Known Questions Flashcards
What are the signs of loss of CN7 function?
Total facial weakness, forehead sparing weakness
Can be caused by:
LMN – bells palsy, skull fracture, parotid tumour
UMN – stroke, tumour
What are the signs of loss of CN11 function?
Weakness turning head away from affected side, weakness shrugging shoulders
Can be caused by:
Polio or stroke
What structures are innervated by CN7?
Superior salivary nucleus
Stapedius muscle
Tympanic plexus
Frontalis muscle
Orbicularis oculi
Orbicularis oris
Buccinator
Taste to anterior 2/3rds of the tongue
What are the possible causes of VII weakness?
Can be idiopathic - bell’s palsy, melkersson-rosenthal syndrome
Infection - Ear infection, TB, Ramsay hunt syndrome, glandular fever, AIDS
Trauma - Facial laceration, parotid surgery
Neoplastic - primary or secondary cancers, neuroma of VII, acoustic neuroma
Metabolic - diabetes mellitus, sarcoidosis, guillain-barre syndrome
What are the warning signs of a stroke?
FAST:
Face drooping
Arm weakness
Speech
Time
How can stroke be prevented?
Smoking cessation
Hypertension control
Diabetic control
Atrial fibrillation
Hypercholesterolaemia
How damaging is stroke?
Leading cause of long term disability in western countries
3rd most common cause of death
How should acute stroke be managed?
Cease dental treatment
Call 000
Give oxygen
Maintain airway
Monitor patient’s vital signs until assistance arrives
What is trigeminal neuralgia?
A disorder characterized by recurrent unilateral brief electric-shock like pains abrupt in onset and termination. limited to distribution of one or more divisions of the trigeminal nerve and triggered by innocuous stimuli
What are the diagnostic criteria for trigeminal neuralgia?
Recurrent paroxysms of unilateral facial pain in the distribution of one or more divisions of the trigeminal nerve with no radiation beyond.
Pain has all of the following characteristics:
Lasting from a fraction of a second to 2 minutes
Severe intensity
Electric shock-like, shooting, stabbing or sharp in quality
What are the characteristics of trigeminal neuralgia pain?
Pain may radiate to another division
Duration can change over time with paroxysms becoming more prolonged
Some attacks appear spontaneously. Doctor should attempt replicating the triggering phenomenon.
Mild autonomic symptoms such as lacrimation and/or redness of the ipsilateral eye.
Following pain there is usually a refractory period where pain cannot be triggered
How is trigeminal neuralgia treated?
Surgery:
Peripheral ablative procedures - neurectomy, cryotherapy, alcohol injection
Trigeminal ganglion - radiofrequency, thermocoagulation, glycerol rhizotomy, balloon decompression
Posterior fossa level - microvascular decompression, gamma knife
Medications:
Carbamezapine
Phenytoin
Gabapentin
Pregabalin
Baclofen
Where is pain usually felt in a cluster headache?
In and around one eye
Where is pain felt in a tension headache?
Pain like a band squeezing the head
Where is pain felt in a migraine?
Pain on one side, nausea, and visual changes
Where is pain felt for a headache caused by neck pain?
Back of head and top of head
What is the concentration of adrenaline in an epipen?
IM adrenaline in epipen is 0.5mg at 1:1000 concentration
What is the difference between oral surgery and oral maxillofacial surgery?
Oral surgery:
Only requires a dental degree with postgrad procedures
Mainly intra-oral procedures
Tooth exo, cysts, implants
Maxillofacial surgery:
Require both dental and medical degree
Larger area of face and neck and even the cranial portion
Cancers, orthognathic surgery, TMJ
What are DRSABCD?
Danger
Response
Send for help
Airway open
Breathing normal
CPR start:
30:2 compression to breathe ratio
120 compressions per minute
4cm for infants and 5cm for adults
Defibrillator attachment
What are the 4Hs and 4Ts of advanced cardiac life support?
Hypovolemia
Hypo/hyperkalaemia
Hypoxia
Hypo/hyperthermia
Thrombosis
Toxins
Tamponade (cardiac)
tension pneumothorax
What are the phases of hepatitis?
Incubation period
Preicteric period
Icteric period
Convalescence
meds
- Peptic ulcer = should give pain meds and antacids but be careful with antibiotics
- Cimetidine and ranitidine possible bone marrow suppression
- PPI’s may change taste perception
- For UC = consider giving pain medication and prophylaxis if they’re immune compromised but can cause C. Difficile over growth
- Pseudomembranous colitis = penicillin and clindamycin can cause overgrowth of C. Difficile
How should HCW respond to HBsAg+ve patient, HBs-ve, and unknown patient following needlestick injury?
HBsAg+ve = HBIG (0.06mL/kg) as soon as possible + initiate hep B vaccine if unvaccinated.
If HCW is vaccinated administer HBIG or 2 doses of HBIG with second 1 month after the first dose.
Which drugs can be given for people with peptic ulcers?
Should give pain meds and antacids but be careful with antibiotics
What is a possible adverse outcome of cimetidine and ranitidine use?
Possible bone marrow suppression
How can PPIs affect patients?
Can change taste perception
What medications should be prescribed to patients with ulcerative collitis?
Pain meds and prophylaxis are fine if they’re immunocompromised but this can cause C.difficile overgrowth
What medications shouldn’t be given to patients with pseudomembranous colitis?
Penicillin and clindamycin because they can cause C. Difficile overgrowth
