Secondary Headaches: Non-Life Threatening

Question 1

Sinusitis is the inflammation of the mucous membranes in the _ _ _ _ _ _ _ _ _ _ _.

Answer 1

Parasinuses

Question 2

Acute sinusitis lasts for how many weeks?

Answer 2

<12 weeks (3 months)

Question 3

How long does sinusitis have to last before it is considered as chronic?

Answer 3

> 12 weeks (3 months)

Question 4

Characteristics of the pain in sinusitis?

Answer 4

Pain over the sinuses (cheeks, forehead), blocked nose, post-nasal drip, hyposmia (loss of smell)

Question 5

Sinusitis pain can radiate to which 2 places?

Answer 5

1. Frontal headache

2. Teeth pain

Question 6

Symptomatic treatment for sinusitis? (4)

Answer 6

1. analgesia
2. saline nasal irrigation
3. nasal decongestants
4. warm face pack

Question 7

What formulation is corticosteroids given for sinusitis?

Answer 7

Nasally

Question 8

What antibiotic is given for sinusitis? (*not systemically unwell)

Answer 8

PenV (phenoxymethylpenicillin)

Question 9

Antibiotic given for sinusitis when systematically unwell

Answer 9

Co-amoxiclav

Question 10

Symptoms of bacterial infection in sinusitis

Answer 10

1. purulent discharge
2. lasts >10 days
3. fever

Question 11

Which of the 2 worsens sinusitis pain - leaning forward or lying flat?

Answer 11

Leaning forward

Question 12

Chronic inflammatory lesions of the nasal and paranasal sinuses are called?

Answer 12

Nasal polyps

Question 13

Complications of sinusitis? (2)

Answer 13

1. Orbital Cellulitis

2. Meningitis

Question 14

Definition of Glaucoma

Answer 14

Strictly speaking, it is loss of the optic nerve fibres (optic neuropathy), typically due to an increase in intraocular pressure (IOP)

Question 15

Main types of Glaucoma (3)

Answer 15

1. Acute angle-closure glaucoma
2. Closed open-angle glaucoma
3. Normal tension glaucoma

Question 16

Name the Glaucoma when there is a sudden physical obstruction in the angle between the iris and the cornea (anterior chamber angle) preventing aqueous drainage through the trabecular meshwork.

Answer 16

Acute Angle Closure Glaucoma

Question 17

What type of pain presents in an Acute Angle Closure Glaucoma?

Answer 17

Rapid progressive and severe painful red eye that can radiate to a frontal headache

Question 18

Clinical presentation of an Acute Angle Closure Glaucoma?

Answer 18

1. Severe, rapidly progressive painful red eye
2. Frontal headache
3. Nausea and vomiting
4. Hazy cornea
5. Halo around lights
6. Non-reactive/fixed mid-dilated pupil

Question 19

Symptoms of Acute Angle Closure Glaucoma will worsen in a light or dark room?

Answer 19

Dark room - causes the pupils to dilate further

Question 20

Why should patients not lie down in a dark room with Acute Angle Closure Glaucoma?

Answer 20

Lying down will increase an increase in IOP and cause the pupils to dilate further, making it worst.

NOTE: lying down without a pillow is used in management

Question 21

What is the most common cause for the obstruction in Acute Angle-Closure Glaucoma?

Answer 21

Pupillary block

Question 22

Investigations for Acute Angle-Closure Glaucoma (2)

Answer 22

1. Tonometry - measures pressure in the eye (IOP)

2. Gonioscopy - analyses the anterior chamber angle

Question 23

Medical management for Acute Angle-Closure Glaucoma? (4) (TIP - OBAPS)

Answer 23

1. Referral to opthalmology
2. Beta-blockers (Timolol) TOP - reduces fluid production
3. Acetazolamide IV/PO
4. Antiemetics/analgesia
5. Pilocarpine TOP - pupil constriction (muscarinic)
6. Steroid eye drops - anti-inflammatory

Question 24

Definitive surgical management of Acute Angle-Closure Glaucoma?

Answer 24

Laser Iridotomy - make a hole in the iris to allow flow of aqueous humour from the posterior chamber to the anterior chamber.

Question 25

Complications of Acute Angle-Closure Glaucoma?

Answer 25

Vision Loss