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Neuro online course > Heachache/Pain > Flashcards

Heachache/Pain Flashcards

0
Q

3 types of familial hemiplegic migraine and genetics

A

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

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1
Q

def chronic headache?

A

> 15d/mo, 3+ mos

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2
Q

Basilar migraine

-timing and avoid what med

A

usu 10-30 min (shorter than other migraines)

No Triptans!

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3
Q

TRansformed Migraine def?

A

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

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4
Q

Type of med triptan is?

A

5HT1 agonist

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5
Q

ERgotamines mech of action?

A

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

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6
Q

s/e of ergotamines?

A

retroperitoneal fibrosis

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7
Q

patient population in cluster vs SUNCT?

Differentiating features and tx?

A

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

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8
Q

SUNCT stands for what?

A

Short lasting unilateral neuralgiform HA w/ Conjunctival injection and tearing

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9
Q

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

A

paroxysmal hemicrania
Tx Indomethacin or CCB
Hemicrania continua: same tx

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10
Q

HA in elderly that is throbbing, wakes pt from sleep

Dx and Tx?

A

Hypnic headache

tx w/ lithium QHS or verapamil, indomethacin

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11
Q

Tx for cough / exertional HA?

A

indomethacin, NSAIDs, ergots, phenelzine (MAOI)

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12
Q

Opening pressure in IICH?

A

> 20

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13
Q

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

A

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

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14
Q

Costen syndrome is what

A

TMJ

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15
Q

Carbamazepine: be careful with what population, check what?

A

Asians: check HLA (incr risk stevens johnsons)

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16
Q

What to check in occipital neuralgia?

A

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

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17
Q

jaw claudication?

A

Temporal arteritis

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18
Q

CADASIL gene/inheritance

A

Notch 3 (AD)

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19
Q

dysesthesia def vs allodynia?

A

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

20
Q

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

A

Alpha delta myelinated fibers

21
Q

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

type of fiber

A

C fibers, unmyelinated

22
Q

descending system for pain is via what main structure?

A

periaqueductal grey

23
Q

opioid receptor is of what type?

A

G- protein linked

24
Q

function of delta opioid receptor?

A

bind enkephalins, less analgesia than mu

25
Q

kappa opiod receptor does what?

A

binds dynorphin, contributes to dysphoria

26
Q

mu receptor opiate binds what?

A

enkephalins and beta endorphin

27
Q

PAraneoplastic small fiber neuropathy has what antibody?

A

anti-Hu

28
Q

painless small fiber neuropathy dx?

A

often uremic

29
Q

distal leg skin biopsy for what dx? what findings?

A

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

30
Q

Two tests you can use for small fiber neuropathy?

A
  1. distal leg skin biopsy

2. autonomic testing (quantitative sudomotor axon reflex testing)…

31
Q

nerve biopsy has role in what possible dx/

A

amyloid, vasculitis, atypical CIDP

32
Q

1st line tx for small fiber neuropathies?

A

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

33
Q

opiate for small fiber neuropathy?

A

tramadol

34
Q

mechanism of gabapentin

A

mostly voltage gated calcium channel modulator, possible GABA modulator

35
Q

major s/e of gabapentin

A

drowsy, LE edema, wt gain

36
Q

mechanism of pregabalin and dosing

A

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

37
Q

Tramadol mecanism and dose and s/e

A

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

38
Q

relationship between pain and vesicles in VZV shingles?

A

pain 4-5 days before vesicles

39
Q

Acyclovir vs valacyclovir for VZV acute zoster?

A

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

40
Q

role of VZV vaccination in elderly?

A

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

41
Q

spinal claudication sx and what might they indicate?

A

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

42
Q

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

A

L4/5: large toe

L5/S1: Small toe

43
Q

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

A

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

44
Q

highest likelihood of phantom limb pain in what population?

A

those w/ pre-amputation pain

45
Q

BEtter meds for thalamic pain syndrome?

A

TCA / SSNRI > SSRI, also AEDs and opioids

46
Q

Two types of complex regional pain syndrome

A
  1. Type 1: previously RSD w/o documented nerve injury
  2. Type 2: causalgia: documented nerve injury
    * EMG dependent
47
Q

two phases of complex regional pain syndrome

A

acute / warm vs chronic cold

48
Q

possible lab findings in complex regional pain syndrome?

A

incr substance P, bradykinin

Neuro online course (21 decks)

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