Term
| what are the most common causes of headache |
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Definition
viral rhinitis / common cold
sinusitis
fever
hypertension
refractive error
tension headache
hypoglycemia
post ictal headache |
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Term
| what are the symptoms of a sinusitis |
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Definition
Frontal dull headache, worse in morning, increased pain in cold damp air, nasal discharge
Pain behind forehead and or cheek bones |
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Term
| what are the symptoms of refractive error |
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Definition
Mild to moderate, made worse with prolonged visual tasks
Resolve with refractive correction |
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Term
| what are the symptoms of a tension headache |
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Definition
Return periodically, may be seasonal
Sharp pain in and around one eye
50-180 min
Alcohol, histamine, nitroglycerine provoke
Often accompanied by lacrimation, rhinorrhea, conjunctiva infection
Mostly in men
Abrupt onset, eye and temporal, partial horners syndrome with ptosis, miosis on side of pain, nocturnal (1-2 hrs after sleep)
Symptoms of migraine, headache, and cluster
No aura, vomiting |
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Term
| what are the symptoms of a cluster headache: what provokes, when is it most common, in who is it most common, how long is it |
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Definition
| • Paroxysmal parasympathetic discharge mediated through greater superificial petrosal nerve and sphenopalatine ganglion |
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Term
| tension headache: what makes it worse, what are the signs, how long, who is it most common in |
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Definition
Pain like band squeezing head
30 min – 7 d
Noise makes it worse
Pericranial tenderness
Equal in male and female |
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Term
| what are the symptoms of a tmj induced headache |
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Definition
TMJ tender, reduced mandible opening, noise with mandible movement
Jaw movements, talking, gum, tough food makes it worse |
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Term
| thunder clap headache: reason, symptoms |
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Definition
Subarachnoid hemorrhage
Sudden onset, severe, constant, elevated BP, can cause change in consciousness |
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Term
| symptoms of a subdural hemotoma headache |
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Definition
| Mild to severe, intermittent, neurologic symptoms, fluctuating consciousness |
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Term
| brain abcess headache signs |
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Definition
| Mild to severe, local or distant infection, may have fever, neurologic signs of infection site |
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Term
| meningitis headache signs |
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Definition
| Severe headache, radiation down neck, acute illness, fever, positive kernig’s sign |
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Term
| increased intraceanial pressure headache signs |
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Definition
| Mild to severe, neurologic symptoms (hemiparesis, visual changes), brainstem symptoms (vomiting, altered consciousness) |
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Term
| CNS neoplasm headache signs |
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Definition
Localized, focal neurologic symptoms, CN symptoms
Coughing, leaning forward, val salva make it worse |
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Term
| whate are the signs of a headache from toxicity, give 2 examples |
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Definition
General headache, pulsation, other toxicity signs
Analgesic overuse: squeezing pain, improves in 2 months of discontinuation
CO: temporary indoor heating |
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Term
| what are the signs of a headache from otitis media or mastoiditis |
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Definition
| Fullness in ear, stabbing pains in head, vertigo, tinnitus |
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Term
| what are the signs of a headache from optic neuritis |
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Definition
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Term
| what are the signs of headache from pre-eclampsia |
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Definition
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Term
| what are the parts of the head / brain sensitive to pain |
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Definition
o Scalp and scalp vessels
o head and neck muscles
o great venous sinuse
o arteries of meninges and cerebral arteries
o areas innervated by CN 5, 9, 10
o dura mater at base of brain |
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Term
| is the brain sensitive to pain |
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Definition
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Term
| what are the possible headache locations |
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Definition
o bi-temporal
o occipital
o fronal
o periorbital
o vertex |
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Term
| whatare the different natures of a headache |
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Definition
o Constant
o Paroxysmal
o Lancinating
o Throbbing |
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Term
| migraine: length, signs, what makes it worse, who is it more common in, when it is occuring, where on the head |
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Definition
• Pain, nausea, visual changes, pulsating
• 4-72 hrs
• Noise, light, walking, stairs makes it worse
• More common in females and familial. Strong association with mensturation
• Commonly unilateral
• Begins in childhood and diminishes with age |
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Term
| in a classic or neurologic migrane what are the symptoms, when does it occur, what relieves it, what aggrevates it |
