Lcrimation and nasal discharge.

1.    A 40 y/o patient presents with a 5-week hx  recurrent headaches that awaken him during the night. The pain is severe, lasts about 1 hour, and is located behind his L eye. Additional symptoms include lacrimation and nasal discharge. His physical examination is within normal limits. The most likely diagnosis is:

a.    Common migraine
b.    Classic migraine
c.    Cluster headache
d.    Increased intracranial pressure (ICP)

2.    Linda is a 22 y/o woman with a 3-year history of recurrent, unilateral, pulsating headaches with vomiting and photophobia. The headaches, which generally last 3 hours, can be aborted by resting in a dark room. She can usually tell that she is going to get a headache. She explains, “I see little ‘squiggles’ before my eyes for about 15 minutes.” Her physical examination is unremarkable. This presentation is most consistent with:

a.    Tension-type headache
b.    Migraine without aura
c.    Migraine with aura
d.    Cluster headache

3.    Prophylactic treatment for migraine headaches includes:

a.    Propanolol
b.    Ergotamine
c.    Naproxen sodium
d.    Enalapril

4.     You are examining a 55-year old woman who has a history of angina and migraine headache. Which of the following represents the best choice of acute headache treatment, called abortive migraine therapy, for this patient

a.    Verapamil
b.    Ergotamine
c.    Ibuprofen
d.    Sumatriptan

5.    With migraine headache, which of the following is true?

a.    Migraine with aura is the most common form
b.    Most migraineurs are in ongoing healthcare for the condition
c.    The condition is equally as common in men and women
d.    The patient is typically described as pulsating

6.    In tension-type headache, which of the following is true?

a.    Photophobia is seldom reported
b.    The pain is typically described as “pressing” in quality
c.    The headache is usually unilateral
d.    Activity makes the discomfort worse

7.    Treatment option in cluster headache include:

a.    NSAIDS
b.    Oxygen
c.    Triptans
d.    All of the above

8.    Which of the following affords the most rapid analgesic onset?

a.    Naproxen
b.    Liquid ibuprofen
c.    Diclofenac
d.    Celecoxib

9.    Limitations of butalbital with acetaminophen and caffeine (Fioricet) use include its:

a.    Energizing effect
b.    Gastrointestinal upset profile
c.    High rate if rebound headache if used frequently
d.    Excessive cost

10.    The use of neuroleptics in migraine headache therapy should be limited to less than 3 times per week due to their:

a.    Addictive potential
b.    Extrapyramidal movement risk
c.    Ability to cause rebound headache
d.    Sedative effect

11.    With appropriately prescribed headache prophylactic therapy, the patient should be informed to expect:

a.    Virtual resolution of headaches
b.    No fewer but less severe headaches
c.    Approximately 50% reduction in the number of headaches
d.    That lifelong therapy is advised

12.    A 48 y/o woman presents with a monthly 4 day premenstrual migraine headache, poorly responsive to triptans and analgesics, and accompanied by hot flashes. The NP considers prescribing all of the following except:

a.    Continuous monophasic oral contraceptive
b.    Phasic oral contraceptive with a 7-day-per-month withdrawal period
c.    Estrogen patch
d.    Triptan prophylaxis

13.    Prophylactic treatment options for the prevention of tension-type headaches include:

a.    Desipramine
b.    Lisinopril
c.    Oxycodone
d.    Butalbital

14.    A 68 y/o man presents with new onset of headaches. He describes the pain as bilateral frontal to occipital and worst when he arises in the morning and when coughing. He feels much better by mid afternoon. The history is most consistent with headache caused by:

a.    Vascular compromise
b.    Increased ICP
c.    Brain tumor
d.    Tension-type with geriatric presentation

15.    Anna is a 33 y/o woman who reports a 10-year history of unilateral, pulsing headache that lasts about 6-10 hours occurring 2-3 times per month. The headache is typically preceded by a gradual onset of paresthesia affecting the ipsilateral face abd arm that lasts about 20 mins. She has used OTC medications with partial relief and is here to request more effective therapy. Neurological exam is within normal limits. Anna asks if she needs “tests” to see what causes her headaches. You respond you should:

a.    Have neuroimaging conducted to rule out intracranial lesion
b.    Keep a headache diary
c.    Be evaluated by neurologist
d.    Continue with current course of therapy

16.    Which of the following represents the best choice of abortive migraine therapy for 55 y/o woman with angina

a.    Verapamil
b.    Ergotamine
c.    Almotriptan
d.    Ibuprofen.

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