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Physiology Flashcards

1
Q

Histology: External Ear - Lined by what?

A

Stratified squamous epithelium

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2
Q

Histology: External Ear - Dermis contains what? (3)

A

Hair follicles
Sebaceous glands
Ceruminous glands

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3
Q

Histology: Middle Ear - Cellular structure

A

Columnar epithelium lined mucosa with a dense fibrous layer

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4
Q

Histology: Inner Ear - Contains what two structures? (2)

A

Cochlea
Vestibular apparatus

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5
Q

Histology: Nose - Nasal Vestibule cells

A

Squamous epithelium

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6
Q

Histology: Nose - Nose and Sinuses

A

Respiratory epithelium (Pseudostratified Ciliated Columnar epithelium) with sero-mucinous glands

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7
Q

Histology: Salivary Gland - Two main components

A

Acinar component
Ductal component

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8
Q

Histology: Salivary Gland - Serous cells appearance

A

Dark staining with digestive enzymes inside

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9
Q

Histology: Salivary Gland - Mucinous component appearance

A

Clear grey staining containing glycoprotein

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10
Q

Histology: Salivary Gland - Ducts are lined by what?

A

Columnar or cuboidal epithelium

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11
Q

Histology: Salivary Gland - Myoepithelial cell appearance

A

Flat or cuboidal cells with clear cytoplasm

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12
Q

Pathology of the Ear: Bacterial causes of Otitis Media (3)

A

Streptococcus pneumonia
Haemophilus influenzae
Moxarella catarrhalis

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13
Q

Pathology of the Ear: Chronic Otitis Media bacterial causes (2)

A

Pseudomonas aeruginosa
Staphylococcus aureus

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14
Q

Pathology of the Ear: Otitis media has a risk of spreading to what?

A

Mastoid

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15
Q

Pathology of the Ear: Cholesteatoma

A

Abnormal collection of skin cells within the ear

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16
Q

Pathology of the Ear: Cholesteatoma - Pathogenesis for acquired causes

A

Chronic otitis media and perforated tympanic membrane

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17
Q

Pathology of the Ear: Cholesteatoma - Pathogenesis for congenital causes

A

Proliferation of the embryonic crest

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18
Q

Pathology of the Ear: Cholesteatoma - Macro appearance

A

Pearly white mass in the middle ear

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19
Q

Pathology of the Ear: Cholesteatoma - Micro appearance

A

Squamous epithelium with abundant keratin production and inflammation

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20
Q

Pathology of the Ear: Cholesteatoma - Locations (3)

A

Superior posterior middle ear
Petrous apex
Anterior superior ear

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21
Q

Pathology of the Ear: Cholesteatoma - More common in what sex?

A

Males

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22
Q

Pathology of the Ear: Vestibular Schwannoma - Pathophysiology

A

Pathology of the vestibular portion of CN VIII

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23
Q

Pathology of the Ear: Vestibular Schwannoma - Occurs where?

A

Within the temporal bone

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24
Q

Pathology of the Ear: Vestibular Schwannoma - May be associated with what?

