Clinical (1-4) Flashcards
(102 cards)
1
Q
What is conductive deafness?
A
Impaired sound transmission via the external or middle ear
2
Q
What can cause a conductive hearing loss?
A
EAM obstruction
Drum perforation
Ossicle problems
Poor eustachian tube ventilation
3
Q
What is sensorineural deafness?
A
Defects central to oval window in cochlea (sensory)
OR
Cochlear nerve defects (neural)
4
Q
What else can cause sensorineural hearing loss?
A
Ototoxic drugs:
- Vancomycin
- Gentamicin
Post-infection
Meniere's
Trauma
Presbyacusis (age-related)
5
Q
What is central hearing loss?
A
Damage to central brain pathways
6
Q
What can cause earache due to auriculotemporal nerve damage (CN V3 branch)?
A
Lower mandible pathology:
- Abscess/Caries/Impacted molars
TMJ lesions -> Costen's syndrome
Infection/Inflammation of ant. 2/3 of tongue
Tooth grinding
Salivary gland disease:
- Infection -> Viral/Mumps
- Stones
- Neoplasm
7
Q
What can cause earache due to CN VII damage?
A
Geniculate herpes
Bell's palsy
Sphenoid/Ethmoid sinus pathology:
- Infection
- Neoplasm
Nose pathology
8
Q
What can cause earache due to tympanic branch of CN IX damage?
A
Tonsillitis/Quinsy
Carcinoma of posterior 1/3 of tongue
Neuralgia
9
Q
What can cause earache due to auricular branch of CN X damage?
A
Foreign body in piriform fossa Carcinoma of piriform fossa Laryngeal carcinoma Post-cricoid carcinoma Piriform abscess
10
Q
What cervical spine pathologies may cause earache?
A
Great auricular nerve:
- Cervical neuritis
- Shingles
Lesser occipital nerve:
- Cervical spongylosis
- Neuritis
- Shingles
11
Q
What can cause otorrhoea?
A
Acute otitis media with effusion (‘Glue ear’)
Chronic otitis media
CSF otorrhoea:
- Abnormal connection to subarachnoid space
- Can lead to meningitis
12
Q
What are the two types of dizzines?
A
Central
Peripheral:
- With or without hearing loss
13
Q
What ear conditions can CT allow us to see?
A
Cholesteatoma
Inflamed tissue
Fluid
14
Q
What can diffusion-weighted MRI allows us to see in the ear>
A
Recurrent disease
15
Q
What sensation of movement is typically felt in vertigo?
A
Spinning
16
Q
What are the 5 vestibular end organs in the inner ear?
A
Ampulae of semicircular canals:
- Lateral
- Posterior
- Superior
Macule of:
- Utricle
- Saccule
17
Q
What does the central balance pathway involve?
A
Vestibulospinal tract
Medial longitudinal fasciculus + ocular muscles
Medial lemniscus, thalamus + cerebrum
Cerebellum via inferior cerebellar peduncle
18
Q
What inner ear conditions can result in dizziness?
A
BPPV
Vestibular neuronitis
Meniere’s
19
Q
What eye conditions can result in dizziness?
A
Cataracts
DM
20
Q
What hoint conditions can result in dizziness?
A
DM
OA
Neurology
21
Q
What heart conditions can result in dizziness?
A
Arrhythmias
Postural hypotension
22
Q
What neurological conditions can result in dizziness?
A
Stress
Migraine
Space occupying lesion
MS
23
Q
What is the clinical relevance of vestibulo-ocular reflex?
A
Nystagmus will be observed in vestibular pathologies:
- Direction depends on involved structures
24
Q
Which of the following examination features is less important when assessing a patient with vertigo:
- Otoscopy
- Neurological
- Cervical spine exam
- BP when lying and standing
- Balance system
- Audiometry
A
Cervical spine exam
25
What is the commonest cause of vertigo on looking up?
Benign Positional Paroxysmal Vertigo (BPPV)
26
What can cause BPPV?
Head trauma
Ear surgery
Idiopathic
27
What is the pathophysiology of BPPV?
Otolith material from utricle -> SCCs:
| - Usually into posterior semicircular canal
28
What features can distinguish vertebrobasilar insufficiency from BPPV?
VBI has other symptoms associated with decreased posterior brain circulation:
- Visual disturbance
- Weakness + numbness
29
What sort of actions can precipitate BPPV?
Turning in bed (worse to one side)
Getting out of bed
Bending forward
Moving head quickly (often only in 1 direction)
30
Describe the Dix-Hallpike Test?
