Bell's Palsy etc & HA

Question 1

tx Bell’s Palsy? (3)

Answer 1

Prednisone 60 mg taper x 10 days
Valacyclovir 1 g TID x 7 days
artificial tears/eye lubei

Question 2

indications for labs/imaging in Bell’s Palsy (2)

Answer 2

fasting blood sugar in DM

MRI if bilateral or no forehead involvement

Question 3

nerve branches more commonly affected by trigeminal neuralgia?

Answer 3

V2 and V3

Question 4

Bell’s palsy is more common on which side

Answer 4

right

Question 5

tx trigeminal neuralgia (4)

Answer 5

Carbemazepine starting 100-200 BID —> 600-1200 mg/day
Anticonvulsants: Lamotrigine, gabapentin, phenytoin
peripheral nerve block
surgical intervention for refractory pain

Question 6

carbamazepine tx special characteristic?

Answer 6

regular CBCs

Question 7

jaw claudication

Answer 7

temporal arteritis

Question 8

diagnostic criteria for temporal arteritis

Answer 8

3/5:
age at onset > 50
new localized HA
temporal a. tenderness and decr. temporal pulse
ESR> 55
positive temporal a. biopsy

Question 9

classic lab finding of temporal arteritis

Answer 9

elevated ESR

Question 10

biopsy for temporal arteritis? (2)

Answer 10

multinucleate giant cells

need > 2 cm of artery due to skip lesions

Question 11

tx temporal arteritis (2)

Answer 11

Prednisone

monitor ESR

Question 12

unilateral weakness/paralysis, numbness, eye irritation, onset w/in 3 days
involves the forehead

Answer 12

Bell’s Palsy

Question 13

periauricular pain & tenderness, crepitus w/ jaw mvmt

Answer 13

TMJ dysfunction

Question 14

more frequent form of migraine?

Answer 14

migraine w/o aura (“common”)

Question 15

throbbing, pulsatile unilateral pain. 4-72h

N/V, confusion, blurred vision, mood changes, sensitivity to light & sound

Answer 15

migraine w/o aura

Question 16

visual, verbal, or sensory sx 10-60 min prior to HA

usually unilateral. N/V, photophobia, etc

Answer 16

migraine w/ aura

“classic”

Question 17

indications for imaging w/ HA (5)

Answer 17

changes in HA
new neuro sx
refractory
new onset after 50
HIV or CA pts

Question 18

chest pressure/heaviness, flushing, weakness, drowsiness, dizziness, malaise, warmth, paresthesias

Answer 18

triptan sensation- a side effect

Question 19

triptan contraindications (5)

Answer 19

uncontrolled HTN
hx MI
CVD
PVD
pregnancy

Question 20

preventative migraine mgmt prescriptions (3)

Answer 20

B-blockers: Propranolol

antidepressants: TCAs, SSRIs
anticonvulsants: Topiramate

Question 21

most common type of HA?

Answer 21

tension type

Question 22

infrequent tension type HA classification?

Question 23

frequent tension HA classification

Answer 23

10-14 days/mo

lasting 30 min to several days

Question 24

chronic tension HA classification

Answer 24

> 15 days/mo

lasts hours to days

Question 25

tension HA triggers (5)

Answer 25

``` stress/lack of sleep jaw clenching missed meals depression head/neck strain ```

Question 26

sharp, boring, unilateral, periorbital HA w/ autonomic sx | attacks last 15-180 min

Answer 26

cluster HAs

Question 27

cluster HA disease course (4 types)

Answer 27

attacks: every other day, 8x day clusters: 6-12 weeks remission: up to 12+ months chronic: clusters lasting > 1 years or remission

Question 28

restless pt, sitting, rocking. Conjunctival injection, lacrimation, eyelid edema, nasal congestion, ptosis, miosis, sweating

Answer 28

cluster HA

Question 29

triggers for cluster HA

Answer 29

alcohol smoking stress

Question 30

cluster HA imaging indication

Answer 30

always initially- these things are crazy! | MRI or CT

Question 31

cluster HA tx (3)

Answer 31

O2, nonrebreather for 15 min subQ sumatriptan Verapamil as preventative

Question 32

moderate pain on sides or top of head | > 15 days/mo during 3+ months

Answer 32

chronic daily HA

Question 33

continuous, fluctuating pain or same side of face/head lasting minutes to days may have tearing, irritated eyes, rhinorrhea

Answer 33

hemicrania continua

Question 34

tx hemicrana continua (2)

Answer 34

indomethacin | &/or corticosteroids

Question 35

mild-severe pain, throbbing/tightening bilaterally. light/sound sensitivity may be following infection, meds, trauma, other condition

Answer 35

newly daily persistent HA

Question 36

tx newly daily persistent HA (3)

Answer 36

muscle relaxants antidepressants anticonvulsants

Question 37

primary stabbing HA tx (3)

Answer 37

indomethacin abortive drugs trigger avoidance

Question 38

primary exertional HA workup

Answer 38

MRI/MRA to r/o vascular abn

Question 39

> 50 y/o, develops during sleep and wakes people up | mild-moderate throbbing, both sides of the head

Answer 39

hypnic HA

Question 40

hypnic HA disease course

Answer 40

> 10 episodes/month | lasting 15 min- 3 h

Question 41

hypnic HA workup & treatments (3)

Answer 41

MRI: new presentation over age 50, waking up at night caffeine at night indomethacin lithium

Question 42

indications for CT/MRI, ~ LP (5) with secondary HA

Answer 42

``` Systemic symptoms or illness (HIV, CA, infection, sinusitis) Neurological hx Onset sudden Older (> 50 y/o) Previous hx (1st HA or change) ```

Question 43

sx increase w/ cough, exertion, straining, position change | Papilledema, vision loss, pulsatile tinnitus

Answer 43

idiopathic intracranial HTN

Question 44

unilateral HA that's not a migraine, secondary can be

Answer 44

CVA

Question 45

delayed onset of dizziness, tinnitus, N/V, visual changes | hx trauma

Answer 45

post concussion syndrome