A 41-year-old male patient presents to the emergency department ...

[cmoore54]

A 41-year-old male patient presents to the emergency department complaining of severe headache pain. He describes it as a piercing, right sided head pain that occurred earlier in day for about 1 hour and now is recurring.
 
  You note lacrimation and rhinorrhea on the right side of the face. Which of the following types of headache is the patient describing?
  A. Sinusitis
  B. Cluster headache
  C. Migraine
  D. Subdural hematoma

Question 2

A 60-year-old female complains of several episodes of dizziness and nausea that started this morning. She denies trauma, falling, or loss of consciousness.
 
  She has a 5-year history of hypertension and takes a beta blocker daily. On physical examination, there are no neurologic deficits or any abnormal findings and ECG is normal. Which of the following tests should be performed?
  A. Test the patient for Kernig's sign
  B. Test the patient for Brudzinski sign
  C. Perform the Hallpike maneuver
  D. Assess for Babinski's sign

[nickk12214]

Answer to Question 1

ANS: B
Cluster headaches have rapid crescendo patterns, peaking in approximately 10 to 15 minutes and often lasting 30 to 60 minutes per episode (rarely lasting over 2 hours each). Attacks occur as frequently as two to three times per day. The pain is generally in the area of the trigeminal nerve and is described as unilateral, penetrating, sharp, excruciating, and unrelenting in nature. There may be associated unilateral lacrimation, nasal congestion or rhinorrhea, pallor, flushing, conjunctival redness, ptosisall on the same side as the pain.

Answer to Question 2

ANS: C
Characterized by sudden-onset dizziness lasting less than 30 seconds and following a head position change, benign positional vertigo (cupulolithiasis) may be accompanied by nystagmus. It usually subsides but may recur at any time. In addition to the history, a provocative test for positional nystagmus can be performed (Hallpike maneuver), although it is not always positive. The provocative test involves moving the patient quickly from a sitting position to a lying position with the head turned to the side and the head dependent over the side of the examination table. After a few seconds, vertigo and nystagmus occur. This response fatigues with immediate repetition of the test.