Headache Test by N7vJp41


									Headache Test.                   Last 4 digits of social security number……………

Circle the correct answer.

1.    Which of the following neurotransmitters is most closely associated with
the development of migraine?

     a.      Gaba amino butyric acid (GABA)
     b.      Acetylcholine
     c.      Dopamine
     d.      Serotonin.

2.     Deirdre is a 25-year-old computer programmer with chronic migraine. She
requests something to prevent the headache saying “I’m tired of all these
interruptions, every time I get a headache it costs me half a day at work.” She
has no systemic diseases. Which of the following prophylactic strategies would
be most appropriate?

     a.      Propranolol
     b.      Nifedipine
     c.      Feverfew
     d.      Cyproheptadine.

3.        The following causes of headaches are life threatening except

     a.      Intracranial hemorrhage
     b.      Temporal arteritis
     c.      Meningitis
     d.      Hypertensive encephalopathy.

4.    The presence of neck stiffness in a patient presenting with meningitis has
a sensitivity of

     a.      10%
     b.      35%
     c.      70%
     d.      95%

5.   Richard is a 56-year-old teacher who presents with recurrent generalized
headaches that he rates as 4/10 on the pain scale. He denies photophobia,
phonophobia, nausea or vomiting, chest pain, blurred vision or shortness of
breath. He has no other symptoms. On examination he is afebrile with a blood
pressure of 170/95 and no neck stiffness. The rest of the examination including a
full neurological examination is normal. What is the most likely cause of his

     a.      Hypertensive encephalopathy
     b.      Migraine
     c.      Tension type headache
     d.      Meningitis

6.   Mary has been diagnosed with chronic tension type headaches. To how
many days a week would you advise her to restrict her medication use?

     a.      2 days a week
     b.      4 days a week
     c.      6 days a week
     d.      Daily use is OK

7.        Which of the following is a contraindication to triptan therapy

     a.      Contraceptive pill
     b.      Ischemic heart disease
     c.      Controlled hypertension.
     d.      Migraine with aura.

8.   Which of the following medications have been associated with rebound

     a.       Triptans only.
     b.       Narcotics and NSAIDs only.
     c.       Triptans, narcotics and NSAIDs
     d.       Narcotics only.

9. Typical features of tension-type headaches include all of the
   following except?

A.        Bilateral location
B.        Mild or moderate pain described as tightness, pressure, or dull ache
C.        Pain often radiating to posterior neck muscles
D.        Headache accompanied by visual disturbances
E.        Pain lasting from 30 minutes to several days
10. Which one of the following is considered a “red flag” in an adult with a

A.     Slow onset
B.     Onset before age 50
C.     Short term nausea and vomiting
D.     Subsequent to head trauma
E.     Exacerbation by climbing stairs

11. Which of the following is true in relation to migraine headache?

A.     Men are more likely to have migraine than women
B.     Most people with migraine are not diagnosed
C.     Migraine is almost always associated with aura symptoms
D.     Lack of throbbing quality of pain rules out the diagnosis of migraine
E.     Lack of a one-sided headache rules out the diagnosis of migraine.

12. Migraine with aura has which one of the following features?

A.     Ipsilateral lacrimation or nasal congestion
B.     Irreversible aural symptoms indicating focal cerebrocortical or brain-stem
C.     Reversible aura symptoms and headache with a pulsatile quality
D.     Pressing or tightening quality
E.     Pressing or tightening quality

Answer the following questions by circling true or false.

          1.     The majority of patients with a subarachnoid hemorrhage have
                 neck stiffness.

          2.     The diagnosis of meningitis may effectively be eliminated if the
                 patient has absence of fever, no neck stiffness and no change
                 in mental status.
3.   Kernigs and Brudzinski signs have a low sensitivity but a high


4.   The resolution of a headache with ketoralac (an NSAID) rules
     out that the cause of the headache is an intracranial bleed.


5.   For a headache to be diagnosed as a migraine it must be
     associated with nausea or vomiting.


6.   A tension headache is increased by physical activity.


7.   In the treatment of migraine steroids are more likely to be
     successful than opiates


8.   A headache that increases with valsalva is associated with an
     abnormality found on neuroimaging.


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