N202 - EXAM 5

what is a tension headache?

headache of musculoskeletal origin

which headache is is most commonly called a stress headache?

a. tension headache

b. migraine

c. cluster headache

d. thunderclap headache

tension headache

what causes a tension headache?

stress

depression

poor posture

poor sleep

what is the timing of a tension headache?

situational, in response to overwork, posture

what is the treatment of a tension headache?

abortive meds = NSAIDs

what is the location of a tension headache?

usually both sides, across frontal, temporal, and/or occipital region of head: forehead, sides, and back of head

what is the character of a tension headache?

bandlike tightness, viselike, nonthrobbing, nonpulsatile

what is the duration of a tension headache?

gradual onset; lasts 30 minutes to 7 days

what is the quantity and severity of a tension headache>

diffuse, dull aching pain

mild-to-moderate pain

what is a migraine?

headache of trigeminal nerve or vascular origin

what causes a migraine?

hormonal changes

drinking alcohol or caffeine

different foods/additives

hunger

let down after stress

sleep changes

smells

lights

what is the location of a migraine?

commonly one-sided but may occur on both sides; pain is often behind the eyes, temples, or forehead

what is the character of a migraine?

throbbing, pulsating

what is the duration of a migraine?

rapid onset; peaks 1-2 hours, lasts 4-72 hours

what is the quantity and severity of a migraine?

moderate to severe pain

what is the timing of a migraine?

prodrome: hours-days before migraine

aura: 5-60 minutes

migraine attack: 4-72 hours

postdrome: 24-46 hours

what characterizes the prodrome stage of a migraine?

changes in mood

behavior

sensitivity to light/sound/smell/hunger/cravings

fatigue

yawning

constipation or diarrhea

what characterizes the aura stage of a migraine?

visual changes (blind spots, wavy lines, flashes of light)

tingling in arms or legs

vertigo

speech/language change

what characterizes the postdrome stage of a migraine?

fatigue or irritability

what is the treatment of a migraine?

lie down in dark room with eye shade and sleep

abortive meds = NSAIDs, anti-nausea meds

what is a cluster headache?

rare headache that is intermittent, excruciating, unilateral, with autonomic signs

what causes a cluster headache?

usually due to alcohol, nitroglycerin, histamine, organic compounds (paint, perfume)

what is the location of a cluster headache?

always one sided, behind or around the eye, temple

what is the character of a cluster headache?

continous, sharp, burning, piercing, excruciating

what is the duration of a cluster headache?

abrupt onset; peaks in minutes, lasts 15-180 min

what is the quantity and severity of a cluster headache?

can occur multiple times a day in "clusters"

very severe pain

what is the timing of a cluster headache?

often occurs at night, waking from sleep

what is the treatment of a cluster headache?

abortive = oxygen, parental tryptins

preventive = calcium channel blockers, corticosteroids, lithium

what is the worst and most dangerous type of headache?

a. tension headache

b. cluster headache

c. thunderclap headache

d. migraine

c. thunderclap headache

what is the character of a thunderclap headache?

pain intensity surges within seconds to minutes

what causes a thunderclap headache?

brain aneurysm - weak spot on brain artery that bulges like a little bubble on a host

what is a concussion?

type of traumatic brain injury that alters normal functioning

what causes a concussion?

occurs when a sudden strong jolt or blow to the head or body causes violent rotation or shaking of the head --> brain bounces around or twists in the skull = chemical changes in the brain that can stretch and damage brain cells

what are serious signs of a concussion?

- forgetfulness of recent events

- loss of consciousness

- mental cloudiness

what is BRAIN?

mnemonic with stages of increasing exercise levels post-concussion

B = stationary bik

R = running

A = agility or non-contact

I = "in-red" or full contact "controlled"

N = no restrictions

what do you ask when patient has a head injury?

did you lose consciousness and then fall or fall then lose consciousness?

what can loss of consciousness before the fall indicate?

cardiac issue (heart slows down + pumps less blood --> blood pressure drops --> brain doesn't get enough oxygenated blood = faint)

what can neck pain associated with stiffness, headache, and fever indicate?

meningitis

what are the different types of stroke?

ischemic: due to blood clot

hemorrhagic: rupture of cerebral vessel

What is peripheral cranial nerve 7 damage?

Bell's palsy

what is nystagmus?

fine, oscillating movement best seen around the iris

what causes Bell's palsy

herpes simplex virus

what does nystagmus occur with?

disease of the semicircular canals in the ears, a paretic eye muscle, multiple sclerosis, or brain lesions

what is the difference between objective and subjective vertigo?

objective vertigo: patient says the room is spinning

subjective vertigo: patient says they feel like they are spinning

what is commonly seen in Grave's disease?

exophthalmos: eyeballs bulge or protrude abnormally from their sockets

what is graves disease?

autoimmune disease with increased production of thyroid hormones (hyperthyroidism) --> increased metabolic rate

what is myxedema?

deficiency of thyroid hormone (hypothyroidism) --> reduces metabolic rate and cases non-pitting edema; usual cause is Hashimoto thyroiditis

what are the regulations of the production of thyroid hormones?

1. hypothalamus secretes thyrotropin-releasing hormone (TRH)

2. TRH tells pituitary gland to secrete thyroid-stimulating hormone (TSH)

3. TSH directs thyroid gland to produce T3 and T4 hormones

4. T3 and T4 signal pituitary and hypothalamus to stop when in bloodstream

what is goiter?

enlarged thyroid due to low iodine; associated with irregular amounts of thyroid (hyperthyroidism or hypothyroidism)

what are normal changes in the eye for an aging adult?

