Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
Tension type ha (TTH) Bilateral, band-like, pressure/tightening
Mild-moderate, NOT pulsating
No nausea/vomiting
+/− mild photophobia
Normal neuro exam
TTH Etiology Stress, anxiety, muscle tension
Poor posture, lack of sleep
Psychosocial stressors (aka PA school)
TTH patho Likely multifactorial: muscular tension + central pain processing dysregulation
NOT vascular
TTH CM Diffuse "headband" pressure
No aura
No focal deficits
TTH acute Tx 1st: Acetaminophen or NSAIDs
If PO fails → IM/IV ketorolac
Rest, hydration
TTH chronic/prophylaxis Tx 1st: Amitriptyline
Alts: Mirtazapine, Venlafaxine
(Limited evidence: SSRIs/SNRIs, muscle relaxants, anticonvulsants, Botox)
TTH BIG NOs NOT treated with triptans
No steroids
No imaging unless red flags
U Cluster Headache (CH) Dx Recurrent, SEVERE unilateral periorbital pain
Autonomic sx: lacrimation, rhinorrhea, ptosis, nasal congestion
Occurs in "clusters" (same time each day)
CH etiology Unknown, hypothalamic involvement
Major risk factor: smoking (88%)
CH patho Trigeminal autonomic cephalalgia
Dysregulation of circadian rhythm
CH CM Severe stabbing orbital pain
Ipsilateral tearing, ptosis, congestion
15-180 mins
Multiple attacks/day
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
CH abortive/acute Tx 1st: 100% O₂ via NRB (12–15 L/min x 15–20 min)
SubQ/Intranasal sumatriptan
Adjuncts: intranasal lidocaine, octreotide (*if cant use triptan)
CH AVOID: Oral triptans (too slow), oral analgesics, opioids
CH prophylaxis 1st : Verapamil (ECG monitoring! AV block risk)
Also 1st line: Suboccipital nerve block
Alternatives: Lithium, valproate, melatonin
Bridge: Prednisone taper
(Refractory cases: neuromodulation or sphenopalatine ganglion stimulation)
⚡ Migraine Headache (MH) Dx: Recurrent unilateral pulsatile HA
Nausea/vomiting
Photophobia/phonophobia
May have aura
Worse with activity
MH etiology Genetic, trigeminovascular activation
Serotonin dysregulation
Hormonal (estrogen fluctuations)
MH patho Neurovascular
Cortical spreading depression → aura
Trigeminal activation → CGRP release → vasodilation + pain
MH CM Unilateral throbbing
Photophobia/phonophobia
Nausea/vomiting
Aura (visual MC)
MH abortive Tx (mild, moderate, adjuncts, new, refractory) Mild: NSAIDs or APAP
Moderate: Triptans (sumatriptan SC fastest)
Combine triptan + naproxen
Adjuncts:
Metoclopramide/prochlorperazine (dopamine blockade)
Zofran (2nd-line antiemetic)
Newer: ubrogepant, rimegepant
Refractory: Dihydroergotamine (ergot), lasmiditan (Serotonin 1F agonist)
Prevent recurrence: dexamethasone
MH prophylaxis 1st:
Beta blockers (propranolol, metoprolol)
Topiramate, valproate*
Amitriptyline
Venlafaxine
CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab)
2nd line:
ACE/ARB: candesartan, lisinopril
CCB: verapamil
Gabapentin
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
MH special sh***t (menstrual/chronic) Menstrual migraine: perimenstrual triptans or hormones
Chronic migraine: Botox
U Temporal Arteritis (Giant Cell Arteritis) we will call
it GCA for this deck. Dx
New HA in age > 50
Jaw claudication, scalp tenderness
Visual symptoms
Tender, nodular temporal artery
GCA etiology Granulomatous vasculitis of medium/large vessels
Associated with polymyalgia rheumatica
polymyalgia rheumatica an inflammatory disorder of the muscles and joints characterized by pain and
stiffness in the neck, shoulders, upper arms, and hips and thighs
GCA patho T-cell-mediated inflammation of vessel walls → ischemia
Can cause vision loss (ophthalmic artery ischemia)
GCA CM Unilateral temporal HA
Jaw pain with chewing
Scalp tenderness
Blurred vision
Systemic: fever, malaise
GCA labs Gold standard: Temporal artery biopsy
ESR/CRP ↑ (but nonspecific)
GCA tx If visual symptoms: IV methylprednisolone 1 g/day × 3 days
Then high-dose oral prednisone
Consider: aspirin 81 mg
Steroid sparing: tocilizumab
YOOOO THIS IS IMPORTANT FOR GCA DO NOT wait for biopsy to start steroids
Untreated → blindness
( Concussion (Mild TBI) Dx GCS 13–15
Brief LOC (<30 min)
Transient confusion
NO structural lesion on CT
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
Concussion (mild TBI) etiology Rapid acceleration/deceleration
Sports injuries
Falls, MVC
Concussion (mild TBI) patho Functional (not structural!)
