Diseases Of Nerves And Muscles Pathology Question And Answers

Diseases of Nerves and Muscles Question And Answers

Question 1. Enumerate the common causes of pain in the tooth and its supporting structures.
Answer.

• Pulpitis
• Fracture of tooth
• Cracked tooth syndrome
• Apical periodontitis
• Phoenix abscess
• Acute periapical abscess
• Pericoronitis
• Lateral periodontal abscess
• HIV-associated periodontitis
• Acute necrotizing ulcerative gingivitis (ANUG).

Read And Learn More: Oral Pathology Short Notes Question And Answers

Question 2. What are the common causes of pain in the jawbone?
Answer.

• Fractures
• Odontogenic infections
• Osteomyelitis
• Osteoradionecrosis
• Infected cyst
• Neuralgia
• Malignant neoplasms
• Pathological fractures
• Sickle-cell infarcts.

Question 3. Name the possible causes of pain in the jaws of edentulous patients.
Answer.

• Trauma from denture
• Mucosal disease below the denture
• Jaw pathology
• Impacted tooth
• Broken root of tooth erupting under the denture
• Excessive vertical height of denture.

Question 4. Name the common causes of postoperative pain in the jaw.
Answer.

• Dry socket
• Aerodontalgia
• Fracture of jaw
• Damage of TM Joint
• Postoperative osteomyelitis
• Damage to the nerve during treatment.

Question 5. Name the different types of neurological pain in the orofacial region.
Answer.

• Trigeminal neuralgia
• Herpes zoster
• Multiple sclerosis
• Post-herpetic neuralgia
• Migrainous neuralgia
• Intracranial tumors
• Bell’s palsy.

Question 6. Name the common types of orofacial pain of extraoral origin.
Answer.

• Maxillary sinusitis
• Carcinoma in maxillary antrum
• Acute parotitis
• Salivary calculi
• Sjogren’s syndrome
• Malignant neoplasm of salivary gland
• Otitis media
• Myocardial infarction.

Question 7. What are the common types of psychological pain?
Answer.Atypical (psychogenic) facial pain and burning mouth syndrome.

Question 8. What is neuralgia?
Answer. Neuralgia can be defied as the pain along the distribution of nerves.

Question 9. Name the common types of neuralgias of the orofacial region.
Answer.

• Trigeminal neuralgia
• Glossopharyngeal neuralgia
• Post-herpetic neuralgia
• Migrainous neuralgia
• Bell’s palsy.

Question 10. What is the most common type of neuralgia?
Answer. Trigeminal neuralgia is the most common neuralgia or nerve pain disorder.

Question 11. What is trigeminal neuralgia?
Answer. Trigeminal neuralgia refers to the pain along the distribution of any branch of the trigeminal nerve, i.e. ophthalmic, maxillary and mandibular nerve.

Question 12. Which branches of the nerve are more often affected in trigeminal neuralgia?
Answer. Maxillary and mandibular branches are mostly affected in trigeminal neuralgia (generally maxillary branch is more often affected than the mandibular branch, while the ophthalmic branch is least affected).

Question 13. Enumerate the etiologic factors of trigeminal neuralgia.
Answer.

• Mostly idiopathic
• Traumatic compression of the nerve resulting in demyelination
• Biochemical change in the nerve cells
• Abnormal blood vessel causing compression of the nerve.

Question 14. Describe the exact nature of pain in trigeminal neuralgia.
Answer. The pain is often extremely severe, always unilateral and of lancinating type, (which feels like sharp stabbing or electric shock). It is radiating in nature and lasts only for few seconds and then disappears promptly.

Question 15. Why trigeminal neuralgia is also called tic douloreux?
Answer. The pain in trigeminal neuralgia may produce spasmodic contractions of the facial muscles; and because of these characteristic muscle spasms, the condition is often called tic dolorous.

Question 16. What is the age and gender prevalence in trigeminal neuralgia?
Answer. It usually occurs among middle-aged females (above 35 years of age).

