NURS 526 UNIT 2- ACUTE
PRESENTATIONS EXAM QUESTIONS
AND ANSWERS GRADED A+ 2026
What is Temporal Arteritis (AKA Giant Cell Arteritis)? - ANS Vasculitis may be localized,
multifocal, or widespread. The disorder tends to affect arteries containing elastic tissue, most
often the temporal, cranial, or other carotid system arteries. Activated T cells and macrophages
cause inflammation that result in the thicking of intima, narrowing and occlusion of the artery,
Many people diagnosed are older then 70 yrs of age. women more then men. and most have
polymyalgia rheumatica.
What lab/diagnostics should be used to rule in or out Temporal Arteritis? - ANS CBC, ESR, C-
reactive protein
How do you treat temporal artheritis? - ANS oral steroids, sometimes long-term. and low
dose ASA
What are the signs and symptoms of temporal artheritis? - ANS Presents as a unilateral
headache (most common symptom. can also present as diffused). Can be gradula or sudden
onset. Unexplained Weight loss, fever, malaise. Visual disturbances is an ominous sign.
Suspected arteritis in any one above 50 who presents with:
A new type of headache
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,Any new symptom or sign compatible with ischemia of an artery above the neck
Jaw pain during chewing
Temporal artery tenderness
Unexplained subacute fever or anemia
What are thunderclap headaches? - ANS Are severe intensity headaches that reach
maximum intensity in less than 1 minute. Often associated with mortality. Causes of
subarchnoid hemorrhage must be ruled out by CT scan, lumbar punture test of CSF. Primary
thunderclap headache' is diagnosed when a complete evaluation fails to identify a specific cause
for thunderclap headache.
Refer to notes made in 518 about migraines, differentials, and their assessments. - ANS Dains
et al. Migrane with aura or without aura. They are vascular. Generally ipsilateral. Pounding or
throbbing. Last 4-72 hours.
Headache diaries - ANS Diaries are important for people to identify their triggers and to help
clinicians diagnose the type of headache the patient has.
Understand the typical evolution, symptoms, qualities and patterns of migraines, cluster
headaches, tension headaches and red-flag headaches - ANS Red flags are sudden onset in
those above the age of 50, asymmetry of pupillary response, decreased deep tendon reflexes,
H/A that is the 'worst ever', change in personality, onset of new or different H/A, onset of a H/A
that progressibely worsens, papilledea, painful temporal arteries. Any of these signs warrants
further investigation, and referral to a specialist or hospital. Positive neurologic findings on
exam are indicative of CNS problem and should not be attributed to a migraine unless prior
pattern has been documented.
Understand when to consider a secondary headache in the presence of unusual symptoms or
unclear presentations, and when to refer and or utilize diagnostic imaging. - ANS It is
important to do a cardiopulmonary and neurological assessment with a major focus on:
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
, funduscopic and pupillary assessment, auscultation of the carotid and verterbal arteries, MSE,
palpate head, neck, and temporal arteries, eval for any neck stiffness, focal weakness, sensory
and gait, VS. It is important to rule out secondary causes of H/a. Tenderness with palpation over
the sinus could mean sinusitus. Is it bacterial versus viral? Do they need antibiotics.
What are common diagnostics for H/A? - ANS Depends on the history and results found on
physical exam. Bloodwork is generally not indicated. HOwever, if it is CBC (r/o infection/anemia),
ESR or CRP to r/t temporal artritis, TSH. BW should be avoided if the results are not going to
change the management. Neuro imaging is indicated if change on neurological exam but not
indicated if someone has had these symptoms for years, if H/A improves without the use of
analgesia, and no focal neurological signs.
When should a physcian be consulted for a patient with a H/A? - ANS Pt is suspected of
having temporal arteritis, change in mental status, nuchal rigidity, neurologic deficit, or new
onset of headache, especially over the age of 50. Should be referred to emergency if
neurological deficits, , trauma, or 'thunderclap' headache.
Understand the pharmacological treatment and non-pharmacological treatment for all types of
headaches - ANS Nonpharmacological management include: encourage relaxation
techniques, stress managment, biofeedback, a wellness program that encourages balanced
meals, sleep, and how to avoid triggers. Tell the patient to keep a headache diary.
Pharmacological management: Preventative therapy should be considered in patients having
more then 4 h/a per month. Anticonvulsants can be considered such as gabapentin, divalproex,
topiramate to control migraine. Patients with reynauds or HTN could benefit from an CCB, which
cause vasodilation and decrease BP. If sleep is a problem or chronic pain can try an
antidepressant such as amitriptyline. Betablockers can work as well especially if they experience
panic disorders or palpitations.
Abortive therapy: used to help decrease the intensity of an attack and to manage associated
symptoms: If symptoms of attacks peek in 15 minutes these patients may benefit from a nasal
spray compaired to oral meds. First line, tylenol and aspirin for mild to moderate H/A. NSAIDS
such as naproxen with the addition of meclopramide can help with nausea and increase the
gastric emptying. Ergot combinations good for moderate to severe attacks that dont respond to
other therapys. Ergots can cause nausea therefore need to be premedicated. Corticosteroids
(dexamethasone) for a persistent attack. Or Triptans. Arterial constrictors. Use cautiously with
CAD.