Ionic flux: K+ out, Na/Ca in
Glutamate release → metabolic crisis
↓ cerebral blood flow → energy mismatch
Concussion/mild TBI CM Acute: confusion, amnesia, brief LOC, headache
Delayed: dizziness, nausea, photophobia, irritability, sleep issues
mild tbi/concission RED FLAGS → CT Immediately Persistent vomiting
Worsening confusion
Focal deficits
Signs of skull fracture
Anticoagulation
mild tbi/concission Tx Symptom-limited rest
Gradual return to activity
Zofran for nausea
Avoid full bedrest
ý Cerebral Contusion (CC) Dx and Labs Structural bruise of brain
CT scan (initial TOC): patchy hyperdense cortical/subcortical lesions
MRI: more sensitive for small/evolving lesions
CC etiology Coup–contrecoup
Direct impact
Most occur in frontal and temporal lobes.
CC patho Localized bleeding + edema
cc cm Concussion-like sx + focal deficits or seizures
cc tx Supportive, ICP management
If large/mass effect/GCS <13 → neurosurgery
⚡ Diffuse Axonal Injury (DAI) High-speed trauma
Immediate coma (GCS ≤ 8)
CT normal or shows punctate hemorrhages
Shearing of white matter
DAI patho Axonal swelling and disconnection + neurotransmitter dumping --> cerebral edema
+ increased ICP
Widespread
stuvia 2026-2027
Tension type ha (TTH) Bilateral, band-like, pressure/tightening
Mild-moderate, NOT pulsating
No nausea/vomiting
+/− mild photophobia
Normal neuro exam
TTH Etiology Stress, anxiety, muscle tension
Poor posture, lack of sleep
Psychosocial stressors (aka PA school)
TTH patho Likely multifactorial: muscular tension + central pain processing dysregulation
NOT vascular
TTH CM Diffuse "headband" pressure
No aura
No focal deficits
TTH acute Tx 1st: Acetaminophen or NSAIDs
If PO fails → IM/IV ketorolac
Rest, hydration
TTH chronic/prophylaxis Tx 1st: Amitriptyline
Alts: Mirtazapine, Venlafaxine
(Limited evidence: SSRIs/SNRIs, muscle relaxants, anticonvulsants, Botox)
TTH BIG NOs NOT treated with triptans
No steroids
No imaging unless red flags
U Cluster Headache (CH) Dx Recurrent, SEVERE unilateral periorbital pain
Autonomic sx: lacrimation, rhinorrhea, ptosis, nasal congestion
Occurs in "clusters" (same time each day)
CH etiology Unknown, hypothalamic involvement
Major risk factor: smoking (88%)
CH patho Trigeminal autonomic cephalalgia
Dysregulation of circadian rhythm
CH CM Severe stabbing orbital pain
Ipsilateral tearing, ptosis, congestion
15-180 mins
Multiple attacks/day
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
CH abortive/acute Tx 1st: 100% O₂ via NRB (12–15 L/min x 15–20 min)
SubQ/Intranasal sumatriptan
Adjuncts: intranasal lidocaine, octreotide (*if cant use triptan)
CH AVOID: Oral triptans (too slow), oral analgesics, opioids
CH prophylaxis 1st : Verapamil (ECG monitoring! AV block risk)
Also 1st line: Suboccipital nerve block
Alternatives: Lithium, valproate, melatonin
Bridge: Prednisone taper
(Refractory cases: neuromodulation or sphenopalatine ganglion stimulation)
⚡ Migraine Headache (MH) Dx: Recurrent unilateral pulsatile HA
Nausea/vomiting
Photophobia/phonophobia
May have aura
Worse with activity
MH etiology Genetic, trigeminovascular activation
Serotonin dysregulation
Hormonal (estrogen fluctuations)
MH patho Neurovascular
Cortical spreading depression → aura
Trigeminal activation → CGRP release → vasodilation + pain
MH CM Unilateral throbbing
Photophobia/phonophobia
Nausea/vomiting
Aura (visual MC)
