Headache

Question 1

how can giant cell arteritis present?

Answer 1

temporal/frontal headache, jaw claudication, scalp tenderness, visual symptoms (e.g amaurosis fugax)

Question 2

what other rheumatological condition is associated with GCA?

Answer 2

polymyalgia rheumatica: 25% of GCA patients will have this

Question 3

what are some signs on examination suggestive of GCA?

Answer 3

thickened and tender temporal arteries and scalp tenderness

Question 4

what investigations are helpful in the diagnosis of GCA?

Answer 4

increased ESR, temporal artery biopsy

Question 5

does a negative biopsy exclude the possibility of GCA?

Answer 5

no as skip involvement is common in GCA

Question 6

What is the treatment for GCA? how does this differ if there are ischaemic visual symptoms?

Answer 6

High dose oral prednisolone (40-60mg) until symptoms settle (5-7 days)
If ischaemic visual symptoms then IV methyl prednisolone for 3 days prior to oral steroids

Question 7

what is a complication of GCA?

Answer 7

blindness

Question 8

when would you give antibiotics before doing an LP in suspected bacterial meningitis?

Answer 8

can’t be done within 1 hour, signs of severe sepsis or rapidly evolving rash, signs of raised intracranial pressure, significant bleeding risk

Question 9

how does trigeminal neuralgia present?

Answer 9

sudden severe shooting or stabbing pain in trigeminal nerve distribution unilaterally. lasts a few seconds and triggered by touching the face or eating.

Question 10

what are some causes of secondary trigeminal neuralgia?

Answer 10

MS, sardcoidosis, lyme disease, malignancy

Question 11

what is the first line management of trigeminal neuralgia?

Answer 11

carbamazepine