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A 37-year-old man with a past medical history of depression, hypothyroidism, fibromyalgia, and nephrolithiasis presents with a well-documented history of migraine headaches. In the past, his headache frequency was less than 5 days a month but they are now occurring at least three times a week. Your suspicion of secondary causes of headache is low and you are considering starting a prophylactic migraine treatment. Which of the following medications should be avoided?
A 32-year-old male comes into the headache clinic for severe headaches. They occur several times a day and last approximately one hour. They are only felt on the left side of his head, and he says he gets a runny nose and a little teary during the episodes. What is a notable side effect of the prophylactic medicine that is considered first-line therapy for this condition?
A 37-year-old female with a past medical history of obesity presented to the emergency room with a severe headache and visual disturbances. The funduscopic exam shows bilateral papilledema. An MRI of the brain shows an empty sella and MRV was normal. A lumbar puncture was performed. The opening pressure was 38 and there were no WBCs or RBCs appreciated in the CSF. What is the most appropriate therapy for her disease?
A 30-year-old female with a past medical history significant for acne, migraine without aura, and depression presents to the emergency room with severe recurrent headaches. She says the headaches come on quickly and only last a couple of minutes but are debilitating. CTH was normal. A CTA head and neck was performed which showed segmental artery narrowing in the proximal MCA territory. Which of the following medications was the most likely trigger of this patient’s presentation?
A 27-year-old female presented with a severe headache for the past 4 days. Last week she gave birth to a healthy baby boy. She says the pain is worse when sitting up or walking but laying down in bed provides some relief. A brain MRI with contrast is ordered which shows thickening and enhancement of the dura. What is the most appropriate therapy for this patient?
Which of the following medication regimens would put a patient at the highest risk of medication overuse headaches?
A 24-year-old female in her third trimester of pregnancy, with no other past medical history, presents with complaints of 1-2 times monthly episodes of sudden onset severe room spinning, nausea, and vomiting for 3 months. They happen randomly and are not associated with head movement. During an episode, sounds and bright light seem to bother her more. She denies motor weakness or hearing change. Her spells resolve after about 1 hour. She endorses she has had bad headaches in the past, but not with these episodes. She endorses she gets car sick easily. On neurologic examination, she has no focal findings, and her vitals are within normal limits. She had an MRI brain with MRA and MR Venogram, all of which were unremarkable. Which is the most likely etiology?
A 5-year-old female was brought to the neurology clinic for a second opinion for paroxysmal spells of dizziness. The family states that several times a month the patient will develop severe dizziness, nausea, and vomiting. Symptoms usually only last less than 5 minutes. An MRI and 24-hour ambulatory EEG have been performed in the last 3 months. Both were unremarkable. What is the most likely diagnosis?
An MRI is performed on a 30-year-old woman with a 3-day history of intractable headache after a recent epidural and uncomplicated vaginal delivery of a healthy baby girl. Axial T1 pre-contrast (left) and post-contrast (right) MRI images are shown below. Which of the following is the most likely diagnosis?
A 34-year-old female presents to the clinic with the chief complaint of headaches. She endorses a unilateral, throbbing headache that occurs up to 8 times a month. Episodes can last between 1-3 hours. She admits to nausea and photophobia during her headaches. What is the most likely diagnosis?
A 37-year-old female with a past medical history of acne, obesity, anxiety, and fibromyalgia presented to the emergency room with a severe headache, papilledema, and visual disturbances. MRI shows an empty sella and MRV was normal. Symptoms started two weeks after her primary care physician initiated a new medication. Which of the following was the most likely medication initiated by the primary care physician?
All of the following therapies can be useful in the management of cluster headaches except:
A 40-year-old man is seen in the clinic with the chief complaint of headaches. He endorses a unilateral stabbing-like pain around the temple. This pain lasts 10-30 seconds at a time and occurs dozens of times a day. There were no clear triggers. There is associated ipsilateral conjunctival lacrimation and rhinorrhea. What is the most likely diagnosis?
Which of the following has the longest half-life?
A 29-year-old man with a 10-pack-year smoking history comes into the clinic with a severe headache. The pain surrounds his right eye and is associated with a runny nose, excessive tearing, and a “droopy eyelid.” He describes the pain as stabbing that usually lasts about 30 minutes and occurs every day after he eats dinner. What is the most likely diagnosis?
