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Clin Med 3 Neuro > Bell's Palsy etc & HA > Flashcards

Bell's Palsy etc & HA Flashcards

1
Q

tx Bell’s Palsy? (3)

A

Prednisone 60 mg taper x 10 days
Valacyclovir 1 g TID x 7 days
artificial tears/eye lubei

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2
Q

indications for labs/imaging in Bell’s Palsy (2)

A

fasting blood sugar in DM

MRI if bilateral or no forehead involvement

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3
Q

nerve branches more commonly affected by trigeminal neuralgia?

A

V2 and V3

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4
Q

Bell’s palsy is more common on which side

A

right

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5
Q

tx trigeminal neuralgia (4)

A

Carbemazepine starting 100-200 BID —> 600-1200 mg/day
Anticonvulsants: Lamotrigine, gabapentin, phenytoin
peripheral nerve block
surgical intervention for refractory pain

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6
Q

carbamazepine tx special characteristic?

A

regular CBCs

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7
Q

jaw claudication

A

temporal arteritis

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8
Q

diagnostic criteria for temporal arteritis

A 
3/5:
age at onset > 50
new localized HA
temporal a. tenderness and decr. temporal pulse
ESR> 55
positive temporal a. biopsy
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9
Q

classic lab finding of temporal arteritis

A

elevated ESR

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10
Q

biopsy for temporal arteritis? (2)

A

multinucleate giant cells

need > 2 cm of artery due to skip lesions

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11
Q

tx temporal arteritis (2)

A

Prednisone

monitor ESR

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12
Q

unilateral weakness/paralysis, numbness, eye irritation, onset w/in 3 days
involves the forehead

A

Bell’s Palsy

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13
Q

periauricular pain & tenderness, crepitus w/ jaw mvmt

A

TMJ dysfunction

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14
Q

more frequent form of migraine?

A

migraine w/o aura (“common”)

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15
Q

throbbing, pulsatile unilateral pain. 4-72h

N/V, confusion, blurred vision, mood changes, sensitivity to light & sound

A

migraine w/o aura

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16
Q

visual, verbal, or sensory sx 10-60 min prior to HA

usually unilateral. N/V, photophobia, etc

A

migraine w/ aura

“classic”

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17
Q

indications for imaging w/ HA (5)

A 
changes in HA
new neuro sx
refractory
new onset after 50
HIV or CA pts
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18
Q

chest pressure/heaviness, flushing, weakness, drowsiness, dizziness, malaise, warmth, paresthesias

A

triptan sensation- a side effect

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19
Q

triptan contraindications (5)

A 
uncontrolled HTN
hx MI
CVD
PVD
pregnancy
20
Q

preventative migraine mgmt prescriptions (3)

A

B-blockers: Propranolol

antidepressants: TCAs, SSRIs
anticonvulsants: Topiramate

21
Q

most common type of HA?

A

tension type

22
Q

infrequent tension type HA classification?

A
23
Q

frequent tension HA classification

A

10-14 days/mo

lasting 30 min to several days

24
Q

chronic tension HA classification

A

> 15 days/mo

lasts hours to days

25
Q

tension HA triggers (5)

A 
stress/lack of sleep
jaw clenching
missed meals
depression
head/neck strain
26
Q

sharp, boring, unilateral, periorbital HA w/ autonomic sx

attacks last 15-180 min

A

cluster HAs

27
Q

cluster HA disease course (4 types)

A

attacks: every other day, 8x day
clusters: 6-12 weeks
remission: up to 12+ months
chronic: clusters lasting > 1 years or remission

28
Q

restless pt, sitting, rocking. Conjunctival injection, lacrimation, eyelid edema, nasal congestion, ptosis, miosis, sweating

A

cluster HA

29
Q

triggers for cluster HA

A

alcohol
smoking
stress

30
Q

cluster HA imaging indication

A

always initially- these things are crazy!

MRI or CT

31
Q

cluster HA tx (3)

A

O2, nonrebreather for 15 min
subQ sumatriptan
Verapamil as preventative

32
Q

moderate pain on sides or top of head

> 15 days/mo during 3+ months

A

chronic daily HA

33
Q

continuous, fluctuating pain or same side of face/head lasting minutes to days
may have tearing, irritated eyes, rhinorrhea

A

hemicrania continua

34
Q

tx hemicrana continua (2)

A

indomethacin

&/or corticosteroids

35
Q

mild-severe pain, throbbing/tightening bilaterally. light/sound sensitivity

may be following infection, meds, trauma, other condition

A

newly daily persistent HA

36
Q

tx newly daily persistent HA (3)

A

muscle relaxants
antidepressants
anticonvulsants

37
Q

primary stabbing HA tx (3)

A

indomethacin
abortive drugs
trigger avoidance

38
Q

primary exertional HA workup

A

MRI/MRA to r/o vascular abn

39
Q

> 50 y/o, develops during sleep and wakes people up

mild-moderate throbbing, both sides of the head

A

hypnic HA

40
Q

hypnic HA disease course

A

> 10 episodes/month

lasting 15 min- 3 h

41
Q

hypnic HA workup & treatments (3)

A

MRI: new presentation over age 50, waking up at night

caffeine at night
indomethacin
lithium

42
Q

indications for CT/MRI, ~ LP (5) with secondary HA

A 
Systemic symptoms or illness (HIV, CA, infection, sinusitis)
Neurological hx
Onset sudden
Older (> 50 y/o)
Previous hx (1st HA or change)
43
Q

sx increase w/ cough, exertion, straining, position change

Papilledema, vision loss, pulsatile tinnitus

A

idiopathic intracranial HTN

44
Q

unilateral HA that’s not a migraine, secondary can be

A

CVA

45
Q

delayed onset of dizziness, tinnitus, N/V, visual changes

hx trauma

A

post concussion syndrome

Clin Med 3 Neuro (3 decks)

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