Exam 3 Head/Face Disorders

Question 1

Facial Palsy etiology? (7)

Answer 1

Compression/Inflamm of CN VII in internal auditory canal

U Idiopathic
Infection
Trauma
Tumor
Cerebrovasc dz
Toxins

Question 2

Bell’s Palsy is?

Answer 2

Idiopath peripheral palsy of facial nn
U 40s
Right > Left

Question 3

Bell’s presentation? (6)

Answer 3

Unilat motor deficits of facial expression involving forehead
Numb
Eyelid won't close
Lacrimal/salivary glands affected
Taste to 2/3 tongue
Develops over no longer than 3 days

Question 4

Bell’s DDX? (6)

Answer 4

Mass lesion is onset > 2wks
Guillain (bilateral)
Lyme (bilateral
Otitis media
MS
Tumor

Question 5

Bell’s exam should include?

Answer 5

Hx of rashes, travel, motor weakness, new meds
General
HEENT
Neuro

Question 6

Central Facial Palsy affect what Motor Neurons?

Presents?

P caused by?

Answer 6

Upper

Contralat lower face
Both eyebrows still raisable

Stroke, Tumor, Trauma of motor cortex

Question 7

Peripheral Facial Palsy affects what Motor Neurons?

Presents?

P caused by?

Answer 7

Lower

Entire Ipsilat Face

Stroke, Tumor, MS of brainstem
Bell’s
Trauma of basilar skull

Question 8

Bell’s labs?

Imaging?

Answer 8

Fast blood sugar if DMII

MRI if
No improvement or worse
BILAT involvement
FOREHEAD spared
Parotid mass
Hx of trauma

Question 9

Bell’s tx?

Answer 9

Prednisone x 10 days
Valtrex x 7 days
Best if w/i 3 days of onset

Spontaneous recovery very high w/i 3 wks

Artificial tears/sunglasses

Question 10

Trigeminal Neuralgia is?

Classic?

Symptomatic: Compression?

Sympt: Demyelination?

Answer 10

Paroxysmal attacks of severe UNILAT face pain
Right > Left

Classic = ido, most C

Tumor compression of CN V root, root entry or aberrant vascular loop

Demyelination from MS -> is BILAT

Question 11

Trigeminal Neuralgia presentation?

Answer 11

Paroxysmal lightening pain
1+ divisions of V affected (2/3 most C)
Physical exam U normal
Triggered by jaw mvmt, shave/wash, cold temps

Question 12

Trigeminal Neuralgia imaging?

Answer 12

MRI to r/o lesion or 2° cause

Question 13

Trigeminal Neuralgia tx?

Answer 13

DOC = Carbemazepine (Tegretol)
Anti-seizure 2nd line
Supra- or infraorbital nn block
Surgery

Question 14

Temporal Arteritis (Giant Cell) is?

Answer 14

P autoimmune cell infiltration of med/large vessels ->
Thicken walls ->
P blindness, brainstem infarct

Question 15

Temporal Arteritis presentation? (7)

Answer 15

UNILAT severe HA
U temporal
Worse w/ touch, pressure, cold
JAW CLAUDICATION w/ chew, talk, swallow
Diplopia, transient blindness
Wgt loss/Fatigue
a/w polymyalgia rheumatica

Question 16

Temporal Arteritis diagnostic criteria? (5)

Answer 16

3 of 5:
Onset > 50yo
New, localized HA
Temporal artery tender/↓ pulse
ESR > 50
\+ temp artery bx = multinuc giant cells

Question 17

Temporal Arteritis mgt?

Answer 17

Prevent Blindness/Stroke:
Prednisone 12 mo
Watch for sxs and s/e
Track ESR

Question 18

TMJ Dysfxn is?

Answer 18

Aching pain around ear from misalignment:

MM hypertrophy
Disk degeneration/displacement

Question 19

TMJ presentation? (6)

Answer 19

Periauricular pain
Tender TMJ and mm of mastication
Crepitus w/ mvmt
Catching/locking
↓ ROM
Asymm mvmt/dental wear

Question 20

TMJ DDX? (7)

Answer 20

Tooth abscess
Wisdom teeth
Zoster
Mastoiditis
Otitis Externa/Media
Parotitis
Trigem neuro

Question 21

TMJ Lab W/U?

Answer 21

Only if suspect systemic cause:
CBC
RF
ANA

Question 22

TMJ imaging?

Answer 22

XRay = erosions, osteophytes, stenosis

MRI if refractory