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43 Cards in this Set
- Front
- Back
- 3rd side (hint)
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T/F Muscle tension cephalgia usually presents as a dull ache that worsens with stress and as the day progresses.
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True
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T/F Nausea and vomiting are frequently associated with muscle tension cephalgia.
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False: Migraine with or without aura
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T/F Migraine with aura presents with a warning that a migraine is pending before the pain actually starts.
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True
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T/F Cluster headaches are predominantly in males, come in groups and are frequently associated with unilateral nasal congestion and eye tearing.
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True
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T/F A patient presenting with a sudden severe headache with progression of pain, fever, neck stiffness and alteration in consciousness most likely has migraine with aura.
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False: r/o infection, metastatic dz, etc.
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T/F Chocolate, alcoholic beverages, menstruation or use of oral contraceptives can all be migraine triggers.
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True
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T/F Migraine headaches are rarely triggered by emotional stress or change in sleeping patterns.
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False
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T/F Chronic daily headache syndrome can be a result of analgesic rebound.
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True
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T/F Papilledema noted on eye exam, disorders of equilibrium, gait, coordination and muscle weakness may indicate increased intracranial pressure.
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True
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T/F Beta-blockers, calcium channel blockers, anticonvulsants and SSRIs are commonly used for migraine prophylaxis.
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True
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T/F The ergot and triptan medications are frequently combined to abort a severe migraine headache.
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False: Should NOT combine
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T/F Heavy menstrual bleeding can be associated with hypothyroidism.
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True
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T/F Caffeine can precipitate a headache through excess or withdrawal.
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True
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T/F Unexplained anemia, elevated serum cholesterol and increased serum CK are all found in hyperthyroidism.
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False: These are found in hypOthyroidism
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T/F Major contraindications to the use of the ergot and triptan medications are HTN, coronary artery disease, cerebrovascular disease as well as peripheral vascular disease.
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True
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A 34 yo female presents with fever, a severe headache and altered mental status. On physical exam, movement of her neck causes increased headache pain. The most important procedures/test for diagnosis are:
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CT and lumbar puncture
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When a patient presents with a severe headache, indications for neuroimaging include which of the following:
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-abnormal neurologic examination
-progression of severe headache over time -risk factors such as immune deficiency or history of malignancy that may metastasize to the brain. |
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A 70 yo male presents with a unilateral headache and blurred visions in his right eye. He states that his tongue and jaw ache when he eats (jaw claudication). On PE the pt exhibits exquisite tenderness over the right side of his scalp to palpation. The dx procedures required for this pt would be:
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temporal artery biopsy
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A 47 yo female presents with sudden onset of a severe headache- "the worst she has ever had." She had been cleaning house and suddenly slumped to the floor with severe headache pain and weakness. Her most likely diagnosis is:
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subarachnoid hemorrhage
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A 78 yo man presents with an acute onset of a left-sided paralysis that evolved over several hours in the middle of the night. On examination, the pt's bp is 130/82. His pulse is 96 and regular. Neurologic exam reveals a left-sided hemiplegia along with hemianesthesia. There is a left homonymous hemianopsia. His head and eyes are deviated to the right side. The artery that is most likley involved is the:
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Right MCA
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The mechanism for this pt's disease (MCA-caused intracranial vascular thrombosis) Most likely relates to:
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thrombosis over an atheromatous plaque
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The diagnostic procedure of choice for a pt with a thrombosis over an atheromatous plaque involving the MCA would be:
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NECT
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If the pt has an ischemic infarction and the neurologic deficits appear to worsen, the drug of choice in this pt during the acute phase would be:
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Heparin
Heparin is used when there is no CT evidence of a cerebral hemorrhage and there is progression of the neurologic deficits. Aspirin is only recommended in the chronic phase of the stroke and for the prevention of TIAs. |
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A patient presents with a left-sided neurological deficit including weakness and decreased sensation in both the left arm and left leg. The symptoms evolved over 3 hours and lasted 10 days. The symptoms then cleared completely. This is called a:
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Reversible ischemic disability. This refers to an ischemic neurologic deficit that lasts longer than 24 hours but resolved in 3 weeks.
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What is an ischemic event that leaves persistent disability but is short of a calamitous stroke?
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Partial non-progressing stroke.
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A more severe ischemia that produces permanent neurologic disability is termed a?
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complete stroke
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What is a gradual worsening of neurological symptoms over hours or weeks?
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A stroke-in-evolution
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What refers to episodes of neurologic dysfunction that develop suddenly and completely clear within 24 hours?
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TIA
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A 25 yo woman is admitted to the ED with a sudden onset of a severe headache. She describes this headache as the "worst headache she has ever had." She has no previous history of other significant illness, including migraine headaches. Physical exam reveals a stiff neck. Her BP is 150/96. The HA persists despite an injection of meperidine. The most likely diagnosis is:
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subarachnoid hemorrhage.
(it is most likely a cerebral aneurysm located close to the Circle of Willis.) |
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A 69 yo man with a history of CAD and HTN presents with acute right facial weakness and numbness. On examination, his speech and extremity strengths are normal, but he has significant weakness of the right face, including the orbicularis oculi. In addition, he complains of roaring in the right ear, and his taste sensation is absent on the right side of the anterior tongue. Sensation is normal to pinprick. The pt most likely has:
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Bell's Palsy.
Bell's Palsy is idiopathic and nearly always acute. |
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All of the following would characterize Gerstmann's syndrome involving the left middle cerebral artery EXCEPT:
-dyscalculia -right-left confusion -agraphia -finger agnosia -denial of the right side |
Denial of the right side.
