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1. Clin Med III > 3- Head and Facial Disorders > Flashcards

3- Head and Facial Disorders Flashcards

1
Q

What is the most common etiology of facial palsy?

A

Idiopathic

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2
Q

What are the RFs for Bell’s Palsy?

A

Pregnancy and DM

(pregnancy also increased recurrence rate)

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3
Q

Pt presents w/ sudden onset (w/i hours) of unilateral facial paralysis with inability to close eye. On PE you note facial drooping with flattening of nasolabial fold, decreased tearing, and hyperacusis. What are you concerned for?

A

Bell’s Palsy

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4
Q

How could you r/o Herpes zoster/ Ramsay Hunt syndrome as a ddx for Bell’s palsy?

A

Vesicles + preherpetic neuralgia

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5
Q

How could you r/o lyme disease as a ddx for Bell’s palsy?

A

Bilateral (lasting less than 2 months)
*eval if young pt*

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6
Q

How could you r/o Guillain-Barre as a ddx for Bell’s palsy?

A

Bilateral

(+ progressive and symmetric)

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7
Q

How could you r/o a tumor as a ddx for Bell’s palsy?

A

Gradual onset (2+ weeks)

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8
Q

How could you r/o a stroke as a ddx for Bell’s palsy?

A

Spares forehead

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9
Q

Pt presents with suspected Bell’s palsy. Are you concerned for peripheral or central facial palsy? LMN or UMN lesion?

A

Peripheral, LMN

Affects ipsilateral face with FH involvement

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10
Q

Pt presents with suspected stroke or tumor. Are you concerned for peripheral or central facial palsy? LMN or UMN lesion?

A

Central, UMN

Affects contralateral face with NO FH involvement

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11
Q

How is Bell’s palsy diagnosed?

A

Clinically- diffuse facial nerve involvement + acute onset 1-2 days

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12
Q

When would diagnostic studies/ imaging be considered for Bell’s palsy?

A

Atypical sxs

No significant improvement in 4 months

Progression beyond 3 weeks

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13
Q

In addition to possible EMG, NCS, CT/ MRI, what labs should be ordered for workup of Bell’s Palsy (if indicated)?

A

Serologic testing for Lyme disease/ HSV

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14
Q

What is the pharmacologic tx recommended for ALL pts with Bell’s Palsy?

A

Prednisone +/- Valacyclovir iniated w/i 3 days of sxs

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15
Q

Due to increased risk of drying, corneal abrasion, or corneal ulceration, what else should be included in the management for Bell’s Palsy?

A

Eye care

(artificial tears, eye ointments, sunglasses)

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16
Q

Pt with hx of Bell’s Palsy presents with blinking causing a twitch in the corner of the mouth and winking with smiling. What should you tell them?

A

New axon growth may be disorganized/ synkinesis

17
Q

Pt presents with recurrent, brief episodes of severe, unilateral shooting pain along the 5th CN (V2/V3) lasting a few seconds. They describe the pain as an electrical, shock-like sensation and note it is triggered with light touch. Sxs began with continuous, dull ache in jaw. On PE you note patient guarding. What are you concerned for?

A

Trigeminal neuralgia (aka “tic doulaureux”)

(continuous, dull ache in the jaw = retrigeminal neuralgia (“aura”))

18
Q

How is trigeminal neuralgia classified?

A

Classic

Idiopathic

Secondary- r/o MS, painful trigeminal neuropathy- causes attributing to nearly continuous sxs

19
Q

Trigeminal neuralgia typically afects V2 and/ or V3. What type of sxs might you notice if V1 is affected?

A

Autonomic

20
Q

How long do episodes of remission last for trigeminal neuralgia and what is important to note about recurrence?

A

Remissions 6+ months

Recurrence more frequent and more disabling

21
Q

According to the internaltional classification of HA disorders, how is trigeminal neuralgia diagnosed?

A

3+ episodes, CN V dist. only, no neuro deficits

22
Q

Clinical suspicion for trigeminal neuralgia should be followed by eval for secondary causes with what imaging study?

A

MRI with and without contrast

23
Q

What is included in the pharmacologic (1st line) management for TN?

A

Carbamazepine (increase gradually w/ maintenance dose)

Anticonvulsants (if Carbamazepine unable to tolerate or ineffective)

Baclofen (alone or in combo)

24
Q

What are the SEs for Carbamazepine (tx of TN) and what must you monitor because of these SEs?

A

Drowsiness, dizziness, N/V, leukopenia, aplastic anemia

Monitor CBC

25
Q

When should surgery be used to treat TN?

A

Refractory to meds

(microvascular decompression, ablation)

26
Q

Ophthalmic artery occlusion (a/w GCA) leads to what clinical manifestation?

A

Blindness

27
Q

Basilar artery occlusion (a/w GCA) leads to what complication?

A

Brain stem infarct

28
Q

What are the RFs for GCA?

A

Polymyalgia rheumatica

Increased age (avg ~ 77 yo)

29
Q

Pt presents with new onset HA, diplopia, transient blindness (amaurosis fugax), and jaw claudication. On PE you note tenderness to temporal artery and neck/ shoulder muscles. What are you concerned for?

(amaurosis fugax: cannot see out of one/ both eyes due to lack of blood flow)

A

GCA

30
Q

What is the most useful screening tool for GCA?

A

ESR

(will be elevated)

31
Q

How is GCA diagnosed?

A

Temporal artery biopsy; multi-nucleated cells

(1-2cm due to possible “skip lesions”)

32
Q

What is the goal in management for GCA and what is prescribed?

A

Prevent blindness/ stroke

High dose prednisone (taper slowly, start prior to confirming dx if high suspicion)

33
Q

Who is at an increased risk of TMJ dysfunction?

A

Rheumatoid arthritis

34
Q

Pt presents (20-40 yo) with periauricular pain and tenderness of TMJ/ muscles of mastication. They also report HA/ ear discomfort and radiating pain. On PE you note decreased jaw ROM, clicking or popping with movement, and abn dental wear. What are you concerned for?

A

TMJ dysfunction

35
Q

How is TMJ dysfunction diagnosed/ treated?

A

Clinical dx (further eval if systemic sxs)

Tx: dental referral

+/- sxs relief (heat, soft diet, jaw exercises, NSAIDS if chronic pain)

36
Q

Pt with suspected TMJ is in extreme pain, has abn x-rays, changes in CNs, or previous surgery to TMJ. What is indicated?

A

CT/ MRI

37
Q

What tx is considered if TMJ dysfunction is refractory?

A

Trigger injections, surgery

1. Clin Med III (29 decks)

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