1. Sit on couch as so head would be off end if lying down
2. Turn head 45 degrees to one side
3. Warn patient not to close eyes
4. Lie back as quickly as comforable
5. Hold and observe:
- 30 second delay
- Classical nystagmus
31
What is the downside to the Dix-Hallpike Test?
There is a reduced response on repetition
32
Describe the Epley manoeuvre?
1. Secure head to 45 degrees to one side while sitting
- Otolith material in posterior SCC
2. Lie patient back so head is off bed
3. Turn head 45 degrees to other side:
- Otolith now in ampule of posterior SCC
4. Turn head 90 degrees to that same side
5. Sit patient up with head facing straight ahead:
- Otolith now back into utricle
33
What are the symptoms of vestibular neuronitis?
Prolonged vertigo -> Days
| No associated tinnitus/hearing loss
34
What can cause vestibular neuronitis?
Viral infection (possibly)
35
What are the symptoms of labyrinthitis?
Prolonged vertigo -> Days
| Possible tinnitus +/- Hearing loss
36
What can cause labyrinthitis?
Viral?
37
What is the typical management of vestibular neuronitis and labyrinthitis?
Supportive with vestibular sedatives
38
What is the pathophysiology of Meniere's DIsease>
Dilation of endolymphatic spaces of membranous labyrinth
39
What are the signs and symptoms of Meniere's Disease?
```
History of vertigo:
- Recurrent (>=2, >=20 minutes each)
- Spontaneous
- Rotational
Nausea and/or vomiting
Tinnitus in affected ear
Aural fullnes on affected side
Sensorineural hearing loss on >=1 occasion
```
40
How can Menieres be prevented?
Salt restriction
Betahistine
Reduce caffeine/alcohol/stress
41
What are some medical and surgical treatments of Meniere's Disease?
Grommet insertion/Meniette
Intratympanic:
- Gentamicin
- Steroids
42
25% of migraine sufferers also experience what?
Spontaneous vertigo
| Ataxia -> Loss of full control of body movements
43
What is the most common auditory symtpoms in migraine?
Phonophobia
44
What is a rare complication of migraine?
Fluctuating hearing loss and acute permanent HL
45
How can we define Definite Migrainous Vertigo?
Episodic vestibular symptoms:
| - Interfere with, do not impede, daily tasks
46
What must be present during a vertigo attacked for the patient to be diagnosed with having Definite Migrainous Vertigo?
At least one of the following in >=2 attacks:
- Migrainous symptoms
- Migraine specific precipitants of vertigo
- Response to anti-migrainous drugs
47
What must be present to suggest Probable Migrainous Vertigo?
At least one of:
- Migraine
- Photophobia
- Phonophobia
- Visual/Other aura
48
What is the Poiseulla equation?
A calculation of pressure loss
49
What is the Bernoulli principle/Venturi effect?
The speed of flow reduces if radius of the pipe decreases
50
What is air flow resistance directly proportional to?
1/r^4
51
What is stridor?
Harsh + high-pitches noise:
| - Due to turbulent airflow through obstructed airway
52
What is stertor?
Low pitched + sonorous sound from nasopharynx
53
What drugs can induce general anaesthesia for ventilation?
Anaesthetic gas -> Sevoflurane
IV:
- Propofol
- Remifentanyl
54
What pharmacotherapy can be used in airway obstruction?
Heliox (79% He and 21% O2)
Nebulised budesonide 2mg
Dexamethasone 0.15-0.6mg/kg
Nebulised adrenaline 1:10000 (5ml)
55
How is a nasal fracture managed?
Often no intervention
| MUA (GA/LA)
56
What are some complications of a nasal fracture?
Epistaxis -> Especially if anterior ethmoid #
CSF Leak -> ?Meningitis
Anosmia -> Cribiform plate fracture
57
How can epistaxis blood flow be arrested?
Pressure and ice
Topical vasoconstrictor +/- LA:
- Lignocaine + Adrenaline
- Co-phenylcaine
58
How can a nasal vessel be cauterised?
Silver nitrate
| Diathermy
59
When would a patient with epistaxis be admitted?
If packed
| Poor social history
60
When would we consider arterial ligation in epistaxis?
If anterior ethmoidal artery bleed
61
True or false; we should sedate admitted patients with epistaxis?
FALSE
62
When should we repair a CSF leak?
If not healed in 10 days
63
Where is a typical fracture site causing a CSF leak?
Cribiform plate
64
How do we treat a pinna haematoma?
Aspirate
Incision and drainage
Pressure dressing
65
What can cause a ear laceration?
Blunt trauma
Avulsion
Dog bite
Tissue loss
66
How do we treat an ear laceration?