A

Extensive exposure to excessive loud noise

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25
Pathology of the Ear: Vestibular Schwannoma - If the case is bilateral and present in the young what must be considered?
Neurofibromatosis 2
26
Pathology of the Ear: Vestibular Schwannoma - Gross appearance
Circumscribed tan/white/yellow mass
27
Pathology of the Nose: Nasal Polyps - If present in young patients what should be considered?
Cystic Fibrosis
28
Pathology of the Nose: Nasal Polyps - Pathophysiology
Micro-allergic associations with eosinophils
29
Pathology of the Nose: Nasal Polyps - Aetiologies (5)
Allergy Infection Asthma Aspirin sensitivity Nickel exposure
30
Pathology of the Nose: GPA abbreviation
Granulomatosis with Polyangiitis
31
Pathology of the Nose: GPA - Pathophysiology
Autoimmune disorder characterised by small vessel vasculitis and necrosis limited to the Respiratory Tract and Kidneys
32
Pathology of the Nose: GPA - Age of presentation
>40 years old
33
Pathology of the Nose: GPA - Presentation (3)
Respiratory Symptoms Renal Disease Nasal symptoms of congestion or septal perforation
34
Pathology of the Nose: GPA - Antibodies (3)
ANCA PR30-ANCA MPO-ANCA
35
Pathology of the Nose: GPA - MPO-ANCA denotes what?
Microscopic polyangiitis and Churg Straus
36
Pathology of the Nose: Sinonasal Papilloma - 3 types
Inverted Exophytic Oncocytic
37
Pathology of the Nose: Sinonasal Papilloma - Age of onset
>50 years old
38
Pathology of the Nose: Sinonasal Papilloma - More common in what sex?
Males
39
Pathology of the Nose: Sinonasal Papilloma - Aetiologies (2)
HPV Organic solvents
40
Pathology of the Nose: Sinonasal Papilloma - Clinical Presentation
Blocked nose
41
Pathology of the Nose: Sinonasal Papilloma - Exophytic presents where?
Nasal Septum
42
Pathology of the Nose: Sinonasal Papilloma - Inverted type presents where?
Lateral walls and paranasal sinuses
43
Pathology of the Nose: Sinonasal Papilloma - Oncocytic type presents where?
Lateral walls and paranasal sinuses
44
Pathology of the Nose: Nasopharyngeal Carcinoma - Highest incidence where?
Far East African Countries
45
Pathology of the Nose: Nasopharyngeal Carcinoma - More common in what sex?
Males
46
Pathology of the Nose: Nasopharyngeal Carcinoma - Strong association with what risk factors?
EBV Volatile nitrosamines in food
47
Pathology of the Nose: Nasopharyngeal Carcinoma - Three types
Keratinising Non-keratinising Baseloid
48
Pathology of the Nose: Nasopharyngeal Carcinoma - Prognosis
Extensive local spread with early nodal metastasis
49
EBV is associated with what cancers? (3)
Burkitt's Lymphoma B Cell Lymphoma Hodgkins Lymphoma
50
EBV: LMP-1 acts as what?
Oncogene
51
EBV: EBNA-2 promotes what?
Transition from G0 to G1
52
Pathology of the Throat: Laryngeal Polyps - Pathophysiology
Reactive changes in the laryngeal mucosa secondary to vocal abuse, infection or smoking
53
Pathology of the Throat: Laryngeal Polyps - Nodule location
Bilateral on the middle to posterior third of the vocal cord
54
Pathology of the Throat: Laryngeal Polyps - Most common patient group
Young women
55
Pathology of the Throat: Laryngeal Polyps - Common pathology of polyps
Unilateral pedunculated polyps
56
Pathology of the Throat: Contact Ulcer - Benign response to what?
Injury at the posterior vocal cord
57
Pathology of the Throat: Contact Ulcer - Clinical Presentation (3)
Chronic throat clearing Voice abuse GORD
58
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Recurrent respiratory papilloma two peaks
<5 years old 20-40 years old
59
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Risk factors
HPV-6 and -11
60
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Three types of Macro type
Exophytic Sessile Pedunculated
61
Pathology of the Throat: Squamous Cell Papilloma or Papillomatosis - Presentation of micro type
Finger-like projections with fibrovascular core covered by stratified squamous epithelium
62
Pathology of the Throat: Paraganglioma - Pathophysiology
Tumours in clusters of neuroendocrine cells throughout the body
63
Pathology of the Throat: Paraganglioma - May secrete what?
Catecholeamines
64
Pathology of the Throat: Paraganglioma - Relates to what structures? (5)
Great vessels of the head and neck around the oral cavity Nose Nasopharynx Larynx Orbit
65
Pathology of the Throat: Paraganglioma - Most common age
>50 years old
66
Pathology of the Throat: Paraganglioma - Associated with what disease?
MEN 2
67
Pathology of the Throat: Squamous Cell Carcinoma - Mainly located where?
Oropharynx
68
Pathology of the Throat: Squamous Cell Carcinoma - Risk factors (3)
Smoking Alcohol HPV
69
Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for well-differentiated cases