Question 17. Name one important indicator of trigeminal neuralgia.
Answer. The presence of trigger zone is a defiitive indicator of trigeminal neuralgia; these are spots or anatomical zones, touching which burst of pain will instantly start in trigeminal neuralgia.

Question 17a. Name another neuralgia in which trigger zones may be present.
Answer.Glossopharyngeal neuralgia.

Question 18. How the trigger zones can be stimulated in trigeminal neuralgia?
Answer. Trigger zones may get stimulated and the excruciating pain starts due to following simple activities:

• Touching a particular spot on the face
• Washing of face and brushing of teeth
• Talking, chewing or eating
• Smiling and shaving
• Even touch of a strong breeze on the face.

Question 19. In which areas of face pain will be felt if the maxillary branch is affected in trigeminal neuralgia?
Answer. If maxillary branch is involved, the pain occurs in the cheek bone, entire nose, upper lips and teeth of upper jaw.

Question 20. In which area of face pain will be felt if the mandibular branch is affected in trigeminal neuralgia?
Answer. If mandibular nerve is involved, the pain occurs in lower cheek, lower lip, lower teeth and lower jaw.

Question 21. Which side of the face is more often affected in trigeminal neuralgia?
Answer. It is generally seen that right side of the face is affected more frequently than the left side.

Question 22. What is the best way to establish the diagnosis of trigeminal neuralgia?
Answer. History of the patient and normal neurological fidings usually establish the diagnosis beyond doubt.

Question 23. Name the laboratory investigations done in trigeminal neuralgia.
Answer.

• MRI may be suggested for detection of any space occupying lesion or any aberrant vessel compressing the nerve root
• CT scan of the head and neck region are advised to rule out suspected brain tumor,meningitis or any other neurological abnormality.

Question 24. Possibility of which other conditions must be ruled out while making the diagnosis of trigeminal neuralgia?
Answer.

• Multiple sclerosis
• Migraine
• Atypical neuralgia
• Myofacial pain
• Cluster headache
• Intracranial hemorrhage
• Acute pulpitis.

Question 25. Describe the different treatment outlines in trigeminal neuralgia.
Answer. Trigeminal neuralgia can be treated by the following methods:

• Peripheral neurectomy
• Injection of alcohol or boiling water into the gasserian ganglion
• Injection of steroid or anesthetic in the ganglion
• Electro-coagulation of the same ganglion
• Administration of carbamazepines and phenytoin, etc.
• A recent treatment called microsurgical decompression of trigeminal root being tried with results.

Question 26. What is sphenopalatine neuralgia?
Answer. Sphenopalatine neuralgia is a distinctive syndrome of headache, characterized by a unilateral radiating pain in the region of the eye, maxilla, ears, teeth, cheek and nose, etc.

Question 27. Name the types of sphenopalatine neuralgia.
Answer. There are two types of sphenopalatine neuralgia—episodic type and chronic type.

Question 28. Describe the clinical presentations of sphenopalatine neuralgia.
Answer.

• Onset of pain is rapid, which persists for few minutes to few hours and then disappears
• The pain often simulates toothache but unlike the trigeminal neuralgia, there are no trigger zones present
• Generally 1 to 3 short attacks of pain occur in a day (sometimes exactly at the same time every day and hence it is often called alarm–clock headache)
• More commonly occurs in females and may be associated with symptoms like sneezing, nasal discharges and watering of the eyes, etc.

Question 28a. Why sphenopalatine neuralgia is also called alarm–clock headache?
Answer. In this neuralgia, pain generally occurs exactly at the same time every day and hence it is often called alarm–clock headache.

Question 29. What is auriculo-temporal (Frey’s) syndrome?
Answer. Frey’s syndrome occurs due to anomalous repair of the damaged auriculo-temporal nerve following injury, which results in the innervations of sweat glands by the parasympathetic salivary fiers.

Question 30. How auriculo-temporal syndrome occurs?
Answer. The condition usually occurs following surgical procedures like removal of the parotid gland or resection of the ramus of mandible, etc.

