484 treatment general pain relief by analgesics care

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484
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Treatment – General • Pain relief by analgesics • Care of the eye ( cornea is protected). Physiotherapy or massage of the facial muscle gives psychological support to the patient. It has not been shown to influence recovery. 485
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Medical management:- Steroids - prednisolone is the drug of choice. If the patient shows signs of improvement dose is tapered, but if it does not show improvement, same dose is continued further. Surgical treatment:- Nerve decompression relieves pressure on the nerve fibres and thus improves the microcirculation of the nerve. 486
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Prognosis:- . 85 - 90% of the patients recover fully. . 10-15% recover incompletely and may be left with some stigmata of regeneration. . Recurrent facial palsy may not recover fully. . Prognosis is guided by E.M.G or nerve excitability or conduction. • Poor prognostic signs are advanced age, hyperacusis, severe initial pain, complete facial palsy. • Good prognostic factors are preservation of EMG responses by muscles, measurable blink reflex. 487
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Melkersson’s Syndrome :- It is an idiopathic disorder consisting of a triad of :- Facial paralysis . Swelling of lips . Fissured tongues Paralysis may be recurrent 488
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Causes of B/L facial paralysis i) Infranuclear:- Acute infections polyneuritis e.g. G.B.S . Leprosy . Sarcoidosis . Myaesthemia Gravis Myotonica dystrophica ii) Supranuclear :- • Cerebrovascular disease . Motor neuron disease 489
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Q ) LMN type Facial palsies - (PGI Dec 02) a) Bell’s palsy most common b) Cornea should be protected c) Bilateral paralysis is seen in Melkerson syndrome d) Unilateral paralysis is seen in Mobius syndrome e) Prognosis affected before repeated electric stimulation 490
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MENINGITIS 491
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Acute meningitis in adolescents and young adults is caused by - (PGI June 04) a) N. meningitidis b) H. Influenzae c) Staphylococcus d) Streptococcus e) E. coli 492
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493
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Q ) CSF glucose level is - (AIIMSjune 2000) a) Half the plasma glucose b) 2/3 of plasma glucose c) 1/3 of plasma glucose d) Same as plasma glucose 494
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495
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Q ) CSF glucose level is - (AIIMSjune 2000) a) Half the plasma glucose b) 2/3 of plasma glucose c) 1/3 of plasma glucose d) Same as plasma glucose B 496
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Pathophysiology of Meningitis - The immediate effect of bacteria or any other microorganism in the subarachnoid space is to cause an inflammatory reaction in the pia and arachnoid as well as in the cerebrospinal fluid. . Since the subarachnoid space is continuous around the brain, spiral cord and optic nerve, an infective agent gaining entry to any one part of the space may spread rapidly to all of it, thus meningitis is always cerebrospinal.
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  • Winter '16
  • jean grey

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