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18 facial pain Flashcards

1
Q

causes of bell plasy

A

HSV/VZV reactivation, demyelination, nerve edema.ischemia, autoimmune damage, vasospasms of nerve-feeding vessels

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2
Q

rapid onset of bilateral facial paralysis consider what

A

guillain-barre and uveroparotid fever (sarcoid)

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3
Q

most freq distribution of trigeminal neuralgia

A

V2/V3

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4
Q

common trigger point for trigeminal neuralgia

A

nasolabial fold

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5
Q

1st line tx for trigeminal

A

carbamazepine (anticonvulsant)

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6
Q

neurosurgery complications

A

facial dysesthesia and anesthesia dolorosa (numbness/pain)

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7
Q

glossopharyngeal neuralgia what’s affected

A

9th nerve (tonsil radiating to ear)

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8
Q

pain felt in ear neuralgia

A

tympanic plexus – ddx from TMD

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9
Q

trigger point for glossopharyngeal neuralgia

A

in ear canal

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10
Q

postherpetic neuralgia timeline

A

persists 1-6 months after onset of rash

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11
Q

postherpetic vs trigeminal

A

postherpetic burns w episodic stabbing

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12
Q

tactile allodynia

A

light touch elicits pain

postherpetic neuralgia

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13
Q

age for postherpetic neuralgia

A

50% of pts over 50 and 75% of pts over 75

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14
Q

atypical facial pain characteristic

A

drawing aching or pulling pain

hot spot on bone scan – increased temperature, tenderness, or marros activity

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15
Q

cluster headache clinical, cause, demographics

A 
pain of midface and upper face, esp around eyes
attacks in temporal groups 
vascular cuase 
80% smokers
\+ fmailial influence
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16
Q

cluster headache aka

A

horton’s syndrome, histaminic cephalgia, migrainous neuralgia

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17
Q

alarm clock headache

A

cluster – same time everyday

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18
Q

cluster headahce vs migraine

A

migraine has aura and pt is reclusive

vs cluster – no aura and hyperactive

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19
Q

paroxysmal hemicrania characteristics

A

attacks last 2-30 min, up to 40x /day

high freq, short attacjs, responds to indomethacin

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20
Q

hemicrania continua

A

unilateral, chronic, daily similar to cluster

responds to indomethacin

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21
Q

chronic paroxysmal hemicrania aka and cayse

A

sjastaad syndrome

congestion of conjunctival blood vessles and increased intraocular pressure

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22
Q

attacks last 2-30 min, up to 40x /day

high freq, short attacjs, responds to indomethacin

A

paroxysmal hemicrania

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23
Q

migraine characteristics

A

paroxysmal, unilateral, 4-72h

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24
Q

migraine cause

A

vasoconstriction of brain arteries 2/2 serotonin reduction –> ischemia and dilation

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25
Q

aura characteristic of

A

migraine
visual hallucination before pain
sparks (scintillation), partial blindness, loss of light perception (scotome), loss of ability to express thoughts (aphasia)

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26
Q

temporal arteritis aka and cause

A

giant cell arteritis, cranial arteritis
multifocal autoimmune vasculitis of temporal artery
headache coincinding with heartbeat

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27
Q

headache coincinding with heartbeat

A

temporal arteritis

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28
Q

temporal arteritis oral symptoms

A

jaw claudication (pain w mastication), pain wearing hats (pressure), blindness

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29
Q

generalized muscle ache and stiffness after headache attack

A

polymyalgia rheumatica

temporal arteritis

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30
Q

temporal arteritis histo

A

chronic inflammation of tunica intima and media, narrowing of lumen from edema and prolif of tunica intima, necrosis, giant cells

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31
Q

chronic inflammation of tunica intima and media, narrowing of lumen from edema and prolif of tunica intima, necrosis, giant cells

