BATES HEENT Assessment Midterm
Questions with Correct Answers
Primary headaches include
migraine, tension, cluster, and chronic daily headaches
Secondary headaches include
headaches arising from underlying structural, systemic, or infectious causes such as
meningitis or subarachnoid hemorrhage and may be life-threatening
Thunderclap headaches
reach maximal intensity over several minutes, occur in 70% of patients with subarachnoid
hemorrhage, and are often preceded by a sentinel leak headache from a vascular leak into the
subarachnoid space
The most important attributes of headache are
its severity and chronologic pattern
Headache Warning Signs ("red flags" that need prompt investigation)
1. Progressively frequent or severe over a 3-month period 2. Sudden onset like a
"thunderclap" or "the worst headache of my life" 3. New onset after age 50 years 4.
Aggravated or relieved by change in position 5. Precipitated by Valsalva maneuver 6.
Associated symptoms of fever, night sweats, or weight loss 7. Presence of cancer, HIV
infection, or pregnancy 8. Recent head trauma 9. Associated papilledema, neck stiffness, or
focal neurologic deficits
If headache is severe and of sudden onset, consider
subarachnoid hemorrhage or meningitis
,What types of headaches are episodic and tend to peak over several hours
migraine and tension headaches
New and persisting, progressively severe headaches raise concerns of
tumor, abscess, or mass lesion
Unilateral headache occurs in
migraine and cluster headaches
Tension headaches often arise in what area
the temporal areas
Cluster headaches may arise in what area
retro-orbital
Nausea and vomiting occur with what
commonly with migraines, but also with brain tumors and subarachnoid hemorrhage
What percentage of patients with migraine have a symptom prodrome prior to onset
60-70%
1/3 of patients with migraine experience
a visual aura, such as spark photopsias (flashes of light), fortifications (zig-zag arcs of light),
and scotoma (area of visual loss with surrounding normal vision)
Due to increased risk of ischemic stroke and cardiovascular disease, the World Health
Association advises women with migraines over age 35 and women with migraines with
aura avoid use of what
, estrogen-progestin contraceptives
Valsalva maneuvers may increase headache pain from
acute sinusitis or from mass lesion due to changing intracranial pressure
Medication for overuse headache is indicated if
analgesics/ergotamines/triptans present >/= 15 days a month for three months and reverts to
</= 15 days a month when the medication is discontinued
Medical terms for farsightedness, aging vision, and nearsightedness
hyperopia; presbyopia; myopia
If sudden unilateral visual loss is painless consider
vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment,
retinal vein occlusion, or central retinal artery occlusion
If sudden unilateral visual loss is painful consider
causes that are usually in the cornea and anterior chamber as in corneal ulcer, uveitis,
traumatic hyphen, and acute glaucoma, optic neuritis from MS may also be painful
If sudden bilateral visual loss that is painless occurs, consider medications that may
contribute:
medications that change refraction such as cholinergics, anticholinergics, and steroids
Gradual bilateral vision loss usually arises from
cataracts or macular degeneration
Slow central vision loss occurs in
nuclear cataract and macular degeneration
Questions with Correct Answers
Primary headaches include
migraine, tension, cluster, and chronic daily headaches
Secondary headaches include
headaches arising from underlying structural, systemic, or infectious causes such as
meningitis or subarachnoid hemorrhage and may be life-threatening
Thunderclap headaches
reach maximal intensity over several minutes, occur in 70% of patients with subarachnoid
hemorrhage, and are often preceded by a sentinel leak headache from a vascular leak into the
subarachnoid space
The most important attributes of headache are
its severity and chronologic pattern
Headache Warning Signs ("red flags" that need prompt investigation)
1. Progressively frequent or severe over a 3-month period 2. Sudden onset like a
"thunderclap" or "the worst headache of my life" 3. New onset after age 50 years 4.
Aggravated or relieved by change in position 5. Precipitated by Valsalva maneuver 6.
Associated symptoms of fever, night sweats, or weight loss 7. Presence of cancer, HIV
infection, or pregnancy 8. Recent head trauma 9. Associated papilledema, neck stiffness, or
focal neurologic deficits
If headache is severe and of sudden onset, consider
subarachnoid hemorrhage or meningitis
,What types of headaches are episodic and tend to peak over several hours
migraine and tension headaches
New and persisting, progressively severe headaches raise concerns of
tumor, abscess, or mass lesion
Unilateral headache occurs in
migraine and cluster headaches
Tension headaches often arise in what area
the temporal areas
Cluster headaches may arise in what area
retro-orbital
Nausea and vomiting occur with what
commonly with migraines, but also with brain tumors and subarachnoid hemorrhage
What percentage of patients with migraine have a symptom prodrome prior to onset
60-70%
1/3 of patients with migraine experience
a visual aura, such as spark photopsias (flashes of light), fortifications (zig-zag arcs of light),
and scotoma (area of visual loss with surrounding normal vision)
Due to increased risk of ischemic stroke and cardiovascular disease, the World Health
Association advises women with migraines over age 35 and women with migraines with
aura avoid use of what
, estrogen-progestin contraceptives
Valsalva maneuvers may increase headache pain from
acute sinusitis or from mass lesion due to changing intracranial pressure
Medication for overuse headache is indicated if
analgesics/ergotamines/triptans present >/= 15 days a month for three months and reverts to
</= 15 days a month when the medication is discontinued
Medical terms for farsightedness, aging vision, and nearsightedness
hyperopia; presbyopia; myopia
If sudden unilateral visual loss is painless consider
vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment,
retinal vein occlusion, or central retinal artery occlusion
If sudden unilateral visual loss is painful consider
causes that are usually in the cornea and anterior chamber as in corneal ulcer, uveitis,
traumatic hyphen, and acute glaucoma, optic neuritis from MS may also be painful
If sudden bilateral visual loss that is painless occurs, consider medications that may
contribute:
medications that change refraction such as cholinergics, anticholinergics, and steroids
Gradual bilateral vision loss usually arises from
cataracts or macular degeneration
Slow central vision loss occurs in
nuclear cataract and macular degeneration