Epithelial cells with keratinisation and prickle cells
70
Pathology of the Throat: Squamous Cell Carcinoma - Micro appearance for poor differentiated cases
Lack of keratinisation and prickle cells
71
Pathology of the Throat: Squamous Cell Carcinoma - Linked to what type of HPV?
HPV-16
72
Pathology of the Throat: Squamous Cell Carcinoma - Cellular immortality due to what?
Increased expression of E6 and E7 disrupt the p53 and Rb pathways
73
Pathology of the Salivary Glands: Sialothiasis
Stones
74
Pathology of the Salivary Glands: Pleomorphic Adenoma - Risk of what?
Malignant transformation to a carcinoma
75
Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what sex?
Females
76
Pathology of the Salivary Glands: Pleomorphic Adenoma - More common in what age?
30-60 years old
77
Pathology of the Salivary Glands: Pleomorphic Adenoma - Macro histological appearance
Well-circumscribed light tan to grey mass
78
Pathology of the Salivary Glands: Pleomorphic Adenoma - Micro histological appearance
Variable epithelial and myoepithelial cells in the chondromyxoid stroma
79
Pathology of the Salivary Glands: Warthin's Tumour - More common in what sex?
Males
80
Pathology of the Salivary Glands: Warthin's Tumour - Most common age
>50 years old
81
Pathology of the Salivary Glands: Warthin's Tumour - Macro histological appearance
Well-circumscribed light grey cystic mass
82
Pathology of the Salivary Glands: Warthin's Tumour - Micro histological appearance
Bilayered oncocytic epithelium with lymphoid stroma
83
Pathology of the Salivary Glands: Most common malignant tumour in the world
Mucoepidermoid Carcinoma
84
Pathology of the Salivary Glands: Most common malignant tumour in the UK
Adenoid Cystic Carcinoma
85
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Location
Mainly the parotid gland
86
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Genetic associations
MECT1-MAML2 Fusion
87
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Macro histological appearance
Well-circumscribed or infiltrative mass
88
Pathology of the Salivary Glands: Mucoepidermoid Carcinoma - Micro histological appearance
Mix of squamous, mucous and intermediate cells with solid and cystic components
89
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Common age
>40 years old
90
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Location in salivary gland and most common location
Parotid Most common - Palate
91
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Complications
Perineural invasion causing pain and loss of function
92
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Macro Histological Appearance
Grey or white infiltrative mass
93
Pathology of the Salivary Glands: Adenoid Cystic Carcinoma - Micro Histological Appearance
Small uniform cells with little cytoplasm in solid, tubular or cribiform patterns
94
Facial Plastic Surgery: Otoplasty
Pinning back of the ears
95
Facial Plastic Surgery: Otoplasty - Assessment Protocol (3)
1cm from the most superior point of the pinna to the mastoid 2cm from the top of the trague (Frankfort) posterior part of the pinna to the mastoid 30 degrees to the mastoid and helix
96
Facial Plastic Surgery: Otoplasty - 3 common problems of the ears
Under-developed anti-helical fold Prominent concha Protruding lobe
97
Facial Plastic Surgery: Otoplasty - Mustarde Suturing or Anterior Scoring Method
Open the back of the ear uo and mattress sutures to reform the anti-helical fold
98
Facial Plastic Surgery: Ageing - What happens to the skin melanocytes with age?
Melanocytes decrease
99
Facial Plastic Surgery: Ageing - Impact on the dermo-epidermal junction
Flattens by 1/3
100
Facial Plastic Surgery: Ageing - Impact on collagen
Decreased
101
Facial Plastic Surgery: Ageing - Impact on elastin
Decreased turnover
102
Facial Plastic Surgery: Ageing - Impact on subcutaneous fat
Decreased
103
Facial Plastic Surgery: Ageing - Changes in fat distribution with age
Decreased - Face, Hands, Feet Increased - Thighs, Waist and Abdomen
104
Facial Plastic Surgery: Belphroplasty
Removal of excess skin from the eyelids
105
Facial Plastic Surgery: Ageing Eyelids - Why do people develop deepening creases in the lower lids?
Accumulation of loose skin
106
Facial Plastic Surgery: Ageing Eyelids - Why does bagginess appear?
Slackening of the muscle beneath the skin allows the fat to cushion the eyes in their sockets to protrude forward
107
Facial Plastic Surgery: Blephroplasty - Process
Incision into the creases of the upper lids and just below the lashes to remove extra fat, excess skin and sagging muscles
108
Facial Plastic Surgery: Reconstruction - Primary closure healing
Wound edges are approximated by sutures, staples or glue