1. decreased tear production (dry eyes)

2. decreased pupil size due to loss of elasticity in lens or presbyopia

3. ectropion: lower lid rolls out

4. cataracts: transparent fibers thicken and yellow

what is PERRLA?

pupils are equal, round, and reactive to light, and accommodation

which cranial nerve is responsible for pupillary constriction?

cranial nerve 3

what is an example of accommodation?

reading small print

(convergence of the axis of the eyes)

What is the Snellen Eye Chart?

an alphabet chart used to assess visual acuity

top number = distance person is standing from the chart

bottom number = distance normal eye could have read from that feet/distance

what is indicated with a curtain fall?

retinal tear

- emergency surgery

- if happens once will most likely happen again

what is strabismus?

deviation in the parallel axis of the two eyes

what is diplopia?

seeing two images of a single object

what are red eye emergencies?

1. sudden vision loss

2. trauma to eyeball

3. herpes zoster infection on face (ex: shingles)

4. corneal damage

5. sudden distorted pupil

what is glaucoma associated with?

increased intraocular pressure

what is indicated with pallor on outer canthus of lower lid?

anemia

what is glaucoma?

loss of peripheral vision due to increase in aqueous humor in eye --> lacks proper outflow of aqueous humor

how would you adjust glasses to mimic glaucoma?

shaving outside of lens and leaving just the middle open

what is diabetic retinopathy?

scattered, shade patches within the lens

what is age-related macular degeneration?

loss of central vision

how would you adjust glasses to mimic age-related macular degeneration?

shaving middle of glasses lens and leving peripheral open

what are risk factors for age-related macular degeneration?

>50 years old

smoking

family history

light colored eyes

increased exposure to UV light

hypertension

CVD

lack of intake of antioxidants and zinc

what are cataracts?

clouding of the lens which causes decreases amount of light that reaches retina

what are the symptoms of cataracts

inhibits vision; blurry vision, glare, halo, double vision, difficulty without contrasting colors, poor night vision

how would you adjust glasses to mimic cataracts?

shading lens with hatch marks, blurring the amount of light that comes in

what are the NORMAL hearing changes in the aging adult?

- hearing loss is slow and gradual

- cerumen is drier and harder

- auricle wrinkles and sags related to loss of elasticity of pinna

- sensor/neural nerve degeneration

- harder to hear consonants; sounds may be garbled and difficult to localize

what is conductive hearing loss?

mechanical dysfunction of external or middle ear

what is partial hearing loss?

patient is able to hear if sound amplitude is increased enough to reach the normal nerve elements in inner ear

what does snsorineural or preceptive hearing loss indicate?

signifies pathology of the inner ear --> gradual nerve degeneration

- harder to hear consonants than vowels; words sound garbled

what is mixed hearing loss?

combination of conductive and sensorineural hearing loss

what is the purpose of cerumen?

protect and lubricate the ear

what should a normal tympanic membrane look like?

pearly gray in color and translucent

what is an audio meter?

hearing acuity test -- handheld sound device; finger is raised when sound is heard

what is a tuning fork test for?

measures hearing through air conduction and bone conduction to help determine the type of hearing loss a patient has

what is should be seen in a normal mouth?

- nose should be free of polyps

- tongue is pink and roughed from papillae and CAN have a white coating (NOT a cheesy coating)

what are normal changes in the nose/mouth/throat in an older adult?

- nose is more prominent due to loss of subq fat

- decreased taste and smell and olfactory nerve fibers

- loss of taste buds

- decreased salivary secretion

- worn teeth

- increased risk for Candidiasis infection

- smoother tongue surface due to papillary atrophy

what gan gingivitis be related to?

anxiety or antidepressants

smoking

type 2 diabetes

what is leukoplakia?

chalky white, thick, raised patches with well-defined borders on the lateral edges of the tongue

are leukoplakia cancerous?

they are precancerous and must refer to a specialist

what cranial nerve is the "ah" test associated with?

tests cranial nerve 10

what cranial nerve is tested with the sticking-out-tongue test?

tests cranial nerve 12

what cranial nerves are tested with the gag reflex test?

tests cranial nerve 9 and 10

what is indicated with painless enlargement of the gums that sometimes overreaches the teeth?

gingival hyperplasia

what is gingivitis?

inflammation of the gums (usually caused by poor dental hygiene or vitamin C deficiency); gum margins are red and swollen and bleed easily

what is meth mouth?

meth usage can lead to extensive dental caries, gingivitis, tooth cracking, and edentulism

what is indicated when you first see a "canker sore" and then a small, round "punched-out" ulcer with a white based surrounded by a red halo?

aphthous ulcers

what are Koplik spots in measles?

small blue-white spots with irregular halo scatter over mucosa; early sign of measles

what is normally seen with a Candidiasis infection?

white, cheesy, or curd-like patch on the buccal mucosa and tongue; "thrush"

what causes a Candidiasis infection?

occurs after antibiotic and corticosteroid use and in immunosuppressed people

what causes a tongue-tie?

ankyloglossia (short lingual frenulum fixes tongue tip to floor of mouth and gums)

what are the characteristics of geographic tongue or migratory glossitis?

pattern of normal coating interspersed with bright, shiny, circular bald areas caused by atrophy of the filiform papillae, with raised pearly borders

what is atrophic glossitis?

smooth, glossy tongue that occurs with pernicious anemia, folic acid deficiency, and iron deficiency anemia

what are characteristics of a black hairy tongue?

elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on the tongue

what causes black hairy tongue?

occurs after use of antibiotics and heavy smoking

what are the characteristics of a carcinoma?

ulcer with rolled edges, indurated at sides, base, and under tongue; associated with leukoplakia

- rich lymphatic drainage increases risk for early metastasis

what accounts for most cases of oral cancer?

smoking and alcohol