Neural and Psychological Conditions - NCLEX-PN
Card 1 of 684
A 50-year-old female client recently diagnosed with multiple sclerosis, presents to the clinic after having a history of several neurological symptoms and is asking the nurse about her condition. The nurse is glad to teach the client about multiple sclerosis.
Which of the following statements about multiple sclerosis is correct?
A 50-year-old female client recently diagnosed with multiple sclerosis, presents to the clinic after having a history of several neurological symptoms and is asking the nurse about her condition. The nurse is glad to teach the client about multiple sclerosis.
Which of the following statements about multiple sclerosis is correct?
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Multiple sclerosis is an autoimmune process with no exact known cause. The myelin sheath is attacked and plaque formation occurs in various regions of the CNS. Without myelin, nerve conduction slows down and may eventually be completely blocked leading to widespread loss of function.
Loss of the dopamine-producing neurons describes Parkinson's disease. Excess dopamine describes dementia. Deficiency of acetylcholine describes Huntington's disease, and the autoimmune disease of the neuromuscular junction is known as Myasthenia Gravis.
Multiple sclerosis is an autoimmune process with no exact known cause. The myelin sheath is attacked and plaque formation occurs in various regions of the CNS. Without myelin, nerve conduction slows down and may eventually be completely blocked leading to widespread loss of function.
Loss of the dopamine-producing neurons describes Parkinson's disease. Excess dopamine describes dementia. Deficiency of acetylcholine describes Huntington's disease, and the autoimmune disease of the neuromuscular junction is known as Myasthenia Gravis.
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Which of the following classes of medication is not used for treatment of migraine headaches?
Which of the following classes of medication is not used for treatment of migraine headaches?
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Migraine headaches are commonly treated at first by over the counter (OTC) medications such as NSAIDS and acetaminophen. Other treatment options include triptans, antidepressants such as amitriptyline, and anti-hypertensives (beta blockers and calcium channel blockers).
Migraine headaches are commonly treated at first by over the counter (OTC) medications such as NSAIDS and acetaminophen. Other treatment options include triptans, antidepressants such as amitriptyline, and anti-hypertensives (beta blockers and calcium channel blockers).
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Which of the following herbs has been shown to be effective in prevention of migraine symptoms?
Which of the following herbs has been shown to be effective in prevention of migraine symptoms?
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Petasites hybridus (butterbur) is a flowering plant of the family asteraceae. It has been shown in studies to reduce the frequency of migraine headaches by as much as 68%. None of the other herbs listed have any significant medicinal benefit in migraine headaches.
Petasites hybridus (butterbur) is a flowering plant of the family asteraceae. It has been shown in studies to reduce the frequency of migraine headaches by as much as 68%. None of the other herbs listed have any significant medicinal benefit in migraine headaches.
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Which of the following interventions has been shown to be effective in reducing the severity of pain in cluster headaches?
Which of the following interventions has been shown to be effective in reducing the severity of pain in cluster headaches?
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One non-pharmaceutical intervention that has shown to provide relief for a significant number of individuals with cluster headaches is 100% oxygen, delivered via mask at a minimum of 12 liters per minute. Relief can be felt in as little as 15 minutes. None of the other interventions mentioned would be likely to improve symptoms of a cluster headache.
One non-pharmaceutical intervention that has shown to provide relief for a significant number of individuals with cluster headaches is 100% oxygen, delivered via mask at a minimum of 12 liters per minute. Relief can be felt in as little as 15 minutes. None of the other interventions mentioned would be likely to improve symptoms of a cluster headache.
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Bell's palsy is due to dysfunction of which of the following cranial nerves?
Bell's palsy is due to dysfunction of which of the following cranial nerves?
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Bell's palsy is due to dysfunction of cranial nerve VII, the facial nerve. The facial nerve provides motor control to the musculature of the face and sensory innervation of taste, facial sensation, and parasympathetic innervation of the submandibular and sublingual glands.
Bell's palsy is due to dysfunction of cranial nerve VII, the facial nerve. The facial nerve provides motor control to the musculature of the face and sensory innervation of taste, facial sensation, and parasympathetic innervation of the submandibular and sublingual glands.
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Bell's palsy is associated with infection by which of the following pathogens?
Bell's palsy is associated with infection by which of the following pathogens?
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While Bell's palsy is most frequently associated with prior infection with herpes simplex 1, is may also be associated with cytomegalovirus, Epstein Barr virus, and herpes zoster.
While Bell's palsy is most frequently associated with prior infection with herpes simplex 1, is may also be associated with cytomegalovirus, Epstein Barr virus, and herpes zoster.