A 34-year-old woman comes to the emergency room with complaints of neck stiffness, headaches that are worse on standing, and diplopia. An MRI brain with contrast shows diffuse dural enhancement. Which of the following findings is also likely to be present in this case?
A 32-year-old female comes into the clinic with a continuous, throbbing headache for 5 months. The pain is unilateral near the temple. The headache is constant but there are periods of pain exacerbations that can last from minutes to days and are debilitating. There is associated lacrimation and rhinorrhea on the ipsilateral side. What is the most likely diagnosis?
A 31-year-old female who recently delivered a healthy boy 3 days ago comes into the emergency room with a headache and vomiting. Other than requiring an epidural for pain management, the delivery of her child was uncomplicated. Her neurological exam is normal. A brain MRI was completed and is shown below (Left: T1, Right: T2 with contrast). Which of the following is the most likely diagnosis?
A 35-year-old woman presents to the clinic with headaches. Her past medical history is significant for migraines and a sprained ankle four months ago that she has been managing with daily NSAIDs. Her headaches started a month ago and have been occurring every day for the past three weeks. She describes the headaches as a band-like pressure around her head. Nothing has helped but the symptoms are worse in the mornings. A recent brain MRI was completed during an emergency room visit which was unremarkable. Which of the following is the most appropriate next step in therapy?
A 25-year-old female presents to the clinic with headaches for a year that occur two to three times a month. The pain usually occurs on one side and is associated with nausea and light and sound sensitivity. During these episodes, she is unable to go to work. Over-the-counter anti-inflammatories are ineffective. Physical exam and vitals are normal. Which therapy is the most appropriate next option in treatment?
A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the correct diagnosis?
A 40-year-old man comes into the clinic with headaches. He has stabbing pain around the left temple that occurs numerous times during the day. The pain lasts 10-30 seconds at a time. He says he has excessive tearing from the left eye during these episodes. What is the most appropriate therapy?
Which of the following medications may be unsafe for the treatment of migraine headaches in patients with a history of coronary artery disease (CAD)?
An overweight 24-year-old woman complains of neck stiffness, daily headaches, and blurred vision. She has disc edema on fundoscopic exam and slit-like ventricles on MRI brain. A spinal tap was performed and confirmed the diagnosis. Which of the following is the first-line therapy?
A 55-year-old male cigarette smoker with a past medical history of hypertension and medication non-compliance presents to the emergency room with an excruciating headache and altered mentation. An MRI of the brain is completed and provided below (T2 sequence). Which of the following is the most likely diagnosis?
A 30-year-old woman presents to the clinic with severe headaches requesting treatment because she “can’t live with this pain”. Episodes are left-sided, occur multiple times a day, and last about 20 minutes each. During episodes, she will also have eye tearing and rhinorrhea. What is the appropriate therapy?
A 55-year-old female with a past medical history of coronary artery disease and ischemic stroke with residual mild left arm weakness presents with headaches for a year. Episodes occur two to three times a month. The pain is unilateral and is associated with nausea and photophobia. During this episode, she is unable to go to work and over-the-counter anti-inflammatories have been ineffective. Physical exam and vitals are normal. Which abortive therapy is the most appropriate next step in management?
All of the following medications have Level A or B evidence in migraine prophylaxis except:
Which of the following is not typically treated with indomethacin?
A 45-year-old female with a past medical history significant for asthma presents to the clinic for migraines with aura. Her headaches occur at least 13 times a month. She was given sumatriptan for abortive therapy six months ago but it has become ineffective. Her vital signs are stable. Her BMI is 33. Which of the following is the best next step in treatment?
A 32-year-old woman comes into the clinic complaining of severe right-sided headaches around the temple. The pain occurs several times a day and lasts approximately 15 minutes and radiates to the right shoulder and arm. There is also associated nasal congestion and lacrimation during the episodes. The patient was treated with indomethacin with complete resolution of symptoms. What is the most likely diagnosis?
A 65-year-old woman with a past medical history of hypertension, hyperlipidemia, and migraine headaches previously well-controlled on propranolol, presents to the clinic with new headache characteristics. The patient states that she recently has a new scalp tenderness. On further history, she endorses jaw soreness after eating. What is the most appropriate initial diagnostic test?
A 48-year-old patient with a past medical history of chronic migraines is brought in by her family with sudden-onset memory complaints. She is unable to recall where she lives or even her own name. A brain MRI (Left: DWI. Right: ADC.) is shown below. Which of the following is the most likely diagnosis?