Author Question: An 8-year-old child presents to the emergency room with a severe unilateral, throbbing headache. She ... (Read 190 times)

kamilo84 · **on:** Jun 25, 2018

An 8-year-old child presents to the emergency room with a severe unilateral, throbbing headache. She is lying on the gurney with her eyes closed while holding her head. She denies ever having this kind of headache in the past.

She complains of sensitivity to light and noise. An appropriate history question to ask the parent would be:
A. What do you think triggered the headache?
B. Have you had a fever?
C. Does anyone in your family suffer from migraine headache?
D. B and C

Question 2

A 36-year-old female patient complains of foot pain when she wears high heels. There is no history of trauma or arthritis. On physical examination, there is tenderness at the space between the third and fourth metatarsal bones.

Foot x-ray shows no evidence of stress fracture. This history is typical of:
A. Plantar fasciitis
B. Morton's neuroma
C. Achilles tendonitis
D. None of the above

Andromeda18 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: D
A migraine is one of the most common types of vascular headache and accounts for a significant percentage of clinic and emergency department visits each year. They occur more frequently in women and the majority of patients report a family history of migraine. Onset of migraine is uncommon after the age of 40 years. They generally do not occur daily and are often associated with the menstrual cycle. Typical migraine pain begins unilaterally but may become generalized and may lateralize to the opposite side and/or radiate to the face or neck. The pain ranges from a dull ache to a throbbing or pulsatile pain. The pain is often severe and/or incapacitating and is often aggravated by movement, light, and noise. Accompanying symptoms may include nausea, vomiting, photophobia, phonophobia, osmophobia, dizziness, chills, and/or ataxia.

Answer to Question 2

ANS: B
Morton's neuroma, also called interdigital neuroma, is actually not neuroma but rather fibrous tissue thickening along digital nerves, typically in the space between the third and fourth intermetatarsals. They occur most frequently in women and may be associated with footwear, such as heels. Most common is localized pain that is increased with walking and decreased with rest and/or removal of shoes. Palpation often reproduces the sharp pain.