ENT and Neuro

Question 1

Pt presents with typical Bell’s palsy

- key hx questions to ask

Answer 1

1. Pain in or behind ear
2. Vesicular rash near ear
3. Loss of taste
4. Hyperacusis
5. Any symptoms of stroke - abnormal gait
6. Impaired blinking / eye watering / pain
7. Tick bites
8. PHx similar episodes

Question 2

parkinsons features

Answer 2

bradykinesa plus one of following

1. muscle rigidity
2. 4-6hz rest tremor
3. postural instability not caused by primary visual, vestibular, cerebellar or proprioceptive dysfunction

Question 3

Parkinsons first line therapy

Answer 3

levodopa + carbidopa 50 + 12.5mg TDS.
increasing to 100+25 over 1-2 weeks

OR
pramipexole 0.125mg TDS, titrate to effect, max 1.5

OR
levodopa + benserazide 50 +12.5mg TDS,

Question 4

Drugs to avoid in parkinson

Answer 4

metoclopramide

prochlorperazine

Question 5

features trigeminal neuralgia

Answer 5

recurrent, unilateral, shock like pain in one or more divisions of trigeminal nerve

• can be demyelination or neurovacscular compression
• ->needs imaging to exclude structural cause - request views of trigeminal nerve and ganglion

Question 6

management of trigeminal neuralgia

Answer 6

carbamezepine MR 100mg BD
Gabapetin 300mg nocte
lamotrigine 25mg, alternate for 2 weekths then OD, then BD up to 100mg BD
pregabalin 75mg nocte, increasing to 150-300 BD

Question 7

Causes of facial pain

Answer 7

migraine 
trigeminal neuralgia
cluster headache 
paroxysm hemicrania
tension headache 
dental infection 
post herpetic neuralgia