Heachache/Pain

Question 0

3 types of familial hemiplegic migraine and genetics

Answer 0

FHM1: CACNA1A (50%), assoc w/ cerebellar sx syndromes too
FHM2: ATP1A2 (Na/K ATPase) < 25%
FHM3: SCNA1

Question 1

def chronic headache?

Answer 1

> 15d/mo, 3+ mos

Question 2

Basilar migraine

-timing and avoid what med

Answer 2

usu 10-30 min (shorter than other migraines)

No Triptans!

Question 3

TRansformed Migraine def?

Answer 3

chronic headache with mild/mod baseline HA and intermittent severe migraines

Question 4

Type of med triptan is?

Answer 4

5HT1 agonist

Question 5

ERgotamines mech of action?

Answer 5

“Dirty triptan”: 5HT1 agonist/antagonist, and D2, NE effect

Question 6

s/e of ergotamines?

Answer 6

retroperitoneal fibrosis

Question 7

patient population in cluster vs SUNCT?

Differentiating features and tx?

Answer 7

younger 20-4 0 males in cluster: O2, triptan, ergot, lido injx
older >50 males in SUNCT lasting sec/min multiple / hour: AED/steroids

Question 8

SUNCT stands for what?

Answer 8

Short lasting unilateral neuralgiform HA w/ Conjunctival injection and tearing

Question 9

Female with face and/or neck pain and autonomic sx lasting mi-hr, exagg by head mvmt
dx andTx?
what if chronic?

Answer 9

paroxysmal hemicrania
Tx Indomethacin or CCB
Hemicrania continua: same tx

Question 10

HA in elderly that is throbbing, wakes pt from sleep

Dx and Tx?

Answer 10

Hypnic headache

tx w/ lithium QHS or verapamil, indomethacin

Question 11

Tx for cough / exertional HA?

Answer 11

indomethacin, NSAIDs, ergots, phenelzine (MAOI)

Question 12

Opening pressure in IICH?

Answer 12

> 20

Question 13

Sharp pain in posterior portion of head posterior to ears
Nerve supply
Dx / Tx?

Answer 13

Dx: occipital neuralgia
C2: greater and lesser occipital nerve
Tx: Carbamazepine, nerve block

Question 14

Costen syndrome is what

Answer 14

TMJ

Question 15

Carbamazepine: be careful with what population, check what?

Answer 15

Asians: check HLA (incr risk stevens johnsons)

Question 16

What to check in occipital neuralgia?

Answer 16

cervical spine (Posterior head: C2 greater and lesser occipital n)

Question 17

jaw claudication?

Answer 17

Temporal arteritis

Question 18

CADASIL gene/inheritance

Answer 18

Notch 3 (AD)

Question 19

dysesthesia def vs allodynia?

Answer 19

allodynia: pain w/ NON painful stimuli
dysestheia: unpleasant abnl sensation (evoked or spontaneous)

Question 20

fibers for quick “1st” pain that is mechanical/thermal in small field?

Answer 20

Alpha delta myelinated fibers

Question 21

Aching “2nd pain” in about a cm of innervation, polymodal

type of fiber

Answer 21

C fibers, unmyelinated

Question 22

descending system for pain is via what main structure?

Answer 22

periaqueductal grey

Question 23

opioid receptor is of what type?

Answer 23

G- protein linked

Question 24

function of delta opioid receptor?

Answer 24

bind enkephalins, less analgesia than mu

Question 25

kappa opiod receptor does what?

Answer 25

binds dynorphin, contributes to dysphoria

Question 26

mu receptor opiate binds what?

Answer 26

enkephalins and beta endorphin

Question 27

PAraneoplastic small fiber neuropathy has what antibody?

Answer 27

anti-Hu

Question 28

painless small fiber neuropathy dx?

Answer 28

often uremic

Question 29

distal leg skin biopsy for what dx? what findings?

Answer 29

look at density of intraepidermal nerve fibers, which are expected to be decreased for those who have incr risk of neuropathic pain

Question 30

Two tests you can use for small fiber neuropathy?

Answer 30

1. distal leg skin biopsy | 2. autonomic testing (quantitative sudomotor axon reflex testing)...

Question 31

nerve biopsy has role in what possible dx/

Answer 31

amyloid, vasculitis, atypical CIDP

Question 32

1st line tx for small fiber neuropathies?

Answer 32

TCAs and SNRI (Duloxetine: Cymbalta) Gabapentin and pregabalin** *Esp for DM* Tramadol, and Lidoderm 5%

Question 33

opiate for small fiber neuropathy?

Answer 33

tramadol

Question 34

mechanism of gabapentin

Answer 34

mostly voltage gated calcium channel modulator, possible GABA modulator

Question 35

major s/e of gabapentin

Answer 35

drowsy, LE edema, wt gain

Question 36

mechanism of pregabalin and dosing

Answer 36

voltage gated calcium channel modulator, decr NE/glutamate/substance P release 75mg BID --> 300mg BID less drowsiness than gabapentin

Question 37

Tramadol mecanism and dose and s/e

Answer 37

synthetic mu opioid receptor agonist, 5HT release, prevents NE reuptake 50mg BID-qid incr sz threshold

Question 38

relationship between pain and vesicles in VZV shingles?

Answer 38

pain 4-5 days before vesicles

Question 39

Acyclovir vs valacyclovir for VZV acute zoster?

Answer 39

acyclovir decr duration of pain/vesicles but not likelihood of post-herpetic neuralgia valacyclovir also may decr duration of post-herpetic neuralgia

Question 40

role of VZV vaccination in elderly?

Answer 40

decr risk of shingles in >60 w/ hx pox and decr severity

Question 41

spinal claudication sx and what might they indicate?

Answer 41

lumbar stenosis, pain in post thighs/calves, exacerbated by standing/walking

Question 42

distinguish between L/4-L5 or L5-S1 disc herniation with sciatic pain?

Answer 42

L4/5: large toe | L5/S1: Small toe

Question 43

Dejerine Roussy syndrome? what is it, what causes it.

Answer 43

thalamic pain syndrome, several months post-stroke, +/- decr sensation, field cut, hemiplegia occurs w/ thalamogeniculate branches of PCA or any lesion of somatosensory pathway

Question 44

highest likelihood of phantom limb pain in what population?

Answer 44

those w/ pre-amputation pain

Question 45

BEtter meds for thalamic pain syndrome?

Answer 45

TCA / SSNRI > SSRI, also AEDs and opioids

Question 46

Two types of complex regional pain syndrome

Answer 46

1. Type 1: previously RSD w/o documented nerve injury 2. Type 2: causalgia: documented nerve injury * EMG dependent

Question 47

two phases of complex regional pain syndrome

Answer 47

acute / warm vs chronic cold

Question 48

possible lab findings in complex regional pain syndrome?

Answer 48

incr substance P, bradykinin