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15 Cards in this Set
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- Back
- 3rd side (hint)
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21 yo F presents with several episodes of throbbing left temporal pain that lasts for 2–3 hours. Prior to its onset, she sees flashes of light in her right visual field and feels weakness and numbness on the right side of her body for a few minutes. Headaches are often associated with nausea and vomiting. She has a family history of migraine.
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Migraine (complicated)
Tension headache Cluster headache Pseudotumor cerebri Trigeminal neuralgia CNS vasculitis Partial seizure Intracranial neoplasm |
CBC
ESR CT - head MRI - brain LP |
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26 yo M presents with terrible right temporal headaches associated with ipsilateral rhinorrhea and eye tearing and redness. Episodes have occurred at the same time every night for the past week and last for 45 minutes.
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Cluster headache
Migraine Tension headache Sinusitis Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm |
CBC
ESR CT - head MRI - brain LP |
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65 yo F presents with severe, intermittent right temporal headache, fever, blurred vision in her right eye, and pain in her jaw when chewing.
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Temporal arteritis
Migraine Cluster headache Tension headache Meningitis Carotid artery dissection Pseudotumor cerebri Trigeminal neuralgia Intracranial neoplasm |
CBC
ESR CRP Temporal artery biopsy Doppler U/S—carotid MRI—brain |
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30 yo F presents with frontal headache, fever, nasal discharge. Pain on palpation of maxillary and frontal sinuses.
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Sinusitis
Migraine Tension headache Meningitis Intracranial neoplasm |
CBC
CT - Sinus LP |
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50 yo F presents with recurrent episodes of bilateral squeezing headaches that occur 3–4 times a week. She is experiencing significant stress in her life.
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Tension headache
Migraine Depression Caffeine or analgesic withdrawal Hypertension Cluster headache Pseudotumor cerebri Intracranial neoplasm |
CBC
Electrolytes ESR CT—head LP |
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35 yo M presents with sudden severe headache, vomiting, confusion, left hemiplegia, and nuchal rigidity.
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Subarachnoid hemorrhage
Migraine Meningitis/encephalitis Intracranial hemorrhage Vertebral artery dissection Intracranial venous thrombosis Acute hypertension Intracranial neoplasm |
CT - head
LP CBC PT/PTT MRI/MRA - brain |
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25 yo M presents with high fever, severe headache, confusion, photophobia, and nuchal rigidity. Kernig’s and Brudzinski’s signs are positive.
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Meningitis
Migraine Subarachnoid hemorrhage Sinusitis/encephalitis Intracranial or epidural abscess |
CBC
CT—head MRI—brain LP—CSF analysis (cell count, protein, glucose, Gram stain, PCR for antigens, culture) |
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18 yo obese F presents with headache, vomiting, and blurred vision for the past 2–3 weeks. She is taking OCPs.
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Pseudotumor cerebri
Tension headache Migraine Cluster headache Meningitis Intracranial venous thrombosis Intracranial neoplasm |
Urine hCG
CBC CT—head LP—opening pressure and CSF analysis |
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47 yo M c/o daily pain in the right cheek over the past month. The pain is electric in character and occurs while he is shaving. Each episode lasts 2–4 minutes.
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Trigeminal neuralgia
Tension headache Migraine Cluster headache TMJ dysfunction Intracranial neoplasm |
CBC
ESR MRI - brain |
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81 yo M presents with progressive confusion over the past several years together with forgetfulness and clumsiness. He has a history of hypertension, diabetes mellitus, and two strokes with residual left hemiparesis. Mental status has clearly worsened after each stroke.
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Vascular (“multi-infarct”) dementia
Alzheimer’s disease Normal pressure hydrocephalus Chronic subdural hematoma Intracranial tumor Depression B12 deficiency Neurosyphilis Hypothyroidism |
CBC
VDRL/RPR Serum B12 TSH MRI—brain CT—head LP—CSF analysis (rare) |
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84 yo F brought by her son c/o forgetfulness (e.g., forgets phone numbers, loses her way back home) along with difficulty performing some of her daily activities (e.g., bathing, dressing, managing money, using the phone). The problem has gradually progressed over the past few years.
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Alzheimer’s disease
Vascular dementia Depression Hypothyroidism Chronic subdural hematoma Normal pressure hydrocephalus Intracranial tumor B12 deficiency Neurosyphilis |
CBC
VDRL/RPR Serum B12 TSH MRI—brain (preferred) CT—head LP—CSF analysis (rare) |
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72 yo M presents with memory loss, gait disturbance, and urinary incontinence for the past six months.
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Normal pressure hydrocephalus
Alzheimer’s disease Vascular dementia Chronic subdural hematoma Intracranial tumor Depression B12 deficiency Neurosyphilis Hypothyroidism |
CT—head
LP—opening pressure and CSF analysis Serum B12 VDRL/RPR TSH |
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55 yo M presents with a rapidly progressive change in mental status, inability to concentrate, and memory impairment for the past two months. His symptoms are associated with myoclonus and ataxia.
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Creutzfeldt-Jakob disease
Vascular dementia Lewy body dementia Wernicke’s encephalopathy Normal pressure hydrocephalus Chronic subdural hematoma Intracranial tumor Depression Delirium B12 deficiency Neurosyphilis |
CBC, electrolytes, calcium Serum B12
VDRL/RPR MRI—brain (preferred) CT—head EEG LP—CSF analysis Brain biopsy |
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70 yo insulin-dependent diabetic M presents with episodes of confusion, dizziness, palpitation, diaphoresis, and weakness.
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Hypoglycemia
Transient ischemic attack Arrhythmia Delirium Angina |
Glucose
CBC, electrolytes Echocardiography ECG MRI—brain Doppler U/S—carotid |
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55 yo F presents with gradual altered mental status and headache. Two weeks ago she slipped, hit her head on the ground, and lost consciousness for two minutes.
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Subdural hematoma
SIADH (causing hyponatremia) Creutzfeldt-Jakob disease Intracranial tumor |
Electrolytes
CT—head MRI—brain LP |
