PHR 954 Block 3 Exam Study Guide
When should you consider adding coverage for fungal pathogens in a patient with
meningitis? - ANSWER -Immunocompromised patients
-In areas where systemic fungal infections are endemic
Acute onset headaches are mostly secondary, are more serious, and can be
life-threatening, whereas chronic or recurrent headaches usually have a benign
prognosis (T/F)? - ANSWER True
Which of the following is the most common form of HA? - ANSWER Tension Type
Patient presents with BP 230/140 with an excruciating headache that started suddenly
about half-an-hour ago, which is why he decided to stop by the BP screening booth. He
said it feels like the worst headache of his life. You call 911 because your #1 differential
for which he needs urgent evaluation is: - ANSWER Intracranial or subarachnoid
hemorrhage ("head bleed")
You are managing medication therapy for a well-known 63 yo patient with HTN,
hyperlipidemia, diabetes, and atrial fibrillation. While talking with her, she all of a
sudden appears very confused and can't seem to get her words out or speak
coherently. You manage to understand that she's saying her "right arm and hand
doesn't work." What is your #1 differential? - ANSWER Acute Stroke
What is papilledema?
A. Swelling of the optic disc
B. Caused by increased intracranial pressure
C. Caused by increased intraocular pressure
D. Swelling of the brain - ANSWER A and B
-A. Swelling of the optic disc
-B. Caused by increased intracranial pressure
A 59 yo man with no significant PMH stops into your pharmacy on the way home from
work complaining of acute onset severe right-sided headache associated with
right-sided red eye, cloudy cornea, and dilated pupil, N/V, and significant photophobia
to the point he cannot keep his right eye open. What is the most likely diagnosis? -
ANSWER Acute angle closure glaucoma
Which of the following are red flag signs/symptoms of headache that warrant medical
referral?
, -New onset neurologic signs or symptoms
-Change in pattern of prior headache history
-Headache is acute in onset, sudden and without warning
-New onset headaches in patients of older age (>50) or new type or quality of headache
-Presence of systemic symptoms or secondary causes, such as active cancer
-All of the above - ANSWER All of the above
A 56 yo woman presents to the ED with a week long history of recurrent and persistent
unilateral left-sided HA, which she described as different in character from "run of the
mill" headaches. Associated symptoms include left-sided scalp tenderness, blurry
vision, and jaw pain when she chews (all symptoms are on the left side). She also
reports general feeling of fatigue malaise, and left-sided blurry vision. Her presentation
is consistent with: - ANSWER Giant cell arteritis (GCA)
-recommend high dose systemic steroid
You are refilling isotretinoin for Ms. Harris, a 24 yo woman who is being treated for acne
by a dermatologist. While waiting, she tells you that for the past couple of weeks she's
had new onset frequent headaches upon waking and blurry vision occurring every day.
Symptoms get better when she sits up. She has no other associated symptoms. What
condition should be at the top of your differential? - ANSWER Pseudotumor cerebri
Describe a Tension-type H/A - ANSWER Most common type of headache. Mild-moderate
pain intensity, bilaterial, nonpulsating headache. Pain is constant but dull combined with
muscle tenderness.
Relatively sudden onset of a dull (mild to moderate), bilateral headache
Constant squeezing ache like band around head
Associated with stiff/painful neck muscles
Common in settings of stress or mental tension - modified by analgesics
Describe a Classic migraine with no aura - ANSWER Moderate to severe pain that is
incapacitating, unilateral, pulsating, or throbbing, and is made worse by physical
activity. Patients may have nausea, vomiting, photophobia, or phonophobia.