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What is the prognosis with Bell's palsy?
What is the prognosis with Bell's palsy?
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In the vast majority of cases Bell's palsy resolves within 1-6 months without medical intervention. Moistening of the affected eye (rather than nerve resection) is required during this period to prevent corneal damage. There is very little risk of permanent paralysis or loss of taste.
In the vast majority of cases Bell's palsy resolves within 1-6 months without medical intervention. Moistening of the affected eye (rather than nerve resection) is required during this period to prevent corneal damage. There is very little risk of permanent paralysis or loss of taste.
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All of the following are common etiologies of seizure disorders except .
All of the following are common etiologies of seizure disorders except .
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The most common causes of seizures include brain injury or tumor, genetic predisposition, medications, and infections such as meningitis. While marijuana may be a trigger for sensitive individuals with seizure disorders, it has not been known to cause seizures in a non-epileptic individual and has shown to reduce seizure incidence in some individuals with this condition when used in a medical setting.
The most common causes of seizures include brain injury or tumor, genetic predisposition, medications, and infections such as meningitis. While marijuana may be a trigger for sensitive individuals with seizure disorders, it has not been known to cause seizures in a non-epileptic individual and has shown to reduce seizure incidence in some individuals with this condition when used in a medical setting.
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A patient is hospitalized for alcohol withdrawal and is started on medication to prevent complications from withdrawal. Which type of medication is used to attenuate the possibility of seizures during this hospitalization?
A patient is hospitalized for alcohol withdrawal and is started on medication to prevent complications from withdrawal. Which type of medication is used to attenuate the possibility of seizures during this hospitalization?
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Benzodiazepines are the mainstay of treatment for alcohol withdrawal. Anti-epileptic drug (AEDs) are not to be used during alcohol withdrawal, and are reserved for patients who have a true seizure disorder. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol is used as symptom based therapy with benzodiazepines to prevent seizures and other complications from withdrawal.
Benzodiazepines are the mainstay of treatment for alcohol withdrawal. Anti-epileptic drug (AEDs) are not to be used during alcohol withdrawal, and are reserved for patients who have a true seizure disorder. The Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol is used as symptom based therapy with benzodiazepines to prevent seizures and other complications from withdrawal.
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Which of the following is the first-line treatment for cauda equina syndrome?
Which of the following is the first-line treatment for cauda equina syndrome?
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Cauda equina syndrome is a serious condition in which the cauda equina is disturbed within the spinal cord, generally due to impingement, trauma, local lesion, or compression. The first-line treatment is surgical decompression. Neither physiotherapy nor muscle relaxants would address the cause of this condition, and chiropractic manipulation may actually exacerbate the symptoms.
Cauda equina syndrome is a serious condition in which the cauda equina is disturbed within the spinal cord, generally due to impingement, trauma, local lesion, or compression. The first-line treatment is surgical decompression. Neither physiotherapy nor muscle relaxants would address the cause of this condition, and chiropractic manipulation may actually exacerbate the symptoms.
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What is the most common cranial mononeuropathy in diabetic patients?
What is the most common cranial mononeuropathy in diabetic patients?
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Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.
Third nerve palsy (cranial nerve III, the oculomotor nerve) is the most common cranial mononeuropathy seen in diabetic patients. They will present with ptosis, dilated and fixed pupils, and an outward and slightly downward deviation of the eye. Bell's palsy involves unilateral facial paralysis as a result of damage to the facial nerve (cranial nerve VII). Cranial mononeuropathy VI is caused by damage to the abducens nerve (cranial nerve VI). Signs of damage include inability to laterally rotate the eye and/or double vision. Auditory neuropathy may be a result of damage to the vestibulocochlear nerve (cranial nerve VIII); the most pronounced symptom is loss of audition.
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A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course.
The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?
A 62-year-old male client is admitted to the hospital with acute pancreatitis. The client has a well-established history of alcohol abuse. The nurse caring for this client is aware he may exhibit withdrawal symptoms during the inpatient course.
The nurse's plan of care for this client should include assessment for all the following symptoms of alcohol withdrawal except?
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The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).
The symptoms of alcohol withdrawal may include confusion, disorientation, and anxiety. Hypersomnolence or excessive sleep is not associated with this condition. Additional symptoms may include agitation, hypervigilance, tremor, rapid and irregular heart beat, hypertension, seizure, and hallucinations (mostly visual).
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What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?
What condition is described by the following: A defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis?
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Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.
