OSCE Flashcards
Acronym for diagnosing a migraine
POUND criteria
Pulsatile/pounding hOurs (4-72 hours) Unilateral Nausea Disabling
(Family practice: headache)
Acronym for headache red flags
SNOOP
Systemic symptoms /or/ Secondary features (HIV or cancer)
Neurological symptoms or signs (altered LOC, focal neuro symptoms/signs, papilledema)
Onset: sudden and maximal at onset - “thunderclap” /or/ Older (over 40)
Other associated features: worsens with Valsalva, cough, exertion, sex; awakens from sleep, trauma
Pattern change: new headache, new symptoms, progressive, increasing frequency
(Family Practise seminar)
Physical examination for headache
Vitals
Eye exam (acute angle closure glaucoma)
Screening neuro exam (Cranial Nerve exam, gait and coordination, pronator drift, sensory and motor)
Listen to heart and lungs
Peripheral vascular exam (temporal arteritis)
Mental status, LOC
kernig’s sign and Bradzinski sign (meningeal irritation - meningitis and subarachnoid hemorrhage)
Check neck stiffness and tenderness (meningitis)
Jolt accentuation (meningitis)
Meningitis symptom triad
Neck stiffness
Fever
Nausea
Rash
Clinical Signs for meningitis
Kernig sign and Bradzinski sign
Areas assessed in a Neurological Exam
Mental status Cranial nerves Sensory Motor Gait Coordination
Refer back to Neuro clin skills notes and summarize
Treatment for chronic, mild tension headaches
Acetaminophen +/- ibuprofen
+ caffeine
+amyitryptaline (prophylactic antidepressant)
(Migraine treatments like ergots won’t help)
When would you not give Advil?
Kidney disease or cardiovascular disease (stop using NSAIDs)
Causes excess restriction of afferent arteriole
Bleeding disorder
When would you not give Tylenol?
Liver disease
Non-pharmacological interventions for regular tension headaches
Sleep, exercise, regular meals
Behavioural treatments, biofeedback, acupuncture
Headache diary to track when they’re happening, precipitating factors, medications used.
Acute, concerning headaches (4)
Meningitis/Encephalitis Thunderclap headache Elevated intracranial pressure Acute angle closure glaucoma Temporal arteritis
(Family Practise Headache seminar)
5 common headaches
Migraine Viral headache Tension Headache Medication overuse Temporal-Mandible Joint Syndrome Cluster headache Cervicogenic, trauma
(Family Practise Headache Seminar)
Medication overuse headache
Use of ergots or tryptans >10 days/mo
Opioids >10 days/mo
Tylenol/Advil >15 days/mo
Medication used to work but isn’t anymore, headaches are getting worse.
Stop taking the medications and headaches should resolve within a few days.
If they can’t go off completely you might be able to do prophylaxis (Amitriptyline), and then we may talk about Botox injections, beta blocker.
Workup for depression, anxiety.
Describe crackles
due to opening of small airways or secretions. They are a discontinuous sound, which sounds like velcro coming apart. These may be coarse or fine and early, late or continuous.
- early crackles – bronchiectasis, and occasionally with asthma
- late crackles – pulmonary fibrosis, congestive heart failure
- continuous – pneumonia
Describe wheeze
all expiratory sounds are now called wheezes, and may be coarse or fine.
They may be due to bronchospasm, secretions, airway collapse or obstruction. In the past, and in many texts, you will see a term called “Rhonchi”. What was called
“Rhonchi” are now called ‘coarse wheezes’
