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Example Questions
Example Question #271 : Conditions And Treatments
A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?
Migraine
Sinus
Caffeine withdrawal
Tension
Migraine
The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:
- More than 5 episodes (lifetime)
- Headache lasts 4-72 hours
- During headache at least one of the following:
- nausea / vomiting
- photophobia or phonophobia
- Headache has at least two of the following characteristics:
- unilateral
- moderate or severe pain intensity
- pulsating
- aggravation by normal physical activity, may cause avoidance of normal activities of life
- Not attributed to another disorder
Example Question #272 : Conditions And Treatments
A 37 year old man comes into the clinic for chronic headaches. He describes his headaches as in his forehead and temples bilaterally, occasionally wrapping around his head toward his neck. Pain is rated as a 4 out of 10. He has these headaches around 3 times per week. No photophobia with his headaches, no nausea or vomiting. Headache feels better when he presses on his scalp. When asked to describe the sensation of the headache, he replies that it's "like a band" around his head. These headaches are not preventing him from normal activity. These are most likely what type of headache?
Classic migraine
Tension headaches
Cluster headaches
Ocular migraine
Tension headaches
The symptoms described by this individual make tension headaches the most likely diagnosis. Tension headaches are defined by the following criteria:
- Minimum of 10 episodes occurring on less than 15 days per month for at least 3 months
- Headaches last from 30 minutes to 7 days
- Headache has at least two of the following qualities:
- mild or moderate intensity
- bilateral
- pressing or tightening (non-pulsing) quality
- not aggravated by routine activities of daily living
- Both of the following:
- no nausea or vomiting
- either photophobia or phonophobia, but not both
- Not attributed to another disorder
Example Question #273 : Conditions And Treatments
A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He has up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types?
Migraine without aura
Cluster headache
Migraine with aura
Tension hedache
Cluster headache
The presentation of this patient's headaches would make cluster headache the most likely diagnosis. Cluster headaches are defined by the following criteria:
- At least 5 attacks
- Severe unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes
- Headache is accompanied by at least one of the following:
- ipsilateral conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid swelling
- ipsilateral facial sweating
- ipsilateral miosis or ptosis
- restlessness or agitation
- Attack frequency ranges from every other day to 8 per day
- Not attributed to another disorder
Example Question #13 : Neural And Psychological Conditions
Which of the following is not a common trigger for migraine headaches?
Caffeine
Lack of sleep
Medication
Food allergies
Caffeine
While caffeine may be a migraine trigger for certain individuals, in the majority of people who experience migraine headaches, caffeine provides significant relief of pain. This may be due to it's antagonizing adenosine receptors, which has the effect of cerebral vasoconstriction. Caffeine withdrawal, however, is a common cause of headaches and may trigger migraine is susceptible individuals. Other common migraine triggers include food allergies, medications, bright lights, stress, lack of sleep, hormone fluctuations, strong odors, alcohol, and certain types of exercise.
Example Question #14 : Neural And Psychological Conditions
Which of the following seizure types is characterized by a brief loss in muscle control, often resulting in a fall or collapse, in the absence of spasm or rigidity?
Atonic seizure
Absence seizure
Tonic-clonic seizure
Myoclonic seizure
Atonic seizure
Atonic seizures are characterized by brief (2-15 second) loss or lapses in muscle control, resulting in sudden relaxation of the neck, legs, or whole body. This seizure type frequently causes injury due to falls or head trauma. There may be spasm or twitching at some point during an atonic seizure, but they generally present without any form of rigidity or clonus, unlike tonic-clonic and myoclonic seizures. Atonic seizures differ from absence seizures in that an individual experiencing absence seizures will generally only experience a loss of consciousness, without an accompanying loss of muscle control.
Example Question #1081 : Nclex
Which of the following symptoms describes the typical "aura" experienced during a complex-partial seizure?
Odd taste in the mouth
Olfactory disturbances: unusual smells, smelling things that are not present
A sense of déjà-vu or a feeling that everything is strangely unfamiliar (jamais-vu).
All of these are correct
Visual disturbances such as sparks, color fluctuations, or blurry vision
All of these are correct
The "aura" experienced before a seizure, while frequently thought-of as a primarily visual experience, can include disturbances in taste or smell, bodily sensations such as stomach ache or tingling, anxiety, or a sense that everything is oddly familiar (déjà vu) or unfamiliar (jamais vu).
Example Question #1081 : Nclex
Which of the following describes a generalized seizure?
A seizure that involves a specific area limited to one hemisphere of the brain in which there is loss or impairment of consciousness
30 minutes or more of uninterrupted seizure activity
A seizure that involves both sides of the brain simultaneously from onset and results in loss of consciousness
A seizure that involves a specific area limited to one hemisphere of the brain in which there is no loss of consciousness
A seizure that involves both sides of the brain simultaneously from onset and results in loss of consciousness
A generalized seizure is one which involves both sides of the brain simultaneously from onset and results in loss of consciousness. This is contrasted with complex and simple partial seizures, in which only one area of the brain is involved and the individual may or may not lose consciousness (in complex and simple partial seizures, respectively). Seizure activity that lasts for 30 or more minutes is a rare and serious condition known as status epilepticus. Any seizure that lasts for over five minutes is considered a medical emergency and requires emergency assistance.
Example Question #1083 : Nclex
Which of the following is not a type of seizure?
Simple partial
All of these are seizure types
Myoclonic
Absence
All of these are seizure types
Currently there are over 40 distinct types of seizures recognized by the medical community. Some of the most common seizure types are generalized tonic-clonic, absence, myoclonic, clonic, tonic, febrile, and atonic. Some other less common types include refractory seizures, gelastic seizures, and dacrystic seizures.
Example Question #1082 : Nclex
A seven year old girl is having issues in school due to lack of attention. Her teacher states that she will "space out" frequently for a period of 10-20 seconds. During these times she will stare straight ahead and will not respond to questions, even if she is called on directly. She does not have any tics or facial movements during these episodes, other than a slight fluttering of the eyelids. Her teacher states she does this several times during the school day, and that it is impacting her performance in school because she is unable to remember what the teacher was talking about during the spell.
This child is most likely experiencing which of the following types of seizures?
Myoclonic
Atonic
Clonic
Absence
Absence
Absence seizures are typified by a brief, 2-30 second loss of consciousness in the absence of other symptoms. Individuals with this condition generally will not experience muscle rigidity (as in a tonic seizure) or jerking (as in clonic or myoclonic seizures), nor do they experience a loss of muscle tone, as seen in atonic seizures. Absence seizures present frequently in young children as "staring spells" and may cause issues with learning or appear as inattentive behavior in school until correctly diagnosed by a medical professional.
Example Question #1083 : Nclex
A seven year old girl is having issues in school due to lack of attention. Her teacher states that she will "space out" frequently for a period of 10-20 seconds. During these times she will stare straight ahead and will not respond to questions, even if she is called on directly. She does not have any tics or facial movements during these episodes, other than a slight fluttering of the eyelids. Her teacher states she does this several times during the school day, and that it is impacting her performance in school because she is unable to remember what the teacher was talking about during the spell.
Which of the following diagnostic tool would help this child's provider identify her "spells" as absence seizures?
CNS ultrasound
Computed tomography (CT)
Electroencephalography (EEG)
Magnetic resonance imaging (MRI)
Electroencephalography (EEG)
While CT and MRI may aid in discovering structural abnormalities associated with certain seizure disorders, the correct tool for diagnosis of seizures is electroencephalography (EEG). An EEG can show abnormal surges in brain activity responsible for temporary loss of consciousness in absence seizures.
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