athlete advances through the steps continually as long as remaining asymptomatic. Each step should be a minimum of 24 h. If any symptoms occur, the athlete should then be asymptomatic for another 24 h before attempting the previous step. The steps include: (1) no activity (2) light aerobic exercise (3) sport-specific exercise (4) noncontact training drills (5) full-contact practice (6) return to play.4
49
HA that comes in waves
pheochromocytoma
50
HA not usually aggravated by physical activity
Tension Can tx with CCB, BB
51
Papilloedema persisitent unilateral HA abnormal eye movements
Red Flags
52
Primary vs secondary trigeminal neuralgia?
``` Primary= compression of the nerve secondary= pressure on the nerve by tumor, MS, cyst etc... "wave-like recurrent pain" ```
53
What is important to remember when tx trigeminal neuralgia with carbamazepine?
titrating up to control the pain the decrease to lowest effective dose

FNPII Test 3 (7 decks)

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