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Definition
Prodromal occurs before headache: changes in mood, behavior, appetite, cognition
Aura: (Visual: photopsias (bright flashing lights), zigzag lines)(Sensory: numbness in limbs, motor weakness, aphasia)
Unilateral and throbbing
Follows 60 min after aura, lasts 4-72 hrs, 1-2 x a month
Nausea, vomiting (may relieve), photophobia, phonophobia
Aggrevated by strain, activity, head movement
Some relief with temporal pressure |
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Term
| in a common migraine what are the causes |
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Definition
| • Tryamine (cheese, wine), MSG, nitrates (cold cuts), pickeled food, alcohol, caffeine |
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Term
| what are signs of a lesion in the left parietal and temporal love |
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Definition
| decreased strength, aphasia, positive babinskis sign |
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Term
| what are signs of a lesion in the parietal lobe |
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Definition
| unable to follow commands |
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Term
| what are signs of lesion in the temporal lobe |
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Definition
| eyelid droop, cant blink to threat |
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Term
| patient with: weakness, inability to speak, HBP irregular, no bruits, left gaze preference, does not blink to threat, facial droop, moves left side spontaniously, upper right extremity is flaccid and does not withdrawl to noxious stimuli, DTR 2+, positive babinski on right. what is the differential diagnosis |
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Definition
| aneurysm, aneurysm rupture, vascular malformation, herpes simplex (likes temporal lobe), temporal or perietal lesion, stroke, tumor, tubercloma |
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Term
| patient with: weakness, inability to speak, HBP irregular, no bruits, left gaze preference, does not blink to threat, facial droop, moves left side spontaniously, upper right extremity is flaccid and does not withdrawl to noxious stimuli, DTR 2+, positive babinski on right. what tests do you perform |
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Definition
| CBCm chem7, CT, CT angiogram, urinalysis, ptt |
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Term
| patient with: weakness, inability to speak, HBP irregular, no bruits, left gaze preference, does not blink to threat, facial droop, moves left side spontaniously, upper right extremity is flaccid and does not withdrawl to noxious stimuli, DTR 2+, positive babinski on right, CT says no bleed. what is the treatment, under what conditions can the treatment be given? |
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Definition
| TPA (clot buster) as long as it is within 4.5 hour window of stroke, pt isnt on blood thinners, does not have BP > 180/105, and stroke mimicers have been ruled out first |
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Term
| what are the major exclusions for a clot buster? |
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Definition
| blood thinners, HBP > 180/105, make sure the issue isnt a troke mimicker, hemorrhage risk, platelets <100,000, increased MR, blood sugar > 500, blood sugar < 50, seizures at onset of stroke (embolic stroke) |
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Term
| when a stroke patient becomes more stable, how do you continue management |
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Definition
| send to stroke center or ICU, monitor BP, watch for bleeding, no asprin |
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Term
| what tests can be done to determine the etiology of a stroke |
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Definition
| DUT: transesophageal echo |
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Term
| if a stroke patient has a history of paryxysmal atrial fibrillation, how would you treat the patient long term |
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Definition
| cumadin, warfarin, heparin |
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Term
| if a stroke patient has 65% occlusion in carotid artery, what do you do? |
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Definition
| operate on systemic stenosis first |
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Term
| patient with: right sided weakness in face, arm, leg, no speech, sensory or visual deficits. where is the lesion? what is the syndrome called? |
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Definition
| pure motor or pure sensory deficits |
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Term
| pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion. what features are important to ask pt? |
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Definition
| quaility of pain, localization, if it is worse in the morning, if it has been going on for >3 days |
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Term
| pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion. what associated symptoms should you ask |
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Definition
| eye symptoms (light sensitivity/photophobic), nausea, vomiting, fever, increased WBC, night sweats (TB), phenophobia |
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Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia.
localization of these findings? |
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Definition
| cerebum involved, cant localize |
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Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia.
most likley diagnosis? |
|
Definition
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|
Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia.
differential diagnosis? |
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Definition
| meningitis, subarachnoid hemorrhage, lung cancer, non-hodfkins lymphoma, CO poisoning |
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Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia.
what other physical signs may be associated with this condition |
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Definition
| kering's and burdzinski's sign |
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|
Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia.
