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migraine HA sx description
- usually unilateral
- throbbing/aching
- variable severity
- onset: fairly rapid, peak 1-2 h
- associated factors: N/V, photophobia, aura..
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tension HA
- usually bilateral
- often frontotemporal
- pressing or tightening pain
- mild to moderate intensity
- gradual onset
- often recurrent with persistence over long periods
- NO n/v
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Cluster HA
- Location: unilateral, periorbital
- Quality/severity: deep, continuous, severe
- Onset: abrupt, peaks within minutes
- Duration: up to 3h
- Course: episodic. several each day for period of time, then relief
- Associated
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Primary HA
Migraines, tension or cluster HA
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Secondary HA
HA having underlying medical cause.
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Subarachnoid Hemorrhage
- Location: generalized
- Quality/Severity: very severe, "worst HA of my life"
- Associated: N/V, possible decrease LOC, neck pain
- Process: bleeding, most often s/p ruptured intracranial aneurysm
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HA from sinusitis
- Location: Frontal or maxillary sinuses
- Process: mucosal inflammation of paranasal sinuses
- Quality: aching, throbbing. Variable in severity.
- variable onset
- associated: local tenderness, nasal congestion, discharge, fever
- +/- aggravated by coughing, sneezing, jarring head, bending down (anything that increases pressure)
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Meningitis
Secondary HA
- Quality: steady or throbbing, very severe
- Fairly rapid onset
- Persistent HA in an acute illness
- associate: fever, stiff neck
Pain location: generalized
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vertigo
spinning sensation accompanied by nystagmus and ataxia
usually from peripheral vestibular dysfunction.
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ptosis
drooping of upper lid.
causes: congenital, myasthenia gravis, oculomotor nerve damage, weakened muscle, relaxed tissue, weight of herniated fat
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entropion
inward turning of lid margin.
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ectropion
margin of lower lid is turned outward, exposing palpebral conjunctiva
- eye no longer properly drains b/c punctum of lower lid turns outward. See increased tearing.
- more common in elderly
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Exophthalmos
eyeball protrudes forward.
Consider: Graves' hyperthyroidism as cause
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Papilledema
- Appearance: Optic disc swollen with blurred margins
- enlarged blind spot
- pink, hyperemic
- often loss of venous pulsations
- Disc vessels more visible, more numerous
- physiologic cup not visible
venous stasis leads to engorgement and swelling of optic disc
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Normal optic disc
- Appearance:
- Margins sharp.
- yellowish orange to creamy pink
- tiny vessels
- physiologic cup central to temporal. 2:1
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A-V nicking
vein appears to stop abruptly on either side of artery
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torus palatinus
midline bony growth on hard palate. benign.
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gingivitis
- reddened and swollen gingival margins. Interdental papillae are blunted, swollen and red.
- Bleeding during teeth brushing
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leukoplakia
- thickened, white patch anywhere in oral mucosa
- usually secondary to local irritant such as chewing tobacco.
- May lead to oral cancer
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chalazion
- subacute nontender and usually painless nodule involving meibomian gland.
- usually points inside lid (rather than lid margin like a sty)
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Light reaction
- pupillary rxn to light bean in one retina
- causes pupillary constriction in eye receiving light and other eye
- Optic nerve (sensory) and oculomotor nerve (constrictor of iris muscles)
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Near reaction
pupillary rxn to shifting gaze from far object to near one.
oculomotor
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Convergence
- extraocular movement
- pupillary constriction occurs, but due to change in shape of lenses to focus. not visible to observer
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accommodation
increased convexity of lenses d/t contraction of ciliary muscles
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Extraocular movements
coordinated action of six eye muscles innervated by CNs III, IV, VI
- nl= conjugate/parallel gaze.
- paralyzed muscle-> deviated eye from nl position.
- LR 6, SR 4, the rest are three, there are no more
(Lateral rectus, medial rectus, superior rectus, inferior rectus, superior oblique, inferior oblique)
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blepharitis
red inflamed lid margin often with crusting
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anisocoria
pupillary inequality
mild deviation nl in about 20%. If PERRL WNL, then benign.
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nystagmus
fine rhythmic oscillation of eyes.
assess during EOM at extreme lateral gaze.
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absence of red reflex suggestive of...
- ...lens opacity (cataract) or vitreous
- detached retina
- retinoblastoma
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weber test
test for sound lateralization
nl: heard midline or equally on both ears
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conductive hearing loss
external or middle ear issue
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Rinne test
- compares air conduction and bone conduction
- nl: AC>BC
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strabismus
dysconjugate gaze d/t imbalance in ocular muscle tone
- Esotropia. inward
- exotropia: outward
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cover-uncover test
to confirm strabismus when corneal reflections are asymmetric
- ??Cover LEFT eye. R eye moves outward to fix on light.
- uncover:
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