-left-sided lesions due to a MCA thrombosis are not associated with denial. A lesions of the right MCA, however, would be associated with denial on the left. |
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What is Gerstmann's syndrome?
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Gerstmann syndrome is characterized by four primary symptoms:
-Dysgraphia/agraphia: deficiency in the ability to write -Dyscalculia/acalculia: difficulty in learning or comprehending mathematics -Finger agnosia: inability to distinguish the fingers on the hand -Left-right disorientation |
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Urinary incontinence, contralateral hemiplegia involving the lower extremities more than the upper extremities and face, and primitive reflexes characterize a problem with:
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Anterior Cerebral Artery
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Ipsilateral cranial nerve findings, contralateral sensory and/or motor deficits, vertigo, ataxia and nystagmus characterize involvement of the
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vertebral and basilar artery
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A 22 yo male is brought to the ED by his wife. According to her, her husband was raking leaves in the back yard, when he suddenly lost consciousness, became rigid, and fell to the ground. His respiration temporarily ceased. This lasted for 45 sec and was followed by a period of jerking all 4 limbs for 2-3 min. The pt then became unconscious for 3-4 min. On examination, the pt is drowsy. There is a large laceration present on his lip. The neuro exam is otherwise unremarkable. Vitals are normal. This pt most likely has.....
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Tonic-Clonic Seizures. These are often associated with a sudden loss of consciousness. The tonic phase is characterized by extended legs, abducted arms and pronotated hands. The clonic phase is characterized by generalized body musculature jerking.Following this is a stage of flaccid coma. Upon wakening, the pt is frequently confused (postictal state).
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Re: the Tonic-Clonic seizure patient:
Which of the following tests would be LEAST useful in the work-up of this patient? -Electroencephalogram -CT scan -Electrolytes -Serum glucose -Skull X-ray |
Skull X-ray would be least useful.
EEG is the gold standard test in working up seizure disorders. |
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Re: the Tonic-Clonic seizure patient:
Which of the following drugs would be LEAST useful in the treatment of this patient? -Phenytoin -Carbamazepine -Phenobarbital -Primidone -Ethosuximide |
Ethosuximide because it is primarily used in treating absence seizures
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A mother presents to your office with her 12 yo daughter. The mother states that for the past 6 months, she and her daughter's teacher have both noticed the child staring into space. This lack of concentration usually only lasts 5-10 seconds.Sometimes there appears to be brief twitching of all limbs during this staring episode. The child's neuro exam is normal. An EEG was performed on an outpatient basis. The patient most likely has....
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Absence (petit mal) seizure. They usually occur in children. They usually present with an abrupt onset that stops all activity. The pt recovers as abruptly as it began and either has partial or no memory for the event. The classic EEG finding is a 3-Hz spike-and-wave pattern. As a rule, these seizures terminate by the third decade.
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RE: the absence seizure patient:
Which of the following drugs would be LEAST indicated in this patient? -Phenytoin -Ethosuximide -Valproic acid -Clonazepam |
Phenytoin is not effective in treatment of absence seizures.
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A 26 yo woman presents with progressive writhing and jerking mvmts of the extremities. She has a brother and sister who are normal and a 1st cousin with a similar problem who died at 45 years of age. A CT of the brain was normal but an MRI reveals hypodense basal ganglia, bilaterally. Her serum transaminases are both elevated with ALT>AST. The alk phos and GGT are only midly elevated. Which of the following test would be MOST USEFUL in this pt?
-anti-mitochondrial antibody -total copper with fractionation into bound and free -Serum ferritin -Heavy metal screening -serum ammonia |
Total copper with fractionation into bound and free.
This pt has Wilson's disease (AR) with a defect in the excretion of copper into bile. |
Copper accumulation in the hepatocytes produces acute followed by chronic hepatitis.
Chronic liver disease lowers the ceruloplasmin levels, which in turn, reduces the total copper (because the amt bound to ceruloplasmin is reduced), but the free copper level is increased.The excess free copper deposits in Descemet's membrane of the eye to produce Kayser Fleischer rings and in the lenticular nuclei to produce the chorea movement. |
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An aura characterized by foul smell or taste sensations followed by isolated, rhythmic jerking of the face or extremities sometimes involving a sequential movement around the body without any loss of consciousness is MOST characteristic of a/an...
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Simple Partial Seizure.
Complex partial seizures will have total or partial loss of memory and consciousness. |
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There is an MRI from a 60 yo woman who presented with a new onset of simple partial seizure involving her left arm and leg. There is a large lesion in the right frontal lobe. The pt's seizure is MOST LIKELY related to......
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a glioblastoma multiforme.
Glioblastomas (malignant glioma) are the most common adult malignant brain tumors. If the pt had a history of a previous cancer, then it would be possible that this was metastasis to the brain. |
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A 38 yo woman complains of experiencing "loss of contact" with her surroundings. She has had these experiences over the last 14 months. Her first episode was brought to her attention by a close friend who said that she had a vague look in her eyes and started smacking her lips and rubbing her right thumb against her other hand for 30 seconds. Since that time, the pt notices a bad odor and taste in her mouth with a kind of rising feeling in her stomach before going into one of these episodes. Lately, she is aware of people during these episodes, but they seem to be in the distance. You suspect the pt has....
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Temporal lobe epilepsy
(a type of complex partial seizure) |
Additional sterotypic non-purposeful movements (automatisms) include constant swallowing, chewing, pacing, fumbling hand movements, humming or mumbling. These sterotypic automatisms are thought to originate from the anteromedial temporal area near the amygdala nucleus.
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