MH abortive Tx (mild, moderate, adjuncts, new, refractory) Mild: NSAIDs or APAP
Moderate: Triptans (sumatriptan SC fastest)
Combine triptan + naproxen
Adjuncts:
Metoclopramide/prochlorperazine (dopamine blockade)
Zofran (2nd-line antiemetic)
Newer: ubrogepant, rimegepant
Refractory: Dihydroergotamine (ergot), lasmiditan (Serotonin 1F agonist)
Prevent recurrence: dexamethasone
MH prophylaxis 1st:
Beta blockers (propranolol, metoprolol)
Topiramate, valproate*
Amitriptyline
Venlafaxine
CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab)
2nd line:
ACE/ARB: candesartan, lisinopril
CCB: verapamil
Gabapentin
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
MH special sh***t (menstrual/chronic) Menstrual migraine: perimenstrual triptans or hormones
Chronic migraine: Botox
U Temporal Arteritis (Giant Cell Arteritis) we will call
it GCA for this deck. Dx
New HA in age > 50
Jaw claudication, scalp tenderness
Visual symptoms
Tender, nodular temporal artery
GCA etiology Granulomatous vasculitis of medium/large vessels
Associated with polymyalgia rheumatica
polymyalgia rheumatica an inflammatory disorder of the muscles and joints characterized by pain and
stiffness in the neck, shoulders, upper arms, and hips and thighs
GCA patho T-cell-mediated inflammation of vessel walls → ischemia
Can cause vision loss (ophthalmic artery ischemia)
GCA CM Unilateral temporal HA
Jaw pain with chewing
Scalp tenderness
Blurred vision
Systemic: fever, malaise
GCA labs Gold standard: Temporal artery biopsy
ESR/CRP ↑ (but nonspecific)
GCA tx If visual symptoms: IV methylprednisolone 1 g/day × 3 days
Then high-dose oral prednisone
Consider: aspirin 81 mg
Steroid sparing: tocilizumab
YOOOO THIS IS IMPORTANT FOR GCA DO NOT wait for biopsy to start steroids
Untreated → blindness
( Concussion (Mild TBI) Dx GCS 13–15
Brief LOC (<30 min)
Transient confusion
NO structural lesion on CT
stuvia 2026-2027
, Clinical Medicine Exam 3 | Neurology | Complete Exam Prep | Practice Questions & Answers
Concussion (mild TBI) etiology Rapid acceleration/deceleration
Sports injuries
Falls, MVC
Concussion (mild TBI) patho Functional (not structural!)
Ionic flux: K+ out, Na/Ca in
Glutamate release → metabolic crisis
↓ cerebral blood flow → energy mismatch
Concussion/mild TBI CM Acute: confusion, amnesia, brief LOC, headache
Delayed: dizziness, nausea, photophobia, irritability, sleep issues
mild tbi/concission RED FLAGS → CT Immediately Persistent vomiting
Worsening confusion
Focal deficits
Signs of skull fracture
Anticoagulation
mild tbi/concission Tx Symptom-limited rest
Gradual return to activity
Zofran for nausea
Avoid full bedrest
ý Cerebral Contusion (CC) Dx and Labs Structural bruise of brain
CT scan (initial TOC): patchy hyperdense cortical/subcortical lesions
MRI: more sensitive for small/evolving lesions
CC etiology Coup–contrecoup
Direct impact
Most occur in frontal and temporal lobes.
CC patho Localized bleeding + edema
cc cm Concussion-like sx + focal deficits or seizures
cc tx Supportive, ICP management
If large/mass effect/GCS <13 → neurosurgery
⚡ Diffuse Axonal Injury (DAI) High-speed trauma
Immediate coma (GCS ≤ 8)
CT normal or shows punctate hemorrhages
Shearing of white matter
DAI patho Axonal swelling and disconnection + neurotransmitter dumping --> cerebral edema
+ increased ICP
Widespread
stuvia 2026-2027
