GP MISC

Question 1

types of headaches

Answer 1

Non-life or sight threatening

• Tension headache
• Migraine
• Cluster headache
• Sinusitis
• Medication-overuse headache
• Trigeminal neuralgia
• Drug side effect e.g. CCB and statins

Life or sight threatening

Life threatening

• Intracranial lesion
  
  • Tumour (benign/malignant or metastasis)
  • Haemorrhage (trauma or aneurysm)
• Meningitis

Site threatening

• Giant cell (temporal) arteritis)
• Acute glaucoma

Question 2

tension headache

Answer 2

• F>M
• younger people
• due to tension in muscles of the head
  
  • poor posture
• worse at end of day

Question 3

migraine

Answer 3

• >F>M
• pathophysiology unclear
• features
  
  • unilateral, temporal or frontal
  • throbbing
  • need ro lie down
• triggers
  
  • food, stress, menstruation
• associated symptoms
  
  • photophobia
  • nausea
  • aura

Question 4

medication overuse headache

Answer 4

• Medication used to treat headaches
• F>M
• 30-40 yrs
• Headache present on at least 15 days/month (constant)
• Using regular analgesics (at least 10 days/month)
  
  • Headache not responding
• Occurs in pts with pre-existing headache disorder

treatment: discontinue medication

Question 5

cluster headache

Answer 5

• M>F
• smoking
• features
  
  • excruciating pain- like ice pick in eye
  • unilateral around eye
  • autonomic symptoms
    
    • red, watery eye and blocked nose
  • appears in clusters with periods of remission
• triggers
  
  • alcohol
  • cigs
  • lack of sleep
• management: oxygen and triptans

Question 6

trigeminal neuralgia

Answer 6

• F>M
• Most caused by compression of CN V due to loop of blood vessels
• 5% due to tumours/skull base abnormalities or AV malformations
• features
  
  • unilateral
  • sharp stapping elecric shock
  • sudden onsett
• triggers
  
  • light touch to face, cold wind, combing hair

Question 7

temporal arteritis

Answer 7

• Vasculitis of large and medium sized arteries of head
  
  • Superficial temporal artery commonly involved.
• F>M
• >50 years (most common >75 yrs)
• features
  
  • abrupt onset of headache
  • jaw claudication
  • visual disturbance

management: methylprednisolone

Question 8

orbital blow out fracture

Answer 8

• Sudden increase in infraorbital pressure (e.g. from retropulsion of eye ball (globe) by fist or ball) fractures floor of orbit (maxilla)
• Orbital content can prolapse and bleed into maxillary sinus
• Fracture site can trap structures e.g. soft tissue extraocular muscle located near orbital floor
• Prevents upward gaze on affected side

key features: double vision, numbness over cheek

Question 9

sebaceous gland blockage

Answer 9

Stye

• Superficial blockage
• Painful lump usually in upper eyelid
• White head
• Localised infection – staphylococcus

Management

• hot compress
• +- topical antibiotics

Question 10

meibomian gland cyst

Answer 10

chalazian

• Deeper blockage
• Painless
• Not caused by infection
• Just blockage
• 1/3 resolve of on own
• Treatment: warm compress and cleaning along eyelid margin
• No Abx

Question 11

meibomian gland cyst

Answer 11

chalazian

• Deeper blockage
• Painless
• Not caused by infection
• Just blockage
• 1/3 resolve of on own
• Treatment: warm compress and cleaning along eyelid margin
• No Abx

Question 12

blepharitis

Answer 12

• Blockage of glands along the eyelid margin
• More extensive
• Less of a localised lump
• Gritty crusting along eyelid margin
• Simple eyelid hygiene
  
  • Warm compress
  • Margin
  • Cleaning

Question 13

pre-orbital (pre-septal) cellulits

Answer 13

Infection occurring within eyelid tissue, superficial to orbital septum

• Secondary to superficial infection e.g. bites, wounds
• Confined to tissues superficial to orbital septum and tarsal plates
• Therefore:
  
  • Ocular function- eye movement and vision remains unaffected
• Can be difficult to differentiate between peri-orbital and more severe orbital cellulitis
• If in doubt refer urgently- high dose IV antibiotics and surgical drainage

Question 14

Orbital (post-septal) cellulitis

Answer 14

Infection WITHIN the orbit posterior or deep to the orbital septum

• Can arise from pre-septal cellulitis
• Usually arises from infection from within the orbit
• Signs
  
  • Proptosis/ exophthalmos- eye pushed forward
  • Reduced +/- painful eye movement
  • Reduced visual acuity (optic nerve involved)
• Most dangerous
  
  • Inferior and superior ophthalmic veins can spread infection to the cavernous sinus causing intracranial infections
    
    • Varbous sinus thrombosis
    • Meningitis
• Treatment
  
  • Abx
  • Surgery

Question 15

conjunctivitis

Answer 15

an infection or swelling in your conjunctiva, which is a thin, transparent membrane that lies over the inner surface of the eyelid and covers the white part of your eye.

• Causes red eye
• But eye not painful
• Highly contagious

Question 16

subconjunctval haemorrhage

Answer 16

• When tiny blood vessel in conjunctiva bursts
• Can look shocking
• But completely self- limiting
• No pain

Question 17

cataracts

Answer 17

when the lens, a small transparent disc inside your eye, develops cloudy patches.

Question 18

Age related macular degeneration

Answer 18

Thinning and atrophy of the macula affects central vision

• Visual loss
• Gradual
• Some types are more rapidly

Question 19

glaucoma

Answer 19

• Problem with fluid drainage
• Causes optic nerve damage secondary top raised intraocular pressure
• Can develop chronically or acutely
• Chronic- most common (open-angle glaucoma)
  
  • Normal iridocorneal angle
  • Trabecular meshwork deteriorates as age → raised in intraocular pressure- build up of fluid in posterior compartment
  • Many asymptomatic (eye screening)
  • Increased ICP → increased optic nerve cupping
  • Gradual loss of peripheral vision

Question 20

Acute – closed angle glaucoma

Answer 20

sudden onset of severe unilateral eye pain or a headache associated with blurred vision, rainbow-colored halos around bright lights, nausea, and vomiting

• Narrowing of iridocorneal angle
• Ophthalmological emergency