A

temporal arteritis

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32
Q

myasthenia gravis mechanism

A

autoimmune attack on ACh receptors w progressive fatigue of skeletal muscle

pts have thymus hyeprplasia or thymoma and at least 1 other autoimmune diosrder

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33
Q

myasthenia gravis clinical

A

subtle but progressive weakness, most noted in head and neck

inability to focus eye, drooping eyelid (ptosis), double vision (diplopia), dysphagia, dysarthria (slurred speeech), difficulty chewing
jaws hang open

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34
Q

inability to focus eye, drooping eyelid (ptosis), double vision (diplopia), dysphagia, dysarthria (slurred speeech), difficulty chewing
jaws hang open

A

myasthenia gravis

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35
Q

myasthenia gravis diagnosis

A

elevated serum ACh receptor antibodies

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36
Q

elevated serum ACh receptor antibodies

A

myasthenia gravis

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37
Q

myasthenia gravis histo

A

degenerated muscle fibers – smaller, lose rounded cross-section look

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38
Q

degenerated muscle fibers – smaller, lose rounded cross-section look

A

myasthenia gravis

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39
Q

neurodegenerative disorders w progressive weakness and mm wasting

A

progressive muscular atrophy
progressive bulbar palsy
amyotrophic lateral sclerosis

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40
Q

most common lethal AR disorder

A

progressive muscular atrophy
(SMN gene)

childhood; no facial involvement

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41
Q

SMN gene

A

progressive muscular atrophy – AR

childhood; no facial involvement

42
Q

progressive bulbar palsy demographic and onset

A

children/young adults
starts w dysphagia
atrophy of facial muscles

43
Q

amyotrophic lateral sclerosis aka, demographic

A

Lou Gehrig dz

middle age

44
Q

amyotrophic lateral sclerosis presentation

A

leg stiffness (one affected more than the other – dragging leg)
fasciculation (small synchronous muscle contractions)
bulbar paralysis – dysfx of mm controlled by medulla oblonfata in late LAS

45
Q

dysfx of mm controlled by medulla oblonfata

A

bulbar paralysis, late ALS

46
Q

leg stiffness/dragging

47
Q

fasciculations

A

small synchronous muscle contractions in ALS

48
Q

small synchronous muscle contractions

A

fasciculations, ALS

49
Q

immune response to ACE inhibitor

A

scalded mouth syndrome

50
Q

scalded mouth syndrome what could case

A

immune response to ACE inhibitor

51
Q

alternative names for burning mouth syndrome

A

glossopyrosis, stomatopyrosis, glossodynia, stomatodynia

52
Q

upper resp infx taste/smell

A

temporary dysgeusia

53
Q

cns tumor taste/smell

54
Q

trauma/tumors/peripheral nerve inflammation

A

transient hypogeusia

55
Q

taste hallucination

A

migraine, bell palsy, VZV

56
Q

hemiageusia

A

ageusia of 1/2 tongue – ischemia and infarction of brainstem

57
Q

periodontisis and taste

A

salty taste, high NaCl content of crevicular fluids

58
Q

flavor and smell

A

75% of flavor info in smell

59
Q

aberran odor perception

A

parosmia

complain of foul or rancid taste

60
Q

phantom taste

A

dysgeusia in absence of food stimulus

61
Q

frey syndrome manifest

A

facial flushing/sweating along auriculotemporal nerve in response to gustatory stimuli

62
Q

frey syndrome casues

A

parotid absess, surgery (40% parotidectomy), trauma, diabetes, forceps delivery
injury to nerve

63
Q

chin and submental gustatory sweating

A

chorda tympani syndrome - dx of submandibular gland

64
Q

gustatory lacrimation

A

facial nerve injury; crocodile tears

65
Q

TMJ osteoarthritis imaging

A

obliteration of joint space, exostoses/osteophytes, subchondral cysts, ossicles in synovial membrane

