Quiz 1: Head and Nose Flashcards
What are Red Flag symptoms indicating a person needs immediate medical attention?
Unconsciousness, alt. mental status, convulsions, persistent HA, extremity weakness, bleeding/fluid from ear(s), loss of hearing
Post-concussion syndrome
1) duration
2) symptoms
1) symptoms can persist for weeks to years
2) HA, fatigue, anxiety, dizziness, memory & attention problems, sleep disturbance, irritability, N/V
What percent of US population seeks medical help for HA?
5-10% of total pop; 20% kids have significant HA
Types of primary HA
Migrane, tension-type HA, cluster HA
Of primary HA, which is least common?
cluster
What percent of all HA are primary HA?
90%
What is meant by Secondary HA?
Caused by underlying medical condition
What are some causes of secondary HA?
Head and neck trauma, cranial or cervical vasc. disorders (hematoma, hemorrhage), non-vasc. intracranial disorders (high/low CSF pressure, infection (meningitis or systemic), disorders of homeostasis, substance abuse/withdrawl, psychiatric conditions, cranial neuralgia, iatrogenic
What are causes related to these S/Sx of Secondary HA
A. Sudden onset of new HA or “worst HA ever”
B. Fever
C. Weakness, clumsiness, postural instability
D. Onset w/ exertion, coughing, sex, valsalva
A. Subarachnoid hemorrhage
B. Infection
C. Focal brain disease
D. Mass, subarach. hemorrhage
What are causes related to these S/Sx of Secondary HA
A. Drowsiness, confusion, memory loss
B. Progressive vision loss
C. Chronic malaise myalgia, arthalgia
A. Infx, mass, subdural hematoma
B. Tumor, inc ICP, MS, Lyme, glaucoma, arteritis
C. Temporal arteritis, collagen vasc. dz, Lyme
T or F: Additional causes of secondary HA
A. Low BP
B. Headache is the same intensity every time
C. Metabolic imbalance (hypoglycemia, thyroid)
D. Focal neurological signs
E. CSF rhinorrhea
A. False, high BP B. False, progressively worsening C. True D. True E. True
Vasc or Non-vasc HA?
A. Pain is throbbing or pounding/sharp
B. Pain is steady, constant, dull
C. Rapid changes in artery size from spasm/contraction
A. Vasc
B. Non-vasc
C. Vasc
Vasc or Non-vasc HA?
A. Examples: HTN, exertion, hangover
B. Examples: Tension-type, TMJ, brain tumor
C. Examples: Sinus/dental infx, inner/middle ear
D. Examples: Migrane, cluster, fever
A. Vasc
B. Non-vasc
C. Non-vasc
D. Vasc
What are Red Flags that you may get upon taking a history for HA that would indicate the patient needed to go to the ER?
Onset after age 50+ or sudden onset
Incr. freq. and severity
Pain moves to lower neck and thoracic spine; lower back
First or worst HA
History of head trauma, HIV, cancer
Any change in mental status, personality, level of consc.
What is the most important exam during the physical exam for HA?
Fundoscopic exam
What is done during the physical exam for a HA?
vitals
head and neck (carotid/temporal a. pulsations, cervical ROM, tenderness, palpate cranium, jaw, neck, sinus, perform oral and ear exam)
Neuro exam (CN, motor/sensory, reflexes, coord.)
fundoscopic exam
What are the Red Flags that might be found during the physical exam?
Fever, neck stiffness/rigidity, papilledema, focal neuro signs, signs of systemic illness or infx
Features of migranes
recurrent, variable (intensity, freq, duration), usually unilateral, anorexia, N/V, maybe aura, photophobia, wipes you out.
What is the most common type of HA? Second?
Tension-type, then migrane
Describe epidemiology of migranes
10-20% of US pop suffers
F:M 3:1
First attack often in childhood
Co-existing conditions associated with migranes
Epilepsy, asthma, sleep disorders, hemorrhagic telangiectasia, Tourettes, Raynauds, familial dyslipoproteinemias, chronic fatigue, depress/anx, ischemic stroke, HTN, atrial septal defect
Triggers for migranes
Stress, hormones, hypoglycemia, loss of sleep, change in weather, odors/lights/smoke, exercise, food intolerance/allergy, tyramine containing foods (antipasto)
What are the two main categories of migranes?
With aura (classic) Without aura (common)
Do the following describe migranes with or w/o aura? A. Must have had at least 5 attacks B. HA must last 4-72 hrs C. Dysphagia - speech disturbance D. Photo/phono- phobia
A. W/out aura
B. Both, but with aura must be preceded by aura
C. With aura
D. Both
Do the following describe migranes with or w/o aura?
x
Do the following describe migranes with or w/o aura?
x
What are prodromal symptoms? Examples?
Occur hrs/days before migrane
hyperactivity, lethargy, depression, cravings, freq. yawning