Question 31. Describe the clinical features of auriculo-temporal (Frey’s) syndrome.
Answer. Patients typically exhibit flashing and sweating in the temporal area during meals.
Moreover, this can happen even when the patient sees or thinks or even talks about certain delicious foods.

Question 32. Define glossopharyngeal neuralgia.
Answer. It is a type of neuralgia, which mostly affects the older individuals and is characterized by repeated episodes of sharp, shooting type of pain in the ear, pharynx, tonsillar area and the posterior part of the tongue, etc.

Question 33. What type of pain generally occurs in glossopharyngeal neuralgia?
Answer. The intensity of the pain is almost similar to that of the trigeminal neuralgia; which occurs unilaterally, lasts for few seconds to few minutes.

Question 34. Is there any trigger zone present in glossopharyngeal neuralgia?
Answer. Yes, usually there is a trigger zone present at the posterior oropharynx or tonsillar fossa area of the patient.

Question 35. What are the triggering factors in glossopharyngeal neuralgia?
Answer. The following actions often trigger pain in glossopharyngeal neuralgia:

• Chewing and swallowing
• Coughing
• Talking
• Laughing.

Question 36. What are the functions of facial nerve?
Answer.

• Blinking
• Closing eyes
• Smiling
• Frowning
• Lacrimation
• Salivation
• Taste sensation from the anterior two-third of tongue.

Question 37. What is Bell’s palsy?
Answer. Bell’s palsy refers to idiopathic ipsilateral paralysis of facial nerve, resulting in inability to control the facial muscles on the affected side of the face.

Question 38. After whom the condition Bell’s palsy is named?
Answer. The condition is named after Scottish anatomist Charles Bell who first described it.

Question 39. Name the conditions which might precipitate Bell’s palsy.
Answer.

• Change in the atmospheric pressure, e.g. while fling or diving, etc.
• Sudden exposure to cold
• Malignant tumors of the parotid gland and brain
• Surgical procedures in the parotid region
• Stroke, meningitis and head injury
• Infections, e.g. acute otitis media and Herpes simplex virus infection
• Melkersson-Rosenthal syndrome
• Lyme disease
• Multiple sclerosis
• Following incorrect pterygo-mandibular block anesthesia
• Ischemic damage of the facial nerve.

Question 40. What is the common age and sex prevalence of patients in Bell’s palsy?
Answer. Bell’s palsy commonly affects the middle-aged females.

Question 41. Describe the salient clinical features of Bell’s palsy.
Answer.

• The onset of paralysis is often rapid
• Patient neither can close the eye on the affected side nor can raise the eyebrow
• Constant watering from the eye and no wrinkle formation in the forehead whenever patient tries
• Drooping of the corner of the mouth on the affected side with constant running of saliva
• Lips do not rise even during smile, which produces a mask–like expressionless face
• As the eye is constantly open, there will be conjunctival dryness or even ulceration
• There will be difficulty in speech (slurred speech), diffiulty in taking foods and loss of taste sensations
• The patients of Bell’s palsy cannot blow whistles by their mouth.

Question 42. Name the syndrome commonly associated with Bell’s palsy and what are its features?
Answer.Melkersson-Rosenthal syndrome; besides Bell’s palsy-the other features of this syndrome include cheilitis granulomatosa, fisured tongue and edema of the face, etc.

Question 43. Name the pain and other sensory disturbances of tongue.
Answer.

• Glossopyrosis: Burning sensation in tongue
• Glossodynia: Painful tongue
• Glossoplegia: Paralysis of tongue
• Glossoptosis: Downward displacement or retraction of the tongue
• Glossophytia: Black hairy tongue.

Question 44. What are the causes of glossodynia and glossopyrosis?
Answer.

• Vitamin deficiency
• Anemia (especially pernicious anemia)
• Hormonal disorder, e.g. diabetes, hypothyroidism
• Xerostomia
• GI disturbances (hyper- or hypoacidity)
• Psychogenic factor, e.g. cancer phobia, chronic anxiety and depression
• Trigeminal neuralgia
• Referred pain from tooth
• Angioneurotic edema
• Heavy metal poisoning, e g. mercurialism
• Moeller’s glossitis
• Post, menopausal syndrome
• Oral thrush
• Cervical nerve injury.

