Neuro: Head & Facial d/o

Question 1

sudden onset unilateral facial paralysis (w/in hours to 1-2 days)

Answer 1

bells palsy

Question 2

What differentiates bell’s palsy from Lyme or GB?

Answer 2

bells is unilateral

Question 3

What can help differentiate bell’s from stroke?

Answer 3

stokes spare forehead

rarely affect ipsilateral facial nerve

Question 4

Bell’s palsy is an LMN d/o that affects the ______ side of the face

Answer 4

ipsilateral

Question 5

stroke is an UMN lesion that affects the ______ side of the face

Answer 5

contralateral

Question 6

workup for bell’s palsy

Answer 6

EMG/NCS
CT/MRI

Lyme/HSV serology

Question 7

When to do dx studies for bell’s palsy

Answer 7

no improvement in 4 mo, or 3 week progression

Question 8

Tx for bell’s palsy

Answer 8

predinisone 60-80 mg PO QD x 7 days

+/- valacyclovir 1g TID x 7d

Question 9

best results from bell’s tx if initiated within ____

Answer 9

3 days

Question 10

Recurrent, brief episodes severe pain along CN V

Electrical shock sensation

Answer 10

trigeminal neuralgia

Question 11

MC presentation of trigeminal neuralgia

Answer 11

unilateral along V2/V3

Question 12

what may precipitate trigeminal neuralgia

Answer 12

dull, continuous achy jaw

Question 13

Dx of Trigeminal neuralgia…

Answer 13

4 paroxysms
afters CN V only
no neuro deficit

Question 14

imaging to support clinical dx of trigeminal neuralgia

Answer 14

MRI contrast and non-contrast

Question 15

What type of trigeminal neuralgia?

vascular compression

Answer 15

classic

Question 16

what study can help determine classic trigeminal neuralgia?

Answer 16

MRA

Question 17

Labs for trigeminal neuralgia monitoring

Answer 17

CBC

HLA-B 15:02 if asian (SJS risk)

Question 18

Tx for trigeminal neuralgia

Answer 18

carbamazepine 100mg-200mg BID

titrate to 600-800mg total QD

Question 19

what can be used with carbamazepine for trigeminal neuralgia

Answer 19

baclofen

Question 20

Pt. presents with:

new headache (unilateral, severe)

transient blindness (amaurosis fugax)

unexplained fever/constitutional sxs

Answer 20

Giant cell arteritis

Question 21

what is the pathognomic sx of giant cell arteritis?

Answer 21

jaw claudication

Question 22

Most useful giant cell arteritis screening lab…

Answer 22

ESR

Question 23

Dx of giant cell arteritis…

Answer 23

temporal artery bx w. multinucleated cells

Question 24

Clinical Dx of giant cell arteritis…

Answer 24

age >50
new localized HA
temporal a. tenderness
ESR > 50 
(+) biopsy

Question 25

giant cell arteritis is assoc. w.

Answer 25

PMR

Question 26

Tx of giant cell arteritis

Answer 26

(prevent stroke)

GC

Question 27

who is at high risk for TMJ dysfunction?

Answer 27

RA

Question 28

Pt. p/w

periauricular pain and tenderness of TMK

HA/ear discomfort

pain radiates to ear/temporal/periorbital regions

crepitus

Answer 28

TMJ dysfunction

Question 29

Dx of TMJ dysfunction

Answer 29

Clinical

Question 30

Tx of TMJ dysfunction

Answer 30

dental referral PRN