Wilson's disease is characterized by a defect of copper excretion, leading to copper overload and feedback inhibition of ceruloplasmin synthesis. This results in copper accumulation, primarily in the liver and the brain. Signs and symptoms include liver failure, cognitive deterioration, clumsiness, and changes in behavior. Symptoms often start in adolescence, but can start any time between 6-20 years old. Aceruloplasminemia is a rare condition of iron accumulation in the basal ganglia, retina, and liver. Hereditary hemochromatosis is also a disorder of iron accumulation, often caused by mutations in the HFE gene. Huntington disease is a genetic neurodegenerative disease unrelated to any mineral storage disorders.
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What is the most common cause of meningitis?
What is the most common cause of meningitis?
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All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
- Haemophilus influenzae type b (Hib)
All of the answers given are possible causes of meningitis, but the most common (and least severe) etiology is viral. There is no vaccine for viral meningitis, but there are vaccines for three different organisms that cause bacterial meningitis:
- Neisseria meningitidis (meningococcus)
- Streptococcus pneumoniae (pneumococcus)
- Haemophilus influenzae type b (Hib)
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Approximately 80% of strokes are of what type?
Approximately 80% of strokes are of what type?
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Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."
Approximately 80% of strokes are ischemic, either caused by thrombus or emboli. Hemorrhagic strokes only account for approximately 15% of all strokes, but are significantly more lethal and account for 30% of all stroke deaths. They involve the rupturing of a weakened blood vessel in the brain and subsequent bleeding in the surrounding areas. Transient ischemic attacks are not considered true strokes, and are often referred to as "mini strokes."
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A 23-year-old male college student presents to the emergency room after experiencing a high fever, nausea, vomiting, and nuchal rigidity. The nurse recognizes that this combination of symptoms are indicative of bacterial meningitis. The nurse is aware cranial nerve dysfunction is related to the condition.
Which of the following cranial nerves (CN) is correctly matched to its dysfunction?
A 23-year-old male college student presents to the emergency room after experiencing a high fever, nausea, vomiting, and nuchal rigidity. The nurse recognizes that this combination of symptoms are indicative of bacterial meningitis. The nurse is aware cranial nerve dysfunction is related to the condition.
Which of the following cranial nerves (CN) is correctly matched to its dysfunction?
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The trigeminal nerve (CN V) is responsible for both sensory and motor functions of the face, including the corneal reflex which is also mediated by the facial nerve (CN VII).
CN II, optic nerve affects vision, including causing papilledema - swelling of the optic disc. CN III, oculomotor dysfunction may cause ptosis. Cranial nerve VIII, vestibulocochlear is responsible for hearing and cranial nerve VI, abducens is responsible for horizontal eye movements.
The trigeminal nerve (CN V) is responsible for both sensory and motor functions of the face, including the corneal reflex which is also mediated by the facial nerve (CN VII).
CN II, optic nerve affects vision, including causing papilledema - swelling of the optic disc. CN III, oculomotor dysfunction may cause ptosis. Cranial nerve VIII, vestibulocochlear is responsible for hearing and cranial nerve VI, abducens is responsible for horizontal eye movements.
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A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?
A young woman presents to a clinic complaining of unilateral headaches that she describes as throbbing, "like a hammer was hitting my head." She experiences these headaches 5-10 times per month, and an episode can last up to 24 hours. During the headache she is sensitive to light, sound, and smell. On a few occasions the pain has been severe enough to induce vomiting. She feels better with coffee, and by lying down alone in a dark room. Her headache is most likely which of the following types?
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The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:
- More than 5 episodes (lifetime)
- Headache lasts 4-72 hours
- During headache at least one of the following:
- nausea / vomiting
- photophobia or phonophobia
- Headache has at least two of the following characteristics:
- unilateral
- moderate or severe pain intensity
- pulsating
- aggravation by normal physical activity, may cause avoidance of normal activities of life
- Not attributed to another disorder
The symptoms this individual describes are most likely due to migraine headache (migraine without aura, also known as common migraine). Migraines are diagnosed by the following criteria:
- More than 5 episodes (lifetime)
- Headache lasts 4-72 hours
- During headache at least one of the following:
- nausea / vomiting
- photophobia or phonophobia
- Headache has at least two of the following characteristics:
- unilateral
- moderate or severe pain intensity
- pulsating
- aggravation by normal physical activity, may cause avoidance of normal activities of life
- Not attributed to another disorder
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A 37 year old man comes into the clinic for chronic headaches. He describes his headaches as in his forehead and temples bilaterally, occasionally wrapping around his head toward his neck. Pain is rated as a 4 out of 10. He has these headaches around 3 times per week. No photophobia with his headaches, no nausea or vomiting. Headache feels better when he presses on his scalp. When asked to describe the sensation of the headache, he replies that it's "like a band" around his head. These headaches are not preventing him from normal activity. These are most likely what type of headache?