```
Debridement
Closure:
- Primary intention
- Reconstruction
Usually LA
Antibiotics if cartilage involved
```
67
What is the battle sign seen in?
Temporal bone fracture
68
What are some examinations that should be done in a temporal bone fracture?
Battle sign
TM and EAM condition
CN VII
Hearing test
69
How can we classify temporal bone fractures?
Longitudinal vs Transverse
Otic capsule:
- Involved
- Spared
70
What is the most common temporal bone fracture?
Longitudinal (80%)
71
Where is the fracture line in a longitudinal temporal bone fracture?
Parallel to long axis of petrous pyramid
72
Where and why does bleeding occur in a longitudinal temporal bone fracture?
From EAM:
| - Due to skin and TM lacerations
73
What can cause a conductive hearing loss in longitudinal temporal bone fracture?
Haemotympanum
| Ossicular chain disruption
74
What % of longitudinal temporal bone fractures have facial palsy?
20%
75
Can a longitudinal temporal bone fracture result in CSF otorrhoea?
Yes
76
What is the mechanism of injury in a transverse temporal bone fracture?
Frontal blow
77
What is the fracture pattern in a transverse temporal bone fracture?
Fracture at right angle to long axis of petrous pyramid
78
What causes sensorineural hearing loss in a transverse temporal bone fracture?
If it crosses the IAM:
| - CN VII and VIII damage
79
What percentage of transverse temporal bone fractures have facial palsy?
50%
80
How is a temporal fracture managed?
```
Often delayed as it is usually part of a polytrauma
CN VII decompression
Manage CSF leak
Hearing restoration:
- Hearing aid
- Ossiculoplasty
```
81
What people are most at risk of neck trauma?
Young adult males
82
Which of the following is not part of a zone 1 injury to the neck:
- Trachea
- Oesophagus
- Thoracic duct
- Larynx
- Thyroid
- Vessels (Brachiocephalic, Subclavian, Common carotid, Thyrocervical trunk
- Spinal cord
Larynx
83
What structures form zone 2 injuries to the neck?
```
Larynx
Hypolarynx
CN X, XI + XII
Vessels:
- Carotids
- Internal jugular
Spinal cord
```
84
What structures form zone 3 injuries to the neck?
```
Pharynx
Cranial nerves X, XI + XII
Vessels:
- Carotids
- Internal jugular
- Vertebral
Spinal cord
```
85
What might be seen on a CXR in a patient with neck trauma?
Haemopneumothorax
| Emphysema
86
What can a CT angiogram show in neck trauma?
Vascular injuries
Pseudoaneurysm
Laryngeal injury
Aerodigestive tract injuries
87
In what situations would emergency exploration be indicated in neck trauma?
Expanding haematoma
Hypovolaemic shock
Airway obstruction
Blood in aerodigestive tract
88
Where does a maxillary fracture bridge between?
Cranial base and dental occlusion plane
89
What causes a maxillary fracture?
High energy blunt force
90
What is the second most common midfacial fracture?
Orbital floor fracture
91
Where do orbital floor fractures tend to occur and why?
Posteromedial region:
| - Thinnest part
92
What causes an orbital floor fractures?
Impact injury to globe:
- Large enough not to penetrate globe itself
- Small enough not to fracture orbital rim
93
Where is the weak point in the orbit?
Infraorbital groove
94
How can the infraorbital groove be fractured?
1. High velocity impact to globe and upper eyelid
2. Kinetic energy to periocular structures
3. Pressure exerted inferomedially
95
What are some signs and symtpoms of an orbital floor fracture?
```
Reduced visual acuity
Diplopia
Periorbital ecchymosis
Oedema
Enophthalmus
Reduced ovular movement
Bony step on orbital ring
```
96
What will be seen on a CT of the paranasal sinuses in orbital floor fracture?
'Tear drop' sign
97
What does a blow out orbital floor fracture involve?
Medial wall and floor of orbit
98
When is a surgical repair attempted in an orbital fracture?
Entrapment
Large defect
Significant enophthalmus
99
What is the path of a Le Fort I (Horizontal) fracture?
Passes horizontally above teeth apices
100
What is the path of a Le Fort II (Pyramidal) fracture?
```
Nasal bridge
Through frontal maxillary processes
Through:
- Lacrimal bone
- Inferior orbital floor
Under sygoma
Across pterygomaxillary fissure
Through pterygoid plates
```
101
What is the other name for a Le Fort III fracture?
Transverse
102
What imaging is important in a Le Fort fracture?
Xray:
- C-spine
- Waters view (Occipitomental view -> Maxillary sinuses)
