The patient with headache

Question 1

When should prophylaxis be considered for migraines?

Answer 1

If > 4 attacks per month or attacks are severe.

Question 2

What is 1st, 2nd and 3rd line prophylactic treatment for migraines?

Answer 2

1st line: Propanolol or amitriptyline
2nd line: Topiramate or sodium valproate
3rd line: Gabapentin

Question 3

What are the 3 most common causative organisms of bacterial meningitis?

Answer 3

Neisseria meningitides
Haemophilus influenzae (kids < 5)
Streptococcus pneumoniae (children > 2, elderly)

Question 4

Which type of cells would you expect to see elevated levels of in a bacterial meningitis lumbar puncture?

Answer 4

Neutrophils

Question 5

Which type of cells would you expect to see elevated levels of in a viral meningitis lumbar puncture?

Answer 5

Lymphocytes

Question 6

What is the immediate treatment for suspected bacterial meningitis?

Answer 6

1.2g IM/IV benzylpenicillin. If pen. allergic, 1g IV cefotaxime

Question 7

What prophylactic antibiotic should be offered to contacts in droplet range of someone with bacterial meningitis?

Answer 7

Ciprofloxacin or rifampicin

Question 8

What is the treatment of temporal arteritis?

Answer 8

200mg iv Hydracortisone or 40mg prednisolone immediately. Refer to neurology and ophthalmology.
Consider starting on aspirin 75mg for stroke prevention