A 37 year old man comes into the clinic for chronic headaches. He describes his headaches as in his forehead and temples bilaterally, occasionally wrapping around his head toward his neck. Pain is rated as a 4 out of 10. He has these headaches around 3 times per week. No photophobia with his headaches, no nausea or vomiting. Headache feels better when he presses on his scalp. When asked to describe the sensation of the headache, he replies that it's "like a band" around his head. These headaches are not preventing him from normal activity. These are most likely what type of headache?
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The symptoms described by this individual make tension headaches the most likely diagnosis. Tension headaches are defined by the following criteria:
- Minimum of 10 episodes occurring on less than 15 days per month for at least 3 months
- Headaches last from 30 minutes to 7 days
- Headache has at least two of the following qualities:
- mild or moderate intensity
- bilateral
- pressing or tightening (non-pulsing) quality
- not aggravated by routine activities of daily living
- Both of the following:
- no nausea or vomiting
- either photophobia or phonophobia, but not both
- Not attributed to another disorder
The symptoms described by this individual make tension headaches the most likely diagnosis. Tension headaches are defined by the following criteria:
- Minimum of 10 episodes occurring on less than 15 days per month for at least 3 months
- Headaches last from 30 minutes to 7 days
- Headache has at least two of the following qualities:
- mild or moderate intensity
- bilateral
- pressing or tightening (non-pulsing) quality
- not aggravated by routine activities of daily living
- Both of the following:
- no nausea or vomiting
- either photophobia or phonophobia, but not both
- Not attributed to another disorder
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A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He has up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types?
A 21 year old male presents to clinic for extremely painful headaches. Pain is felt above the left eye and described as a 9 out of 10. Headaches are short; most episodes last for 30-45 minutes, and always on the left side. He notices that during an episode, his left eye will become red and watery, and his nose will run on the left side. He has up to three episodes per day. During a headache he will become agitated and restless, and will pace, groan, and hit the wall or floor with his fist. He is very concerned that he may have a brain tumor, meningitis, or some other serious condition. His headaches are most likely which of the following types?
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The presentation of this patient's headaches would make cluster headache the most likely diagnosis. Cluster headaches are defined by the following criteria:
- At least 5 attacks
- Severe unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes
- Headache is accompanied by at least one of the following:
- ipsilateral conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid swelling
- ipsilateral facial sweating
- ipsilateral miosis or ptosis
- restlessness or agitation
- Attack frequency ranges from every other day to 8 per day
- Not attributed to another disorder
The presentation of this patient's headaches would make cluster headache the most likely diagnosis. Cluster headaches are defined by the following criteria:
- At least 5 attacks
- Severe unilateral orbital, supraorbital or temporal pain lasting 15-180 minutes
- Headache is accompanied by at least one of the following:
- ipsilateral conjunctival injection and/or lacrimation
- ipsilateral nasal congestion and/or rhinorrhoea
- ipsilateral eyelid swelling
- ipsilateral facial sweating
- ipsilateral miosis or ptosis
- restlessness or agitation
- Attack frequency ranges from every other day to 8 per day
- Not attributed to another disorder
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Which of the following is not a common trigger for migraine headaches?
Which of the following is not a common trigger for migraine headaches?
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While caffeine may be a migraine trigger for certain individuals, in the majority of people who experience migraine headaches, caffeine provides significant relief of pain. This may be due to it's antagonizing adenosine receptors, which has the effect of cerebral vasoconstriction. Caffeine withdrawal, however, is a common cause of headaches and may trigger migraine is susceptible individuals. Other common migraine triggers include food allergies, medications, bright lights, stress, lack of sleep, hormone fluctuations, strong odors, alcohol, and certain types of exercise.
While caffeine may be a migraine trigger for certain individuals, in the majority of people who experience migraine headaches, caffeine provides significant relief of pain. This may be due to it's antagonizing adenosine receptors, which has the effect of cerebral vasoconstriction. Caffeine withdrawal, however, is a common cause of headaches and may trigger migraine is susceptible individuals. Other common migraine triggers include food allergies, medications, bright lights, stress, lack of sleep, hormone fluctuations, strong odors, alcohol, and certain types of exercise.
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