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18 facial pain Flashcards

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1
Q

causes of bell plasy

A

HSV/VZV reactivation, demyelination, nerve edema.ischemia, autoimmune damage, vasospasms of nerve-feeding vessels

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2
Q

rapid onset of bilateral facial paralysis consider what

A

guillain-barre and uveroparotid fever (sarcoid)

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3
Q

most freq distribution of trigeminal neuralgia

A

V2/V3

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4
Q

common trigger point for trigeminal neuralgia

A

nasolabial fold

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5
Q

1st line tx for trigeminal

A

carbamazepine (anticonvulsant)

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6
Q

neurosurgery complications

A

facial dysesthesia and anesthesia dolorosa (numbness/pain)

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7
Q

glossopharyngeal neuralgia what’s affected

A

9th nerve (tonsil radiating to ear)

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8
Q

pain felt in ear neuralgia

A

tympanic plexus – ddx from TMD

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9
Q

trigger point for glossopharyngeal neuralgia

A

in ear canal

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10
Q

postherpetic neuralgia timeline

A

persists 1-6 months after onset of rash

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11
Q

postherpetic vs trigeminal

A

postherpetic burns w episodic stabbing

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12
Q

tactile allodynia

A

light touch elicits pain

postherpetic neuralgia

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13
Q

age for postherpetic neuralgia

A

50% of pts over 50 and 75% of pts over 75

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14
Q

atypical facial pain characteristic

A

drawing aching or pulling pain

hot spot on bone scan – increased temperature, tenderness, or marros activity

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15
Q

cluster headache clinical, cause, demographics

A 
pain of midface and upper face, esp around eyes
attacks in temporal groups 
vascular cuase 
80% smokers
\+ fmailial influence
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16
Q

cluster headache aka

A

horton’s syndrome, histaminic cephalgia, migrainous neuralgia

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17
Q

alarm clock headache

A

cluster – same time everyday

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18
Q

cluster headahce vs migraine

A

migraine has aura and pt is reclusive

vs cluster – no aura and hyperactive

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19
Q

paroxysmal hemicrania characteristics

A

attacks last 2-30 min, up to 40x /day

high freq, short attacjs, responds to indomethacin

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20
Q

hemicrania continua

A

unilateral, chronic, daily similar to cluster

responds to indomethacin

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21
Q

chronic paroxysmal hemicrania aka and cayse

A

sjastaad syndrome

congestion of conjunctival blood vessles and increased intraocular pressure

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22
Q

attacks last 2-30 min, up to 40x /day

high freq, short attacjs, responds to indomethacin

A

paroxysmal hemicrania

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23
Q

migraine characteristics

A

paroxysmal, unilateral, 4-72h

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24
Q

migraine cause

A

vasoconstriction of brain arteries 2/2 serotonin reduction –> ischemia and dilation