66
Q

stages of rheumatoid arthritis

A

autoiimune destruction of joints

starts as synovitis –> then pannus (reative m/ph-laden fibroblastic proliferation from synovium onto joint surface)

67
Q

reative m/ph-laden fibroblastic proliferation from synovium onto joint surface

A

pannus, rheumatoid arthritis

68
Q

most affected joint in osteoarthritis

69
Q

most affected joints in rheumatoid arthritis

A

hands and feet

hips least affected

70
Q

joint shape in rheumatoid arhtritis

71
Q

tmj in rheumatoid arthritis

A

75%
usually bilateral
flat condylar head

72
Q

nontender subcutaneous growth near joint

A

rhematoid nodules

amorphous eosinophilic necrosis surrounded by thick layer of mononuclear cells

73
Q

rheumatoid labs

A

80% elevated RF, 50% ANAs

74
Q

histo rheumatoid arthritis

A

rice bodies: small white villi made of cellular debris admixed w fibrin/collagen

75
Q

rice bodies

A

small white villi made of cellular debris admixed w fibrin/collagen
rheumatoid arthritis

76
Q

anklysoing spondylitis

A

systemic rheumatic disease

HLA B27 in 90% of pts

77
Q

risk factors and sex predilection for bell palsy

A

Risk factors:
Obesity /Pregnancy / preeclampsia / Diabetes /HT/
Infection 30% have HSV
F > M

78
Q

guillain barre cause and presentation

A

autoimmune
aka landry’s paralysis

damage to PNS - bilateral
mm weakness: behins ain feet and hands

acute polyneuropathy (1st to appear)
numb/tingling pain
respiratory failure

79
Q

diagnostic clinical features of trigeminal neuralgia

A

refractory period

80
Q

giant cell arteritis demographic

A

> 50yr, scandinavian/north european/F

HLA-DR4

81
Q

complication of giant cell arteritis

A

blindness
pain chewing in masseter and temporalis

aorta ffected in 50%

82
Q

labs in giant cell arteritis

A

elevated ESR , C-reactive protein, and platelet count

83
Q

HLA-DR4

A

giant cell arteritis

84
Q

Polymyalgia Rheumatica:

A

 Symptom found in Giant Cell Arteritis (GCA)

 Morning stiffness in neck, shoulder, pelvis

85
Q

narrowing of joint space: OA vs RA

A

OA narrow

RA narrow only if ankylosis

86
Q

subchondral cysts

A

OA; Large degenerative space beneath cartilage (Radiolucent)

87
Q

OA in joint what find

A

 Subchondral cysts: Large degenerative space beneath cartilage (Radiolucent)
 Ossicles: metaplastic bone
 Chondral bodies: Multiple hyaline cartilage granules
 Narrowing of joint space

88
Q

pannus

A

RA

Fibroblastic proliferation / Macrophage laden

89
Q

Polyarthralgia:

90
Q

ankylosis RA or OA

91
Q

anvil joints

92
Q

joints in RA

93
Q

RA in joint space

A

rice bodies, pannus, anvil joints, ankylosis

94
Q

skin in RA

A

rheumatoid nodules (20%) beneath skin near affected joints, pathognomonic

95
Q

labs for RA

A

ACPAs * Specific*
80% RF
50% ANA
90% elevated ESR

96
Q

OA vs RA cause, age, location

A 
OA:
Degenretaive due to age
 >50yrs
 Hips, knees, spine (weight bearing
joints)
RA: 
Autoimmune
 25-35yrs
 Bilateral , symmetrical involvement of
small joints, hands and feet
97
Q

heberden

A 
OA 
nodules at distal or
interphalanges joints. Due to calcific
spurs (osteophytes) from repeated
trauma
98
Q

crepitation RA or OA

99
Q

swan neck deformity

A

and ulnar deviation

RA

100
Q

pain in morning better later

101
Q

pain worse toward evening

102
Q

rice bodies

OP - Yield (19 decks)

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