NR601 Week 7: Neurology & Mental Health in
Older Adults – 80 Multiple-Choice Questions with
Rationales- Chamberlain
HEADACHE DISORDERS (~10 questions)
1. A 68-year-old patient presents with recurrent unilateral, throbbing headaches
accompanied by photophobia and nausea. What is the MOST appropriate initial
treatment for this headache type?
A. Acetaminophen alone
B. Triptans and NSAIDs
C. Opioid analgesics
D. Butalbital-containing compounds
Answer: B
Rationale: This describes migraine. First-line acute treatment includes triptans and
NSAIDs. Opioids and butalbital are not first-line.
2. Which accompanying headache symptom requires urgent evaluation due to
suspicion of a secondary headache disorder?
A. Mild photophobia
B. Nausea without vomiting
C. Phonophobia
D. Diplopia and new-onset confusion
Answer: D
Rationale: Diplopia, confusion, focal neurologic deficits, or sudden severe headache
suggest secondary causes (e.g., stroke, mass, hemorrhage).
3. Which of the following is a red flag for a secondary headache in older adults?
A. Headache lasting 4–72 hours
B. Unilateral throbbing pain
C. New-onset headache after age 50
D. Headache with aura
Answer: C
Rationale: New-onset headache after age 50 warrants evaluation for secondary causes
(giant cell arteritis, mass, etc.).
,4. Which medication is contraindicated in older adults with uncontrolled
hypertension or cardiovascular disease for migraine treatment?
A. Ibuprofen
B. Sumatriptan
C. Acetaminophen
D. Metoclopramide
Answer: B
Rationale: Triptans cause vasoconstriction and are contraindicated in uncontrolled
HTN, CAD, or history of stroke.
5. Which of the following is a first-line preventive medication for chronic migraine in
older adults?
A. Topiramate
B. Propranolol
C. Amitriptyline
D. All of the above
Answer: D
Rationale: Topiramate, beta-blockers (propranolol), and tricyclics (amitriptyline) are
preventive options, but amitriptyline is anticholinergic – use caution.
6. Which of the following is the most common primary headache disorder in older
adults?
A. Migraine
B. Tension-type headache
C. Cluster headache
D. Hypnic headache
Answer: B
Rationale: Tension-type headache is most common. Migraine prevalence decreases
with age. Hypnic headache is rare but specific to older adults.
7. A 72-year-old presents with a severe, unilateral headache with scalp tenderness
and jaw claudication. ESR is 65 mm/hr. What is the most likely diagnosis?
A. Migraine
B. Giant cell arteritis
C. Trigeminal neuralgia
, D. Tension headache
Answer: B
Rationale: Scalp tenderness, jaw claudication, elevated ESR, and age >50 suggest giant
cell arteritis. Urgent treatment with steroids is needed.
8. Which medication is first-line for acute treatment of cluster headache?
A. Sumatriptan injection
B. Ibuprofen
C. Acetaminophen
D. Oxygen therapy
Answer: A
Rationale: Sumatriptan injection and high-flow oxygen are first-line for acute cluster
headache.
9. Which of the following is a contraindication to triptan use?
A. History of migraine with aura
B. History of ischemic stroke
C. Age over 65
D. Mild hypertension
Answer: B
Rationale: Triptans are contraindicated in patients with history of ischemic stroke, MI,
or uncontrolled hypertension.
10. Which of the following is a nonpharmacologic treatment for migraine
prevention?
A. Riboflavin (vitamin B2)
B. Magnesium
C. Coenzyme Q10
D. All of the above
Answer: D
Rationale: Riboflavin, magnesium, and CoQ10 have evidence for migraine prevention
with few side effects.
DEMENTIA & COGNITIVE IMPAIRMENT (~15 questions)
Older Adults – 80 Multiple-Choice Questions with
Rationales- Chamberlain
HEADACHE DISORDERS (~10 questions)
1. A 68-year-old patient presents with recurrent unilateral, throbbing headaches
accompanied by photophobia and nausea. What is the MOST appropriate initial
treatment for this headache type?
A. Acetaminophen alone
B. Triptans and NSAIDs
C. Opioid analgesics
D. Butalbital-containing compounds
Answer: B
Rationale: This describes migraine. First-line acute treatment includes triptans and
NSAIDs. Opioids and butalbital are not first-line.
2. Which accompanying headache symptom requires urgent evaluation due to
suspicion of a secondary headache disorder?
A. Mild photophobia
B. Nausea without vomiting
C. Phonophobia
D. Diplopia and new-onset confusion
Answer: D
Rationale: Diplopia, confusion, focal neurologic deficits, or sudden severe headache
suggest secondary causes (e.g., stroke, mass, hemorrhage).
3. Which of the following is a red flag for a secondary headache in older adults?
A. Headache lasting 4–72 hours
B. Unilateral throbbing pain
C. New-onset headache after age 50
D. Headache with aura
Answer: C
Rationale: New-onset headache after age 50 warrants evaluation for secondary causes
(giant cell arteritis, mass, etc.).
,4. Which medication is contraindicated in older adults with uncontrolled
hypertension or cardiovascular disease for migraine treatment?
A. Ibuprofen
B. Sumatriptan
C. Acetaminophen
D. Metoclopramide
Answer: B
Rationale: Triptans cause vasoconstriction and are contraindicated in uncontrolled
HTN, CAD, or history of stroke.
5. Which of the following is a first-line preventive medication for chronic migraine in
older adults?
A. Topiramate
B. Propranolol
C. Amitriptyline
D. All of the above
Answer: D
Rationale: Topiramate, beta-blockers (propranolol), and tricyclics (amitriptyline) are
preventive options, but amitriptyline is anticholinergic – use caution.
6. Which of the following is the most common primary headache disorder in older
adults?
A. Migraine
B. Tension-type headache
C. Cluster headache
D. Hypnic headache
Answer: B
Rationale: Tension-type headache is most common. Migraine prevalence decreases
with age. Hypnic headache is rare but specific to older adults.
7. A 72-year-old presents with a severe, unilateral headache with scalp tenderness
and jaw claudication. ESR is 65 mm/hr. What is the most likely diagnosis?
A. Migraine
B. Giant cell arteritis
C. Trigeminal neuralgia
, D. Tension headache
Answer: B
Rationale: Scalp tenderness, jaw claudication, elevated ESR, and age >50 suggest giant
cell arteritis. Urgent treatment with steroids is needed.
8. Which medication is first-line for acute treatment of cluster headache?
A. Sumatriptan injection
B. Ibuprofen
C. Acetaminophen
D. Oxygen therapy
Answer: A
Rationale: Sumatriptan injection and high-flow oxygen are first-line for acute cluster
headache.
9. Which of the following is a contraindication to triptan use?
A. History of migraine with aura
B. History of ischemic stroke
C. Age over 65
D. Mild hypertension
Answer: B
Rationale: Triptans are contraindicated in patients with history of ischemic stroke, MI,
or uncontrolled hypertension.
10. Which of the following is a nonpharmacologic treatment for migraine
prevention?
A. Riboflavin (vitamin B2)
B. Magnesium
C. Coenzyme Q10
D. All of the above
Answer: D
Rationale: Riboflavin, magnesium, and CoQ10 have evidence for migraine prevention
with few side effects.
DEMENTIA & COGNITIVE IMPAIRMENT (~15 questions)