what tests would you order? |
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Definition
| Tox screen, head CT, chem 7, CBC, no MRI, meningitis culture |
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Term
| how can you determine viral vs bacterial infection |
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Definition
viral: RBC high
bacterial: WBC high |
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Term
| what are the potential complications of meningitis |
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Definition
| increased ICP, fungal mycobacterial infection, subdural edema, stroke, SIADH, increased intercranial pressure, seizures |
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Term
| what factors are important in the prognosis of meningitis |
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Definition
| functinal capacity, age, early therapy, length of infection, type of infection |
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Term
pt with: 35yo, male, headache, fever, strange behavior for a few days, confusion, sinusitis 2 weeks ago.
objective: vitals 39degC, 110/65, 90bpm, RRR. frontal tenderness, nuchal rigidity, disorientation, poor attention, photophobia. CT negative.
what lab tests should you send CSF for? |
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Definition
| RBC/WBC/neutrophils/lymphocyte cell count , gram stain, bacterial stain cultures, viral load, proteins |
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Term
| meningitis patient is HIV positive, what infection etiologies should be included in the differential diagnosis too |
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Definition
| TB neurosyphillis, toxoplasmosis, cryptococcosis |
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Term
| patient you thought had meningitis shows CSF RBC 2000. what is the new most likley diagnosis |
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Definition
| herpes, subarachnoid hemorrhage |
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Term
pt with: 28yo fm, 2 mo, tingling and numbness in feet, worse in morning, shock in feet on flexing neck, fatuge, heat intolerance, zoloft for stress.
Objective: mental wnl, CN wnl, lower extremities increased tone, strengeth wnl, decreased vibration sense in feet, DTR +3, normal proprioception.
what part of the nervous system is involved |
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Definition
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Term
pt with: 28yo fm, 2 mo, tingling and numbness in feet, worse in morning, shock in feet on flexing neck, fatuge, heat intolerance, zoloft for stress.
Objective: mental wnl, CN wnl, lower extremities increased tone, strengeth wnl, decreased vibration sense in feet, DTR +3, normal proprioception
differential diagnosis? |
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Definition
| infection (unlikley), vavolue in C spine, neuropathy, lead or murcery poisining, MS |
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Term
| what are some signs of MS |
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Definition
| upper motor motor and lower motor neuron tone |
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Term
pt with: 28yo fm, 2 mo, tingling and numbness in feet, worse in morning, shock in feet on flexing neck, fatuge, heat intolerance, zoloft for stress.
Objective: mental wnl, CN wnl, lower extremities increased tone, strengeth wnl, decreased vibration sense in feet, DTR +3, normal proprioception
what tests do you order? |
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Definition
| MRI cervical and thoracic |
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Term
pt with: 28yo fm, 2 mo, tingling and numbness in feet, worse in morning, shock in feet on flexing neck, fatuge, heat intolerance, zoloft for stress.
Objective: mental wnl, CN wnl, lower extremities increased tone, strengeth wnl, decreased vibration sense in feet, DTR +3, normal proprioception.
MRI lesion on T2 and C4-C5. CSF wnl, increased IgG
diagnosis? |
|
Definition
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Term
| what tests can help you diagnose MS |
|
Definition
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Term
pt with: 28yo fm, 2 mo, tingling and numbness in feet, worse in morning, shock in feet on flexing neck, fatuge, heat intolerance, zoloft for stress. pain in left eye, blurred vision
Objective: mental wnl, CN wnl, lower extremities increased tone, strengeth wnl, decreased vibration sense in feet, DTR +3, normal proprioception
diagnosis and treatment |
|
Definition
| neuromylitis optics, steroids (classic ms) |
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Term
pt with: 55yo, fm, severe headache, nausea, photophobia, sound phobia.
differential diagnosis |
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Definition
| tumor, migraine, temporal arthritis, meningitis, blood vessel constriction, tension, sinusitis, fever, hypertension, refractive error, hypoglycemia, post ictal headache, cluster, post traumatic brain abcess, glaucoma, tuhunder clap |
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Term
pt with:farigue, stiffness, tremor, difficulty performing tasks for year, turning, walking, small handwriting
objective:slow speech, decreased facial expression, increased tone, mild tremor on right, small quick steps.