Pharmacological management for cluster headaches? - ANS Verapamil or lithium for
preventative therapy. Triptans and NSAIDS.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
PRESENTATIONS EXAM QUESTIONS
AND ANSWERS GRADED A+ 2026
What is Temporal Arteritis (AKA Giant Cell Arteritis)? - ANS Vasculitis may be localized,
multifocal, or widespread. The disorder tends to affect arteries containing elastic tissue, most
often the temporal, cranial, or other carotid system arteries. Activated T cells and macrophages
cause inflammation that result in the thicking of intima, narrowing and occlusion of the artery,
Many people diagnosed are older then 70 yrs of age. women more then men. and most have
polymyalgia rheumatica.
What lab/diagnostics should be used to rule in or out Temporal Arteritis? - ANS CBC, ESR, C-
reactive protein
How do you treat temporal artheritis? - ANS oral steroids, sometimes long-term. and low
dose ASA
What are the signs and symptoms of temporal artheritis? - ANS Presents as a unilateral
headache (most common symptom. can also present as diffused). Can be gradula or sudden
onset. Unexplained Weight loss, fever, malaise. Visual disturbances is an ominous sign.
Suspected arteritis in any one above 50 who presents with:
A new type of headache
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 1
,Any new symptom or sign compatible with ischemia of an artery above the neck
Jaw pain during chewing
Temporal artery tenderness
Unexplained subacute fever or anemia
What are thunderclap headaches? - ANS Are severe intensity headaches that reach
maximum intensity in less than 1 minute. Often associated with mortality. Causes of
subarchnoid hemorrhage must be ruled out by CT scan, lumbar punture test of CSF. Primary
thunderclap headache' is diagnosed when a complete evaluation fails to identify a specific cause
for thunderclap headache.
Refer to notes made in 518 about migraines, differentials, and their assessments. - ANS Dains
et al. Migrane with aura or without aura. They are vascular. Generally ipsilateral. Pounding or
throbbing. Last 4-72 hours.
Headache diaries - ANS Diaries are important for people to identify their triggers and to help
clinicians diagnose the type of headache the patient has.
Understand the typical evolution, symptoms, qualities and patterns of migraines, cluster
headaches, tension headaches and red-flag headaches - ANS Red flags are sudden onset in
those above the age of 50, asymmetry of pupillary response, decreased deep tendon reflexes,
H/A that is the 'worst ever', change in personality, onset of new or different H/A, onset of a H/A
that progressibely worsens, papilledea, painful temporal arteries. Any of these signs warrants
further investigation, and referral to a specialist or hospital. Positive neurologic findings on
exam are indicative of CNS problem and should not be attributed to a migraine unless prior
pattern has been documented.
Understand when to consider a secondary headache in the presence of unusual symptoms or
unclear presentations, and when to refer and or utilize diagnostic imaging. - ANS It is
important to do a cardiopulmonary and neurological assessment with a major focus on:
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 2
, funduscopic and pupillary assessment, auscultation of the carotid and verterbal arteries, MSE,
palpate head, neck, and temporal arteries, eval for any neck stiffness, focal weakness, sensory
and gait, VS. It is important to rule out secondary causes of H/a. Tenderness with palpation over
the sinus could mean sinusitus. Is it bacterial versus viral? Do they need antibiotics.
What are common diagnostics for H/A? - ANS Depends on the history and results found on
physical exam. Bloodwork is generally not indicated. HOwever, if it is CBC (r/o infection/anemia),
ESR or CRP to r/t temporal artritis, TSH. BW should be avoided if the results are not going to
change the management. Neuro imaging is indicated if change on neurological exam but not
indicated if someone has had these symptoms for years, if H/A improves without the use of
analgesia, and no focal neurological signs.
When should a physcian be consulted for a patient with a H/A? - ANS Pt is suspected of
having temporal arteritis, change in mental status, nuchal rigidity, neurologic deficit, or new
onset of headache, especially over the age of 50. Should be referred to emergency if
neurological deficits, , trauma, or 'thunderclap' headache.
Understand the pharmacological treatment and non-pharmacological treatment for all types of
headaches - ANS Nonpharmacological management include: encourage relaxation
techniques, stress managment, biofeedback, a wellness program that encourages balanced
meals, sleep, and how to avoid triggers. Tell the patient to keep a headache diary.
Pharmacological management: Preventative therapy should be considered in patients having
more then 4 h/a per month. Anticonvulsants can be considered such as gabapentin, divalproex,
topiramate to control migraine. Patients with reynauds or HTN could benefit from an CCB, which
cause vasodilation and decrease BP. If sleep is a problem or chronic pain can try an
antidepressant such as amitriptyline. Betablockers can work as well especially if they experience
panic disorders or palpitations.
Abortive therapy: used to help decrease the intensity of an attack and to manage associated
symptoms: If symptoms of attacks peek in 15 minutes these patients may benefit from a nasal
spray compaired to oral meds. First line, tylenol and aspirin for mild to moderate H/A. NSAIDS
such as naproxen with the addition of meclopramide can help with nausea and increase the
gastric emptying. Ergot combinations good for moderate to severe attacks that dont respond to
other therapys. Ergots can cause nausea therefore need to be premedicated. Corticosteroids
(dexamethasone) for a persistent attack. Or Triptans. Arterial constrictors. Use cautiously with
CAD.
Pharmacological management for cluster headaches? - ANS Verapamil or lithium for
preventative therapy. Triptans and NSAIDS.
@COPYRIGHT 2026/2027 ALLRIGHTS RESERVED 3
