64 Questions
What is the role of receptors?
To open ion channels in response to chemical signals
What is peripheral sensitization?
Increased responsiveness and reduced threshold of nociceptors
What is allodynia?
A painful sensation caused by innocuous stimuli
What is the term used to describe the alteration of neural impulses as they travel up to the higher centers?
Central modulation
Which factor can contribute to the 2nd order neuron in the central nervous system becoming hypersensitive?
Negative pain experience
Which approach can enhance outcomes in chronic pain management?
A multidisciplinary team approach
What type of treatment is an example of complementary and alternative medicine for chronic pain management?
Acupuncture
What can cause injuries to the Trigeminal Nerve?
Traumatic crush
Which condition can lead to neurodegenerative disease-induced nerve injury in the somatosensory system?
Multiple Sclerosis
How can compression injuries to the Trigeminal Nerve occur?
Blood vessel compression
Which type of pain is unresponsive to NSAIDs and low dose of opioids?
Neuropathic pain
What is the quality of pain associated with neuropathic pain?
Sharp and stabbing
Who is most likely the first clinician to see a patient with neuropathic pain?
Dentist
What is the typical distribution pattern of Trigeminal Neuralgia (TN) pain?
Does not cross the midline of the face
Which activities are most likely to trigger Trigeminal Neuralgia (TN) pain?
Talking and chewing
What is the common accompaniment to a pain attack in Trigeminal Neuralgia (TN)?
Tic-like cramps or involuntary spasms of the facial muscles
What is the peak incidence age for Trigeminal Neuralgia (TN)?
50-60 years
What is the ratio of male to female in Trigeminal Neuralgia (TN)?
1:2
Why is MRI preferred over CT for diagnosing Trigeminal Neuralgia (TN)?
MRI is more sensitive to intracranial lesions and MS
What is the most common cause of Trigeminal Neuralgia (TN)?
Compression of the trigeminal root by a blood vessel near the dorsal root entry zone (DREZ)
What is a common misconception that can lead to unnecessary dental treatments in Trigeminal Neuralgia (TN) patients?
The paroxysmal nature of TN being confused with dental pathologies
How does TN differ from dental pathologies?
It involves compression of the trigeminal root by a blood vessel near the dorsal root entry zone (DREZ)
What is the next step if pain in a vital tooth without periapical lucency is found to have a crack upon close inspection?
Extract the tooth if it already has root canal treatment
What should be done if an occlusal splint shows positive results for excessive tooth loading during sleep and the pain reduces?
Adjust the device to reduce heavy contact on the painful area and continue use
What is the recommended action if there is no evidence of excessive tooth loading on the occlusal guard and the pain continues?
Refer for proper diagnosis of other possible orofacial pain conditions
What is the course of action if there is no evidence of crack on close inspection of a vital tooth with pain that continues?
Restore the tooth filling if no evidence of crack is found
What is the first-line pharmacological treatment for pain relief in Trigeminal Neuralgia?
Carbamazepine (300mg once daily)
In refractory cases of Trigeminal Neuralgia, which medication is used for pain relief?
Gabapentin (300mg)
What is the maximum daily dosage of Carbamazepine for pain relief in Trigeminal Neuralgia?
1200mg
What are the two main sensory branches of the Glossopharyngeal Nerve?
Tympanic and pharyngeal branches
Which activities are known to precipitate intense, sharp, stabbing pain in Glossopharyngeal Neuralgia?
Tongue movement
At what age does Glossopharyngeal Neuralgia typically onset?
40-50
What symptom may lead to confusion between Glossopharyngeal Neuralgia (GN) and Temporomandibular Disorder (TMD)?
Sensitivity to cold liquid
How can the pain attack of Glossopharyngeal Neuralgia (GN) be triggered?
Tongue movement
What action should be taken if a patient experiences a pain attack triggered by swallowing cold liquid?
Initiate mandible immobilization
What is the main characteristic of Postherpetic Neuralgia (PHN)?
Constant, deep, burning, aching, and itching pain
Which branch of the trigeminal nerve has the worst prognosis for symptoms of Postherpetic Neuralgia (PHN)?
Ophthalmic branch
What is the first-line pharmacotherapy for treating Postherpetic Neuralgia (PHN)?
Gabapentin (min 100-300mg/d- max 1800-3600mg/d)
When do antivirals decrease the incidence of Postherpetic Neuralgia (PHN)?
When initiated within 72 hours from onset of rash
What is the most likely mechanism involved in Atypical Odontalgia (AO)?
Deafferentation
Which procedure is NOT typically associated with the pathophysiology of Atypical Odontalgia (AO)?
Orthodontic treatment
What is a common story associated with Atypical Odontalgia (AO), as mentioned in the text?
"I have seen multiple dentists and have had multiple procedures and still have pain on the tooth"
What is the characteristic quality of pain associated with Atypical Odontalgia (AO)?
Throbbing and burning pain
What is the recommended treatment for Atypical Odontalgia (AO) according to the text?
Tricyclic antidepressants
What is the typical gender distribution for Atypical Odontalgia (AO) according to the text?
Mostly women in 40-50s
What type of pain attack is characteristic of Atypical Odontalgia (AO)?
Constant dull ache with occasional sharp pain
Which type of pain is characterized by a recurring, paroxysmal sharp, stabbing pain lasting for a maximum of 2 minutes?
Trigeminal Neuralgia
What diagnostic block will be equivocal (ambiguous) in Atypical Odontalgia (AO)?
Block to eliminate pain
What should be checked to determine the origin of pain in the case of Odontogenic toothache?
Vitality of the tooth and x-ray
What is a common characteristic of migraine without aura?
Pain increases with routine physical activity
How long can a migraine without aura attack last if left untreated?
4 to 72 hours
What percentage of migraine without aura cases experience unilateral pain?
60%
What is the typical duration of reversible focal neurological symptoms in cases of migraine with aura?
Between 5 to 60 minutes
Which of the following is an example of a sensory disturbance associated with aura in migraine with aura?
Flashes of light
How many attacks with reversible visual, sensory, and motor aura are required for the diagnosis of migraine with aura?
At least 2 attacks
What is the main characteristic of the trigeminovascular system?
Consists of trigeminal neurons and the blood vessels they innervate
What is the role of CGRP (calcitonin gene-related peptide) in migraine pathophysiology?
Highly potent vasodilator
Which symptom helps in rapid screening for migraine?
Nausea or sickness when experiencing a headache
What is the confirmatory evidence of a migraine pain disorder according to the text?
Sumatriptan (25 mg tid)
Which division of the trigeminal nerve supplies the maxillary sinus, teeth, and masticatory throbbing pain?
V2
What is the main artery that supplies the maxillary sinus, teeth, and masticatory throbbing pain according to the text?
Maxillary artery
What are the three major features of Trigeminal Autonomic Cephalgias (TACs) according to the text?
Trigeminal pain, autonomic signs, and vasodilation of blood vessels
Which symptom is typically associated with Trigeminal Autonomic Cephalgias (TACs)?
all of the above
Which sensory disturbance is characteristic of TACs according to the text?
Hyperalgesia
Test your knowledge of pain neurophysiology, neuropathic orofacial pain, neurovascular disorders, and trigeminal autonomic cephalgias with this quiz. Explore topics like chronic pain, trigeminal neuralgia, migraine, and cluster headaches.
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