Unilateral (in most cases, some are global or frontal) HA that builds quickly over an hour
and last 4-72 hours
Describe a Migraine with aura - ANSWER Moderate to severe pain that is incapacitating,
unilateral, pulsating, or throbbing, and is made worse by physical activity. -Patients may
have nausea, vomiting, photophobia, or phonophobia. Aura consists of flashing lights,
scotoma, visual disturbances, paresthesia, or a prodrome of tiredness, fatigue, mood
When should you consider adding coverage for fungal pathogens in a patient with
meningitis? - ANSWER -Immunocompromised patients
-In areas where systemic fungal infections are endemic
Acute onset headaches are mostly secondary, are more serious, and can be
life-threatening, whereas chronic or recurrent headaches usually have a benign
prognosis (T/F)? - ANSWER True
Which of the following is the most common form of HA? - ANSWER Tension Type
Patient presents with BP 230/140 with an excruciating headache that started suddenly
about half-an-hour ago, which is why he decided to stop by the BP screening booth. He
said it feels like the worst headache of his life. You call 911 because your #1 differential
for which he needs urgent evaluation is: - ANSWER Intracranial or subarachnoid
hemorrhage ("head bleed")
You are managing medication therapy for a well-known 63 yo patient with HTN,
hyperlipidemia, diabetes, and atrial fibrillation. While talking with her, she all of a
sudden appears very confused and can't seem to get her words out or speak
coherently. You manage to understand that she's saying her "right arm and hand
doesn't work." What is your #1 differential? - ANSWER Acute Stroke
What is papilledema?
A. Swelling of the optic disc
B. Caused by increased intracranial pressure
C. Caused by increased intraocular pressure
D. Swelling of the brain - ANSWER A and B
-A. Swelling of the optic disc
-B. Caused by increased intracranial pressure
A 59 yo man with no significant PMH stops into your pharmacy on the way home from
work complaining of acute onset severe right-sided headache associated with
right-sided red eye, cloudy cornea, and dilated pupil, N/V, and significant photophobia
to the point he cannot keep his right eye open. What is the most likely diagnosis? -
ANSWER Acute angle closure glaucoma
Which of the following are red flag signs/symptoms of headache that warrant medical
referral?
, -New onset neurologic signs or symptoms
-Change in pattern of prior headache history
-Headache is acute in onset, sudden and without warning
-New onset headaches in patients of older age (>50) or new type or quality of headache
-Presence of systemic symptoms or secondary causes, such as active cancer
-All of the above - ANSWER All of the above
A 56 yo woman presents to the ED with a week long history of recurrent and persistent
unilateral left-sided HA, which she described as different in character from "run of the
mill" headaches. Associated symptoms include left-sided scalp tenderness, blurry
vision, and jaw pain when she chews (all symptoms are on the left side). She also
reports general feeling of fatigue malaise, and left-sided blurry vision. Her presentation
is consistent with: - ANSWER Giant cell arteritis (GCA)
-recommend high dose systemic steroid
You are refilling isotretinoin for Ms. Harris, a 24 yo woman who is being treated for acne
by a dermatologist. While waiting, she tells you that for the past couple of weeks she's
had new onset frequent headaches upon waking and blurry vision occurring every day.
Symptoms get better when she sits up. She has no other associated symptoms. What
condition should be at the top of your differential? - ANSWER Pseudotumor cerebri
Describe a Tension-type H/A - ANSWER Most common type of headache. Mild-moderate
pain intensity, bilaterial, nonpulsating headache. Pain is constant but dull combined with
muscle tenderness.
Relatively sudden onset of a dull (mild to moderate), bilateral headache
Constant squeezing ache like band around head
Associated with stiff/painful neck muscles
Common in settings of stress or mental tension - modified by analgesics
Describe a Classic migraine with no aura - ANSWER Moderate to severe pain that is
incapacitating, unilateral, pulsating, or throbbing, and is made worse by physical
activity. Patients may have nausea, vomiting, photophobia, or phonophobia.
Unilateral (in most cases, some are global or frontal) HA that builds quickly over an hour
and last 4-72 hours
Describe a Migraine with aura - ANSWER Moderate to severe pain that is incapacitating,
unilateral, pulsating, or throbbing, and is made worse by physical activity. -Patients may
have nausea, vomiting, photophobia, or phonophobia. Aura consists of flashing lights,
scotoma, visual disturbances, paresthesia, or a prodrome of tiredness, fatigue, mood
