NMS Q&A Family Medicine

chap ter 4Pain and HeadacheManagementExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 Each of the following is a solid indication for neuroimagingin a patient with headache except:(A) Onset of headaches over the age of 50 years(B) Seizures associated(C) Prolonged aura(D) Nausea and vomiting(E) Headache worsening with movement2 Triptans, selective serotonin receptor agonists (SSRAs),have made a huge impact on treatment of migraineand to some extent cluster headaches. Of the manycontraindications to their usage, which of the followingis not a contraindication to taking a triptan?(A) Presence of ischemic heart disease(B) Taking within 24 hours of another triptan(C) Concomitant use with nonsteroidalantiinflammatory drugs (NSAIDs)(D) Taking in concert with ergotamine(E) Taking during a prolonged aura3 All of the following are commonly found in clusterheadache except for which one?(A) Alcohol ingestion(B) Tearing and rhinorrhea(C) Visual aura(D) Abrupt onset(E) Eyelid edema, ptosis4 A 26-year-old woman in her second trimester ofpregnancy complains of a recurrence of right hemicranialheadache that has been present for 24 hoursand is associated with photophobia and nausea asoccurred on numerous previous occasions. Which ofthe following is acceptable and safe for relief of herheadache?(A) Gabapentin (Neurontin)(B) Valproic acid(C) Vitamin B2(D) Lisinopril (Prinivil)(E) Candesartan (Atacand)5 A patient enters your practice with complaint ofrecent onset of acute headache. Which of the followingwould be the least indicative of serious pathologyunderlying the cause of the headache?(A) Occipitonuchal distribution(B) Age 50 years(C) Headache waking the patient from sleep(D) History of taking ibuprofen daily for arthritis(E) Increasing frequency of the headaches over time6 A 35-year-old woman complains of headaches thatare throbbing and frontal or occipital in distribution.These have been occurring for most of her adult lifebut have become more severe over the last severaldays, lasting the whole day, several times per week.They require her to take over-the-counter ibuprofenonce or twice weekly and usually respond thereto.Although the headaches remit during sleep, theyrecur during the day. Neurological history (includinginquiry regarding visual and other neurologicalsymptoms accompanying the headaches) and examinationare negative. Funduscopy is negative for hemorrhages,exudates, and papilledema. Blood pressureis 116/75. Which of the following is most likely as thediagnosis of the headaches?(A) Tension headache(B) Cluster headache(C) Migraine headache(D) Intracranial hemorrhage(E) Sinusitis7 A 45-year-old man complains of daily unilateralheadaches associated with rhinorrhea and tearing forthe past several weeks. Vascular examination is normal.There are no visual or musculoskeletal symptoms.Which of the following is the most likelydiagnosis?25