Severe left sided pain in the face - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 09-24-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Question Severe left sided pain in the face

A 65-year-old man describes pain on the left side of his face 1 head which is severe and intermittent. It occurs during the day, lasts several seconds, and resolves spontaneously. He occasionally notes spasm of his jaw muscles during episodes, which are sometimes triggered by chewing. He has had a full workup with a dentist, which was unrevealing. He has a history of hypertension and hypothyroidism. There is no prior surgical history. There is a family history of colon cancer (three relatives in their 60s). Medications include daily aspirin (81 mg), levothyroxine and hydrochlorothiazide.
On physical exam, he appears well. Vital signs: BP 138/88 mmHg P 76/min R 12/min T 37.0°C. There is some tenderness with palpating the left side of his face, just below his ear. There is no lymphadenopathy, no bruits, and no elevated JVP. Cardiovascular exam is normal. Lungs are clear; abdomen is benign. Prostate is enlarged, smooth and non tender. Neurologic exam is normal. There is no rash. Chemistry panel is normal, urinalysis is negative. Sedimentation rate is 50mm/hr. PSA is 2.4 ng/ml.

Which of the following is most likely to improve this patient's symptoms?

A. Prednisone, 60-80 mg orally
B. Nighttime use of a mouth guard
C. Carbamazepine, orally
D. Monthly Vitamin B12 injections
E. Leuprolide acetate, subcutaneously

Please explain your answer
Reply With Quote Quick reply to this message



  #2  
Old 09-24-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Answer C The patient has Trigeminal neuralgia, lightening pain across the distribution of the Trigeminal nerve. DOC is Carbamazepine .
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
  #3  
Old 09-24-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

Quote:
Originally Posted by step_enhancer View Post
Answer C The patient has Trigeminal neuralgia, lightening pain across the distribution of the Trigeminal nerve. DOC is Carbamazepine .
why not Temporal arteritis ? what are points in question against this ?
Reply With Quote Quick reply to this message
 
  #4  
Old 09-24-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 851
Threads: 88
Thanked 710 Times in 380 Posts
Reputation: 720
Default

Quote:
Originally Posted by tyagee View Post
why not Temporal arteritis ? what are points in question against this ?
Temporal arteritis will have Unilateral headache ,Jaw claudication/pain, blurred vision and elevated ESR.Also association of polymyalgia rheumatica.
I think for temporal arteritis they need to mention something more rather than just Jaw pain to point the diagnosis to it.
The pain of temporal arteritis is in the area of temples not below the ear as in this patient.
http://movies-macaulaywangrussell.bl...arteritis.html

However "left side of his face 1 head which is severe and intermittent", severe pain points to Trigeminal Neuralgia which has a shooting or lightening pain.
The area specified in the Question is characteristic for Trigeminal Neuralgia.
__________________
"Don't Forget they need us too"
Reply With Quote Quick reply to this message
The above post was thanked by:
drshaziamirza (09-26-2012), tyagee (09-24-2012)
  #5  
Old 09-24-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

Carbamazepine orally, he has Tic Douloreux or Trigeminal neuralgia ..=)

He cannot have temporal arteritis because here the pain is intermittent, and lasts several seconds and has identifiable triggers, whereas jaw claudication and the pain of temporal arteritis is not below the ear
Reply With Quote Quick reply to this message
  #6  
Old 09-24-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Also ESR is >50 in TA (usually over 100)
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”
Reply With Quote Quick reply to this message
The above post was thanked by:
XpaezX (09-25-2012)



Reply

Tags
Internal-Medicine-, Neurology-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Left sided weakness and tongue deviation! Evergreen USMLE Step 1 Forum 3 03-22-2012 06:00 PM
SP is in severe pain! oti nogonno USMLE Step 2 CS SP Challenges 1 01-09-2012 11:15 AM
Treatment of Sharp Electrifying Face Pain! scopusmount USMLE Step 1 Forum 8 12-06-2011 08:23 AM
Right-sided facial pain! USMLE-Syndrome USMLE Step 2 CK Forum 2 06-27-2011 01:03 PM
Right Sided Versus Left Sided Colonic Cancer lee-usmle USMLE Step 1 Bits & Pieces 1 06-19-2010 12:14 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)