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25
aura characteristic of
migraine visual hallucination before pain sparks (scintillation), partial blindness, loss of light perception (scotome), loss of ability to express thoughts (aphasia)
26
temporal arteritis aka and cause
giant cell arteritis, cranial arteritis multifocal autoimmune vasculitis of temporal artery headache coincinding with heartbeat
27
headache coincinding with heartbeat
temporal arteritis
28
temporal arteritis oral symptoms
jaw claudication (pain w mastication), pain wearing hats (pressure), blindness
29
generalized muscle ache and stiffness after headache attack
polymyalgia rheumatica | temporal arteritis
30
temporal arteritis histo
chronic inflammation of tunica intima and media, narrowing of lumen from edema and prolif of tunica intima, necrosis, giant cells
31
chronic inflammation of tunica intima and media, narrowing of lumen from edema and prolif of tunica intima, necrosis, giant cells
temporal arteritis
32
myasthenia gravis mechanism
autoimmune attack on ACh receptors w progressive fatigue of skeletal muscle pts have thymus hyeprplasia or thymoma and at least 1 other autoimmune diosrder
33
myasthenia gravis clinical
subtle but progressive weakness, most noted in head and neck inability to focus eye, drooping eyelid (ptosis), double vision (diplopia), dysphagia, dysarthria (slurred speeech), difficulty chewing jaws hang open
34
inability to focus eye, drooping eyelid (ptosis), double vision (diplopia), dysphagia, dysarthria (slurred speeech), difficulty chewing jaws hang open
myasthenia gravis
35
myasthenia gravis diagnosis
elevated serum ACh receptor antibodies
36
elevated serum ACh receptor antibodies
myasthenia gravis
37
myasthenia gravis histo
degenerated muscle fibers -- smaller, lose rounded cross-section look
38
degenerated muscle fibers -- smaller, lose rounded cross-section look
myasthenia gravis
39
neurodegenerative disorders w progressive weakness and mm wasting
progressive muscular atrophy progressive bulbar palsy amyotrophic lateral sclerosis
40
most common lethal AR disorder
progressive muscular atrophy (SMN gene) childhood; no facial involvement
41
SMN gene
progressive muscular atrophy -- AR childhood; no facial involvement
42
progressive bulbar palsy demographic and onset
children/young adults starts w dysphagia atrophy of facial muscles
43
amyotrophic lateral sclerosis aka, demographic
Lou Gehrig dz | middle age
44
amyotrophic lateral sclerosis presentation
leg stiffness (one affected more than the other -- dragging leg) fasciculation (small synchronous muscle contractions) bulbar paralysis -- dysfx of mm controlled by medulla oblonfata in late LAS
45
dysfx of mm controlled by medulla oblonfata
bulbar paralysis, late ALS
46
leg stiffness/dragging
ALS
47
fasciculations
small synchronous muscle contractions in ALS
48
small synchronous muscle contractions
fasciculations, ALS
49
immune response to ACE inhibitor
scalded mouth syndrome
50
scalded mouth syndrome what could case
immune response to ACE inhibitor
51
alternative names for burning mouth syndrome
glossopyrosis, stomatopyrosis, glossodynia, stomatodynia
52
upper resp infx taste/smell
temporary dysgeusia
53
cns tumor taste/smell
dysgeusia
54
trauma/tumors/peripheral nerve inflammation
transient hypogeusia
55
taste hallucination
migraine, bell palsy, VZV
56
hemiageusia
ageusia of 1/2 tongue -- ischemia and infarction of brainstem
57
periodontisis and taste
salty taste, high NaCl content of crevicular fluids
58
flavor and smell
75% of flavor info in smell
59
aberran odor perception
parosmia | complain of foul or rancid taste
60
phantom taste
dysgeusia in absence of food stimulus
61
frey syndrome manifest
facial flushing/sweating along auriculotemporal nerve in response to gustatory stimuli
62
frey syndrome casues
parotid absess, surgery (40% parotidectomy), trauma, diabetes, forceps delivery injury to nerve
63
chin and submental gustatory sweating
chorda tympani syndrome - dx of submandibular gland
64
gustatory lacrimation
facial nerve injury; crocodile tears
65
TMJ osteoarthritis imaging
obliteration of joint space, exostoses/osteophytes, subchondral cysts, ossicles in synovial membrane
66
stages of rheumatoid arthritis
autoiimune destruction of joints | starts as synovitis --> then pannus (reative m/ph-laden fibroblastic proliferation from synovium onto joint surface)
67
reative m/ph-laden fibroblastic proliferation from synovium onto joint surface
pannus, rheumatoid arthritis
68
most affected joint in osteoarthritis
hips
69
most affected joints in rheumatoid arthritis
hands and feet | hips least affected
70
joint shape in rheumatoid arhtritis
anvil
71
tmj in rheumatoid arthritis
75% usually bilateral flat condylar head
72
nontender subcutaneous growth near joint
rhematoid nodules | amorphous eosinophilic necrosis surrounded by thick layer of mononuclear cells
73
rheumatoid labs
80% elevated RF, 50% ANAs
74
histo rheumatoid arthritis
rice bodies: small white villi made of cellular debris admixed w fibrin/collagen
75
rice bodies
small white villi made of cellular debris admixed w fibrin/collagen rheumatoid arthritis
76
anklysoing spondylitis
systemic rheumatic disease | HLA B27 in 90% of pts
77
risk factors and sex predilection for bell palsy
Risk factors: Obesity /Pregnancy / preeclampsia / Diabetes /HT/ Infection 30% have HSV F > M
78
guillain barre cause and presentation
autoimmune aka landry's paralysis damage to PNS - bilateral mm weakness: behins ain feet and hands acute polyneuropathy (1st to appear) numb/tingling pain respiratory failure
79
diagnostic clinical features of trigeminal neuralgia
refractory period
80
giant cell arteritis demographic
>50yr, scandinavian/north european/F | HLA-DR4
81
complication of giant cell arteritis
blindness pain chewing in masseter and temporalis aorta ffected in 50%
82
labs in giant cell arteritis
elevated ESR , C-reactive protein, and platelet count
83
HLA-DR4
giant cell arteritis
84
Polymyalgia Rheumatica:
 Symptom found in Giant Cell Arteritis (GCA) |  Morning stiffness in neck, shoulder, pelvis
85
narrowing of joint space: OA vs RA
OA narrow | RA narrow only if ankylosis
86
subchondral cysts
OA; Large degenerative space beneath cartilage (Radiolucent)
87
OA in joint what find
 Subchondral cysts: Large degenerative space beneath cartilage (Radiolucent)  Ossicles: metaplastic bone  Chondral bodies: Multiple hyaline cartilage granules  Narrowing of joint space
88
pannus
RA | Fibroblastic proliferation / Macrophage laden
89
Polyarthralgia:
RA
90
ankylosis RA or OA
RA
91
anvil joints
RA
92
joints in RA
anvil
93
RA in joint space
rice bodies, pannus, anvil joints, ankylosis
94
skin in RA
rheumatoid nodules (20%) beneath skin near affected joints, pathognomonic
95
labs for RA
ACPAs * Specific* 80% RF 50% ANA 90% elevated ESR
96
OA vs RA cause, age, location
``` OA: Degenretaive due to age  >50yrs  Hips, knees, spine (weight bearing joints) ``` ``` RA: Autoimmune  25-35yrs  Bilateral , symmetrical involvement of small joints, hands and feet ```
97
heberden
``` OA nodules at distal or interphalanges joints. Due to calcific spurs (osteophytes) from repeated trauma ```
98
crepitation RA or OA
OA
99
swan neck deformity
and ulnar deviation | RA
100
pain in morning better later
RA
101
pain worse toward evening
OA
102
rice bodies
RA

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