Question 45. Describe the symptoms of glossodynia.
Answer.

• Clinically normal appearing tongue with no lesions or ulcerations
• But the patients feel pain and burning, itching or stinging sensations
• The pain is low or absent during morning hours but gradually builds up as the day progresses.

Question 45a. What is gustatory sweating (Gustatory means- upon testing some food)?
Answer.Sweating on the forehead, face, scalp and neck occurring soon after tasting some food.

Question 45b. In which disease gustatory sweating can occur?
Answer. It occurs in Frey’s syndrome.

Question 46. What is causalgia?
Answer. Causalgia refers to the burning pain in the area of previous injury or surgical procedures.

Question 46a. Why causalgia occurs?
Answer. Causalgia results from damage to the peripheral nerve at the area of injury or surgery.

Question 47. Does causalgia occur in the oral cavity?
Answer. Yes, in the oral cavity it may occur following tooth extraction.

Question 48. Name the criteria of true causalgia.
Answer.

• Pain must be spontaneous, severe and persistent
• It should be present for at least 5 weeks
• Pain should be felt distal to the proximal nerve injury.

Question 49. Name the injuries which might cause causalgia.
Answer.

• Bullet injury, head injury and surgical injury
• Injury from a high-velocity sharp instrument
• Tooth extractions
• Polio and stroke
• Myocardial infraction.

Question 50. How many days after the initial injury, the pain starts in causalgia?
Answer. The pain arises within a few days to several weeks after the injury or surgery, although by that time, the original wound had already healed-up.

Question 51. In which parts of the body pain in causalgia is most commonly felt?
Answer. Pain in causalgia is most commonly felt in the limbs.

Question 52. What is anesthesia and what is paresthesia?
Answer. Anesthesia means complete loss of sensation in any part or organ of the body, while paresthesia means perception of abnormal sensations in any part of the body.

Question 53. Name the causes of anesthesia and paresthesia of the lip.
Answer.

• Inferior alveolar nerve block
• Injury or fracture of the jaw
• Acute osteomyelitis
• Malignant or metastatic tumor of mandible
• Exposed mental foramen
• Herpes zoster
• Multiple sclerosis
• Tetany.

Question 54. What is generalized familial muscular dystrophy?
Answer. Generalized familial muscular dystrophy is a rapidly progressing muscular disease, which predominantly affects the children and most of the patients are the sons of their carrier mothers.

Question 55. Describe the clinical manifestations of generalized familial muscular dystrophy.
Answer.

• Weakness of the muscles of extremities with inability of the child to stand, run or walk even after attaining a standard age
• Initial muscular enlargement followed by muscle atrophy and weakness
• Limbs appear flccid and patients often have a waddling gait
• Kids fall down immediately everytime while making an attempt to stand or walk by themselves due to poor muscular strength
• In severe cases, weakness in all the muscles of the body including those of the facial, masticatory or ocular groups are seen
•  Many kids die before the age of 20 years due to pulmonary infections related to the respiratory muscle weaknesses.

Question 56. What are the oral manifestations of generalized familial muscular dystrophy?
Answer.

• Facial, masticatory, laryngeal and pharyngeal muscles are affected late in the course of the disease
• Due to lack of muscle tension teeth cannot be aligned properly in the arch
• Open-bite or cross-bite with malocclusion
• Macroglossia
• Expanded dental arch
• Locking and clicking sound in TM joint.

Question 57. Name the histological changes seen in the muscles in case of generalized familial muscular dystrophy.
Answer. Histologically the involved muscles exhibit gradual loss of muscle fiers and are replaced by connective tissue or fat. At the beginning of the disease some muscle fiers are hypertrophic while others are atrophic; but in the severe stages of the disease, no muscle fiers survive.

