Primary Headache
Secondary Headache
Headaches Mixed
Terminology
Little of everything
100
Seth is a 40 Y/O executive who is coming into the office for eval of headache. He reports a band like type of distribution of pain that almost feels as if he is wearing a tight baseball cap. He reports that this is a very stressful time at work and that he has been working long hours. His exam is normal except for neck muscle tightness
What is tension HA
100
carl is a 23Y/O who presents with s/p having an unrelenting upper respiratory tract infection for the past 15 days. He reports that his headaches are becoming unbearable. He reports pain is more concentrated in the frontal region and that it gets worst if he leans forward for any reason. on exam you note tenderness in the frontal head right above the orbit. What primary diagnosis is likely for Carl?
What is Sinusitis
100
Patient X is a 87 Y/O retired gentle man who resides in a nursing home. He has a history of cerebellar stroke and has residual ataxia that causes him to fall a lot. His last fall was three days ago and his wife reports a direct blow to the head. His wife brings him in for evaluation due to transient confusion and reports of intense HA with pain more consistent over the right eye. Patient likely has
What is a Subdural hematoma
100
an incident or substance that brings on a migraine
What is a trigger
100
Jim presents with C/O of Throbbing type HA associated with Photophobia, nausea, vomiting and right face and arm numbness. Headache is unilateral more pronounced on the right side of his head. His work up does not reveal any pathology. Jim's HA is likely:
What is what is a migraine
200
Jim is a 13 Y/O that you are seeing today for the evaluation of unilateral throbbing pain in his head, he reports that light bothers his eyes a lot when he has these headaches and that when his little sister cries he feels as if his head wants to explode
What is common migraine without aura
200
Jane a 24Y/O female is in the ED for C/O of unrelenting HA. She denies photophobia or phonophobia, she denies visual disturbances, she denies nausea or vomiting. Jane's only medical history is lumbar surgery which she had 5 days earlier and her only medication is dilaudid 4mg po every 3 hours for her back pain. She reports that the last time she took her dilaudid was approximately 2hours ago. Her physical exam is unremarkable and her diagnostic test are all negative except for a fox screen which is positive for opiates. What is the likely cause of Jane's HA
What is drug overuse HA
200
Mr. John is a 40 Y/O male presents S/P seizure. He reports no prior history of seizures. His medical history is significant for chronic ear infection. He reports HA for the past five days, he reports that pain onset was gradual with increasing intensity everyday. He also reports a generalized sick feeling, and a notable weakness on the right side of his body. His VS T 102.2, HR 100, RR 19 BP 140/70.
What is A Brain Abscess
200
headache present for > 4 weeks, without neurological signs and symptoms associated with missing work and school and depressed mood...
What is psychogenic
200
Kenneth is a 54Y/O male who presents with intense pain in the right eye that started 30minutes. On exam you note R eye lacrimation, ptosis, redness and lid swelling. MRI of brain is negative for pathology. Kenneth is having
What is a cluster HA.
300
Jane is a 24y/o high school teacher who presents with HA that usually starts at the end of her school day and it is accompanied by tight achy neck and shoulders
What is a tension HA
300
Sue is a 50Y/O female who presents with C/O of a sharp localized temporal pain. She reports malaise and anorexia. Her only medical history is of polymyalgia rheumatica. On exam you note temp 102.1, HR 87, RR 22 BP 125/67. Her exam reveals tenderness over a nodular temporal artery, what differential diagnosis is most consistent with Sue's symptoms
What is Temporal arthritis
300
Terri is a 24 Y/O female who presents with C/O increased HA followed by blurred vision when she moves her eyes. On exam you note that you are able to elicit these symptoms on examination of (EOM), she also has overall diminished visual acuity, and decreased pupillary reflex. You suspect optic neuritis what are your primary plan of care.
What is MRI with attention to orbit and Opthalmology consult
300
Stiff neck
What is meningismus
300
Gene is a 18 Y/O obese female who presents with unrelenting HA for the past 2 weeks. She describes the headache as progressive. She has no past medical history but reports that she does take tetracycline daily to help with her acne... Her brain imaging does not reveal any pathology..Gene should be evaluated for..
What is pseudotumor cerebri
400
Sue is a 30Y/O female presents with C/O of severe HA that usually occurs right before her period. She notes that 2 days prior to the onset of HA she is very moody, easily agitated and sometimes exhibit depressed mood. Her HA is throbbing, some times with nausea, vomiting and she experiences photopsias prior to and during the episode of headache. She also notes that her headaches are brought on if she eats too much chocolate
What is Migraine with aura
400
Henry is a 67 Y/O male who presents with C/O of HA that started 2 weeks ago and has been progressively getting worse everyday. He notes that the HA is worse in the early mornings but gets better once he is up and about. He also notes that over the past few days he has had some dull type feeling around the right side of his face. He denies any previous medical history. The pattern of pain duration for Henry's HA indicates that he may have
What is increased intracranial pressure
400
Marleen is a 50y/o female, with a past medical history of DM, HTN and CAD. She presents with C/O of sudden onset intense HA located on the top of her head, with resultant R sided weakness. Her vital signs on presentation are temp 100.5, HR 66, RR 16, BP 180/100. Marleen's Headache is likely due to....
What is an Intracerebral Hemorrhage
400
symptoms that occur before, during or after a HA and last no more than 30 minutes
What is an aura
400
Jane is a 50 Y/O female presents with C/O of burst of sharp pain over the face innervated by the affected nerve. Stimulation of the face on exam makes the pain increased. One of the things that we will be looking for in this patient is
What is Trigeminal Neuralgia
500
Lisa is a 50Y/O postmenopausal female who presents to the hospital with Headache and bi temporal hemianopsia. she reports this started acutely earlier that day. Her only medical history is stage 1 hypertension. Her MRI is negative and the rest of her physical exam is unremarkable
What is complicated Migraine
500
Jim presents with C/O of a sudden onset intense HA while gardening this morning. Reports hearing a loud clap with its onset. He states that immediately after he had to go into his house and try to lay down because outside was too bright. He is currently in your office with his hands over his ears because he reports that the noise is unbearable. On exam you note meningismus, what is your next action in handling Jim's care
What is call 911 and get him to the ED
500
Jim is a type 1 diabetic who presents with severe generalized Headache after playing basket ball. He reports dizziness, and a sense of not feeling well. He is nauseated, vomiting and lethargic. He is also diaphoretic. What is a priority assessment that must be made on Jim:
What is a blood glucose check
500
Spots of flickering light near or in the center of the visual field prevents vision in the scotoma area, associated with migraine headaches.
What is Scintillating Scotoma
500
26 Y/O male presents with complaints of severe, chills, myalgias, stiff neck. On exam the patient has positive Brudzinski, positive kerning's. On examination of skin patient has petechial rash through out. What are the most pertinent test to order for this patient:
What is CTB, and Lumbar Puncture
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