Outpatient Medicine
Terms
undefined, object
copy deck
- what do you do when you think you've diagnosed Temportal arteritis?
- Get a temportal artery biopsy!!
- How do you tx temporal arteritis?
-
1. high-dose prednisone
2. cytooxic drugs to prevent blindness - What does the pt present with who has temporal arteritis?
-
*Giant cell
*female/male-2/1
*age>50
*univlateral temporal HA
*associated c/ jaw claudication, temporal A. tenderness c/ palpation
*ESR > 50!!! - How do you rule in a trigmeinal nerualgia diagnosis?
-
GEt a head CT or MRI
*want to rule out:
1. sinusitis
2. cerebellopontine angle neoplasm
3. multiple sclerosis
4. herpes zoster - What are the sx of trigminal neuralgia?
- episodic, severe pain shooting from the side of the mouth to ipsilateral ear, eye or nose
- How do you tx trimgeminal neuralgia?
-
with seizure meds!!
1. carbamazepine (1st line)
2. phenytoin (1st line)
3. clonazepam
4. valproic acid - What are si/sx or otitis externa?
-
1. pulling on pinna
2. pushing on tragus cases pain - What is usual bacterial cause of otitis externa?
- pseudomonas is usual cause in pts with diabetes, can be chronic in pts with seborrhea
- How do you tx otitis externa?
- antibiotic ear drops
- what are ddx or otitis externa?
-
Ramsay Hunt syndrome (herpes zoster oticus)
1. herpes infection of geniculate ganglia (CN VII)
2. si/sx: painful vesicles in ext. auditory meatus
3. tx: urgent acyclovir to prevent extension to meningitis - what is ramsay hunt syndrome?
-
Ramsay Hunt syndrome (herpes zoster oticus)
1. herpes infection of geniculate ganglia (CN VII)
2. si/sx: painful vesicles in ext. auditory meatus
3. tx: urgent acyclovir to prevent extension to meningitis - in a diabetic with otitis externa, what are you concerned with that would warrant a CT/MRI?
-
*osteomyelitis (malignant otitis externa)
*get CT/MRI of temporal bone to r/o
*requires surgical debridement - what are the characterisitics of a tension HA?
-
1. m/c HA type
2. B/L bandlike, dull in quality
3. worse c/ stress; not aggravated by activity
4. chronic HA a/c depression
5. ususally found after age 20 yr (rare after age 50) - what are the characterisitics of a cluster HA?
-
1. Unilat, stabbing peri/retro-orbital pain, lasting 15 min to 3 hr
2. seasonal attacks occur in series (6x/day) lasting wks, followed by months of remission
3. a/c c/ ipsilateral lacrimation (85%), ptosis, nasal congestion, & rhinorrhea
4. often occurs w/in 90 min of onset of sleep
5. male/female=6/1
6. mean age 30 yr - what are the characterisitics of a migraine HA?
-
1. classically, HA is unilat (60%) c/ aura (only 15%); pt looks for a quiet place to rest
2. visual aura: scotoma (blind spots), teichopsia (jagges zigzag lines), photopsias (shimmering lights), or rhodopsins (colors)
3. accompanied by nausea and photophobia
4. triggered by stress, odors, certain foods, alcohol, menstruation, or sleep deprivation
5. 80% have positive FHx
6. female/male=3/1 - what are the characterisitics of a temporatl arteritis (giant cell)?
-
1. unilat temporal HA
2. a/c c/ faw claudication, temportal artery tenderness c/ palpation
3. ESR >50
4. female/male=2/1
5. age >50
6. 50% also have polymyalgia rheumatica
7. if not treated, leads to optic neuritis and blindness
8. screen by ESR
9. dx c/ temporal artery bx - what are the characterisitics of a trigeminal nerualgia?
-
1. epicodic, sever pain shooting from side of mouth to ipsilateral ear, eye, or nose
2. peak age at 60 yr - what are the characterisitics of a withdrawal HA?
-
1. common cause of frequent HAs
2. can be withdrawal from various drugs - what are the characterisitics of a subarachnoid hemorrhage?
-
1. head trauma is most common cause
2. spontaneous: usually berry aneurysm rupture
3. classically the "worst HA of my life" - what are the characterisitics of a TMJ disorder?
-
1. can be related to osteoarthritis or previous trauma to TMJ
2. temporomandibular disorders (TMD), medical and dental conditions affecting the TMJ and/or the m. of mastication
3. si/sx: chronic ear pain, HA, faw stiffness, facial pain, pain c/ chewing/ jaw point pain, jaw joint noises, grinding or clienching one's teeth - how do you tx a tension HA?
-
1. acutely NSAIDs or Midrin (combo of isometheptene mucate, dicholoralphenazone, and acetaminophen)
2. prophylaxis c/ antidepressants or b-blockers - how do you tx a cluster HA?
-
1. acutely 100% O2, sumatriptan, or dihydroergotamine
2. prophylaxis c/ verapamil, lithium, methysergide, or ergotamine - how do you tx a migraine HA?
-
1. acutely with sumatriptan, dihydroergotamine, NSAIDS, antiemetics
2. prophylaxis c/ B-blockers (1st line) or calcium blockers - how do you tx a temportal arteritis?
- 1. high-dose prednisone or cytotxic drug to prevent blindness
- how do you tx a trigeminal neuralgia?
-
seizure meds!
1. carbamazepine (first line)
2. phenytoin
3. clonazepam
4. valproic acid - how do you tx withdrawal?
- 1. NSAIDs
- how do you tx a subarachnoid hemorrhage?
-
1. immediate nerosurgical eval
2. nimodipine to reduce incidence of postrugture vasospasm and ischemia - how do you tx TMJ disorders?
-
1. NSAIDS/relaxation techniques/stress reduction
2. muscle relaxants
3. dental appliance (mouth guard)
4. provide m. relaxation and support for the jaw joints
5. refer to dental/oral surgery - what is sumatriptan contraindicated with?
-
1. known coronary dz
2. ergot drugs taken within 24 hr.