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level: Level 1

Questions and Answers List

level questions: Level 1

QuestionAnswer
How is headache examinedBlood pressure Palpation - temporal arteries - sinuses Temperature Neck examination Fundoscopy
What is general approach for management of headacheReassurance, hydration, optician review Headache diary - identify and avoid triggers
One feature of a tension headache that is different from a migraineNausea, Aura
What are red flags for a headacheAge above 50 Thunderclap headache Progressive/persistent Previous head injury
Difference between primary and secondary headachePrimary - Non identifiable - Common (90%) - Generally not life threatening Secondary - Symptom of underlying disease - Uncommon - May be life threatening - Sinusitis, SOL, Haemorrhage, Meningitis
What are red flags for a headacheAge above 50 Thunderclap headache Progressive/persistent Previous head injury
Where is tension headache likely to occurBilateral, frontal-temporal
Nausea comes with Tension headache True or FalseFalse
What is the cause of tension headache and how is it treatedCause - Stress/depression Treatment - Simple analgesia - Does not reduce recurrence and may lead to secondary headache - Stress management - NSAIDS, aspirin, paracetamol
Where is migraine likely to occurUnilateral, throbbing and disproportionally disabling
Difference between classical migraine and common migraineClassical Migraine (10-30%) - Migraine with aura (neurological change, usually visual symptom) Common Migraine (70-90%) - Migraine without aura
What are managements for migraineAnalgesia Antiemetic Triptans
One feature of a tension headache that is different from a migraineNausea, Aura
What are specific symptoms leading to diagnosis of clusterExcruciating and restlessness Increased tear production Redness of eyes
Treatment for ClusterDO NOT suggest simple analgesia - does not work Short burst of oxygen therapy Injecting or intranasal triptan
How would patient present with Trigeminal neuralgiaSudden severe facial pain Shooting/Burning sensation Triggered by light touch
Treatment for Trigeminal neuralgiaCarbamazepine - If cannot use it, refer it to specialist
What drugs may lead to Medication overuse headacheChronic use (over 10days) of these drugs - Paracetamol - NSAIDs - Opioids - Triptans
Treatments for medication overuse headachesRebound phenomenon - Pain gets worst when they stop painkillers However, resolves with discontinuation within 2 months
What differentiates from viral or bacterial infection of sinusitisBacterial infection (2%) - blood/pus production - Creamy discharge from nose or throat Majority is viral infection
What are symptoms of SinusitisTenderness Fever Rhinitis
What is space occupying lesionPrimary/Secondary brain tumour (from Lung, breast, Bowel, Kidney, Skin) - primary way more common Abscess or Haematoma
What are symptoms and signs or SOLSymptoms - Progressively worsening morning - due to raised intercranial pressure - Vomiting - Seizure Signs - Altered GCS - Cushing's triad (Low heart rate, respiratory rate, increased blood pressure) - Papilloedema
What is subarachnoid haemorrhageBleed into subdural space - following rupture of vein Neurological emergency It may be result of berry aneurysm, AV malformation, traumatic head injury
How would pateints present with subarachnoid haemorrahgeThunderclap headache - worst headache in their life Meningism - neck stiffness, photophobia Nausea Altered vision Drowsiness
What are examinations for SAHCT/MRI Cerebral spinal fluid becomes xanthochromic - Lysis of RBC resulting in haemoglobin breaking down to bilirubin
What is meningitisInflammation of meninges - bacterial or viral infection Life threatening which can mimic influenza
What are symptoms of meningitisHeadache Fever Stiff neck Non-blanching purpuric rash Opisthotonos - Arched body with neck hyperextended Kernig's sign - Pain when knee extended with hip flexed
What bacteria causes meningococcal SepticaemiaNeisseria Meningitidis (meningococcus)
Why is Meningococcal Septiciaemia a paediatric emergencyImpacts clotting cascade - Failure in coagulation Leads to risk of sepsis
What is Temporal arthritis (Giant cell arthritis)Auto-immune inflammatory vasculitis
What age group is prone to temporal arthritis and which gender is more vulnerableRare under 50 More common in women
Why is temporal region painful for patients with temporal arthritisTemporal region supplied by temporal artery Due to inflammation, pain Pain may radiate to temples and jaws May lead to Jaw claudication
What indicates medical emergency in case of temporal arthritisLoss of vision