Question 58. What is the signifiant biochemical change in generalized familial muscular dystrophy?
Answer. Elevation of serum creatine phosphokinase is a signifiant laboratory fiding.

Question 59. What treatment can be done in generalized familial muscular dystrophy?
Answer. There is no satisfactory treatment for this disease.

Question 60. What type of disease myasthenia gravis is?
Answer. Myasthenia gravis is one of the best known autoimmune diseases, characterized by severe muscle weaknesses and pronounced fatigability.

Question 61. Why myasthenia gravis occurs?
Answer. It is an autoimmune disease, in which antibodies are produced against acetylcholine receptors (Ach R0 of the muscle end plate of the neuromuscular junctions). This results in an impairment of acetylcholine signal transmissions across the neuromuscular junction; thereby causing muscle weaknesses and pronounced fatigability.

Question 61a. What is the basic reason behind development of myasthenia gravis?
Answer.Defect in the neuromuscular transmission.

Question 62. Describe the clinical features of myasthenia gravis.
Answer. The disease commonly affects middle-aged females; besides muscle weakness and fatigability, patients may also have hyperplasia of thyroid gland. Dropping of head,diplopia, ptosis, weight loss and exhaustion are important features. Many patients die of respiratory failure; however, few patients survive and lead a relatively normal life.

Question 63. What are the oral manifestations of myasthenia gravis?
Answer. Patients with myasthenia gravis often exhibit the following oral manifestations:

• Diffiulty in mastication and deglutition
• Dropping of the jaw, slurring of speech and loss of taste sensation
• Dry mouth, ulceration of the tongue, buccal mucosa and palate
• Atypical facial pain and oral candidiasis.

Question 63a. What is the histological change in the muscles in myasthenia gravis?

Answer. There is no histologic change in the muscles.

Question 64. Name the important diseases, which might co-exist with myasthenia gravis.
Answer.Systemic lupus erythematosus, Sjogren’s syndrome and progressive systemic sclerosis,etc.

Question 65. What is the treatment of myasthenia gravis?
Answer. Intramu scular administration of physostigmine, it improves the strength of the affected muscles readily; however, this remission is only temporary.

Question 66.What is myositis ossifians?
Answer. Myositis ossifians is a skeletal muscle disease of unknown etiology, which is characterized by the formation of bone (calcifiation) and connective tissues within the muscles.

Question 67. Name the types of myositis ossifians.
Answer.

• Non-hereditary type (traumatic myositis ossifians): This is the common type, in which ossification occurs following injury in the muscle
• Hereditary type: It is known as myositis ossifians progressive and in this type, the ossification occurs without injury
• In other classifications, myositis ossifians can be described as focal (where only a single muscle is involved) or it can be generalized (where the entire group of muscles of the body are involved).

Question 67a.What is Rider’s bone and Drill bone in myositis ossifians?
Answer. These are features of traumatic myositis ossifians.

Question 67b. What is Rider’s bone?
Answer. Localized ossifiation of the adductors muscle tendon of the thigh; which occurs due to inflmmation of the muscle resulting from horse riding.

Question 68. Describe the clinical features of myositis ossifians.
Answer.

• Myositis ossifies occur frequently among children and young adults
• Patients develop solitary or multiple, soft, flctuant or fim, nodular, painless swellings on the body
• In the later stages, some of the nodules disappear while the remaining nodules become bony hard and they often exhibit an overlying red skin
• The condition can be painful, especially when the affected muscle is used for any work.

Question 68a.What is the principal histologic change in the affected muscle in myositis ossifians?
Answer.Replacement of muscle tissue by connective tissue.

Question 69.In the orofacial region, which muscle is frequently affected in myositis ossifians?
Answer. The masseter muscle is often affected by this disease, which results in trismus and diffiulty in food intake.

Question 70.What is the most serious complication in myositis ossifians?
Answer. In extreme cases, the entire group of muscles in the body becomes ossifid and this transforms the patient virtually into a rigid organism.

Question 71. What is the treatment of myositis ossifians?
Answer. There is no treatment possible for this disease; surgical treatment has only limited success.