diagnosis? |
|
Definition
parkinsons syndrome: sign and symptoms leading to secondary disease
or
parkinsons disease: affecting one area
or
trauma |
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Term
pt with:farigue, stiffness, tremor, difficulty performing tasks for year, turning, walking, small handwriting
objective:slow speech, decreased facial expression, increased tone, mild tremor on right, small quick steps.
where is the lesion |
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Definition
| basal nuclei, mostly substantia niagra which is made of locus serrilus nuckei and pars compacta |
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Term
| what symtoms of a lesion in the basal nuclei present as |
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Definition
| decreased dopamine, tremors, rigidity, statue face, imbalanced gait or shuffle, aphasia, congitive deficiency, early dementia due to accumulation of lewy bodies, small writing |
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Term
pt with:farigue, stiffness, tremor, difficulty performing tasks for year, turning, walking, small handwriting
objective:slow speech, decreased facial expression, increased tone, mild tremor on right, small quick steps.
how can parkins be distinguished? what are other causes? |
|
Definition
CT/MRI
trauma, infection, medication, no genetic causes, racial links to northern europeans |
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Term
pt with:farigue, stiffness, tremor, difficulty performing tasks for year, turning, walking, small handwriting
objective:slow speech, decreased facial expression, increased tone, mild tremor on right, small quick steps.
what tests are needed |
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Definition
| MRI, CT, CBC, chem7, pet scan |
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Term
| how is parkinsons treated |
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Definition
dopamine replacement with levodopa which is corgi dopa and dopamine. corgi dopa keeps domapine in CNS and synaptic terminal
in 10 years pt bed ridden |
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Term
pt with: 70yo wm, right handed, cannot remember appointments, strange fears, unable to pay bills, 25/30 MMSE, neuro exam wnl
where is the lesion? give a reason for the location being in that area (4 types) |
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Definition
o Temporal lobe due to verbal memory impairment
o Right handed will cause more loss in the left frontal lobe
o Parietal lobe and frontal lobe involvement due to decreased circulation and visuoseptal function in non-dominant parietal region
o Left and right frontal lobe due to apathy and delusion |
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Term
pt with: 70yo wm, right handed, cannot remember appointments, strange fears, unable to pay bills, 25/30 MMSE, neuro exam wnl
diagnosis and differential diagnosis |
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Definition
Dx: Dementia type of Alzheimer’s (vascular disease with Alzheimer’s disease as the differential diagnosis) or vascular dementia alone.
ddx v• Vascular dementia, Alzheimer’s, thyroid issues, B12 deficiency, subdural hematoma, thiamine deficiency, toxins, formaldehyde, MS, Huntington’s, prion infection, meningitis, hydrocephalus, paneoplastic syndrome, metabolic deficiency, traumatic brain injury, tumor |
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Term
| vascular alzheimers: risk factors, most common pathology, symptoms, MRI signs |
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Definition
o Risk factors: aging, down syndrome
o Pathology: neurofibralatory triangles (plaques) from the brain in the neocortex and hippocampal region
o Symptoms: memory impairment, aphasia, apraxia, bed ridden in 10 years
o MRI results: black areas of plaque, shrinking, enlarged ventricles, decrease in neurons |
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Term
pt with: 70yo wm, right handed, cannot remember appointments, strange fears, unable to pay bills, 25/30 MMSE, neuro exam wnl
what tests do your order |
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Definition
• MRI to show frontal and parietal lobe, enlarged cavities, decreased neurons
• Prion tests, MS, meningitis, blood work
• RPR, UDRI (syphilis test), cat scan, thyroid reaction, B12 test, ECG |
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Term
pt with: 70yo wm, right handed, cannot remember appointments, strange fears, unable to pay bills, 25/30 MMSE, neuro exam wnl, blood work wnl, MRI with diffuse atrophy consistant with age, more atrophy in temporal and parietal
leading diagnosis, treatment |
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Definition
| • Dementia, continued neurologic degradation, abnormal behavior, delusions, Alzheimer’s, aercept (slow degration of neurons due to pressure), taerin (ACh esterase inhibitor), healthy food |
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Term
| what can you tell the family of an alzheimers pt |
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Definition
• Family needs to take care of and support patient
• Patient will be bed ridden within 10 years
• Dementia makes the patient a phsyc patient |
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