109
Facial Plastic Surgery: Reconstruction - Skin Grafts
Transplantation of the skin covers a large surface area
110
Facial Plastic Surgery: Reconstruction - Skin Grafts Two Types
Donor section - thin layer of skin from a healthy part of the body Full thickness skin graft - pinching and cutting skin away from the donor section
111
Facial Plastic Surgery: Reconstruction - Skin Flaps
Healthy skin and tissue that is partly detached and move to a nearby wound
112
Airway Obstruction: Neonatal Respiratory System - Obligate ... breather
Nasal
113
Airway Obstruction: Neonatal Respiratory System - Nares are ...
Small
114
Airway Obstruction: Neonatal Respiratory System - Difference with larynx
Small and soft
115
Airway Obstruction: Neonatal Respiratory System - Difference in tongue
Large tongue
116
Airway Obstruction: Neonatal Respiratory System - Sub-glottis
Narrow - 3.5mm at the cricoid
117
Bernoulli Principel OR Venturi Effect
Pressure on the internal wall of the airways occurs due to flow of air
118
Stridor
High pitched harsh noise due to turbulent airflow resulting from airway obstructions
119
Stertor
Low pitched sonourous sound arising from the nasopharyngeal airway
120
Adenotonsillar Hypertrophy: Clinical sign
Breathes with mouth open due to nose blockage
121
Acute Epiglottitis: Mainly due to what?
Haemophilus Influenza Type B
122
Acute Epiglottitis: Management
Intubated with resuscitation to secure the airway (24-48 hours) until the inflammation is reduced
123
Respiratory Papillomatosis: Associated with what?
HPV
124
Subglottic Stenosis: Management
Division of the stenosis with laser and balloon OR laryngotracheal resection and reconstruction
125
Subglottic Stenosis: Associated with what condition?
Vasculitis
126
Subglottic Stenosis: Clinical Presentation
Progressive SOB that is exacerbated by exertion
127
Burns: How to secure the airway?
Endotracheal intubation or tracheostomy
128
Airway Endoscopy: General Anaesthetic
Anaesthetic Sevoflurane Gas OR IV Propofol or Remifentanyl
129
Airway Endoscopy: Pharmacotherapy Anaesthesia (4)
Heliox - 79% Helium + 21% Oxygen Nebulised Budesonide - 2mg Dexamethasone - 0.15-0.6 mg/kg Nebulised Adrenaline
130
Hearing: Sound Definition
Pressure wave caused by oscillating molecules that are set in motion by vibration
131
Hearing: Humans can perceive what frequencies?
20-20,000 Hz
132
The Ear: Tympanic Membrane:Oval Window Ratio
18:1
133
What is the functional unit of the ear?
Hair cells
134
The Organ of Corti: Depolarisation of the Organ of Corti has what following pathway?
Stimulates the CN VIII to the Superior Temporal Gyrus Pathways
135
Oval and Round Windows: High frequency hair cells located where?
At the base
136
Oval and Round Windows: Low frequency hair cells located where?
At the apex of the curve
137
Eustachian Tube: Cartilaginous tube opened when?
By the tensor veli palatini and levator palatine muscles to allow air into the middle ear to return to atmospheric pressure
138
Eustachian Tube: Dysfunction leads to what?
Negative middle ear pressure - progresses to fluid or effusion within the ear
139
Hearing: Neural Pathway (4 pathways)
1. CN VIII 2. Cochlear nucleus 3. Up the brainstem 4. Into the cerebrum - primary auditory complex in the Posterior Superior Temporal Gyrus and Brodman Areas
140
Hearing: When can the foetus hear?
18 weeks
141
Hearing: When will the foetus respond to sound or voice?
26 weeks
142
Balance: Central Pathways - Inputs (4)
Visual Proprioceptive Cardiovascular System Vestibular System
143
Balance: Central Pathways - Output (2)
Vestibulospinal Tract Vestibulo-ocular Reflex
144
Balance: The Inner Ear - Locations of the Superior Vestibulocochlear Nerve (3)
Lateral Semicircular Canal Anterior Superior Semicircular Canal Utricle
145
Balance: The Inner Ear - Locations of the Inferior Vestibulocochlear Nerve (2)
Posterior Semicircular Canal Saccule
146
Balance: The Inner Ear - Longest hair cell
Kinocilium
147
Balance: The Inner Ear - The name for hair cells that are not the Kinocilium
Sterocilia
148
Balance: The Inner Ear - Deflection towards the hair cells has what impact on action potential?
Increased potential firing rate
149
Balance: The Inner Ear - Deflection away from the hair cells has what impact on action potential?
Decreased potential firing rate
150
Balance: The Inner Ear - Two Otolith Organs
Utricle Saccule
151
Balance: The Inner Ear - What overlies the hair cells?
Calcium carbonate crystals within a gel membrane
152
Balance: Semi-Circular Canals - What are the three pairs?
Left and Right Horizontals Left Posterior and Right Anterior Left Anterior and Right Posterior
153
Balance: Vestibulo-Ocular Reflex - Stereocilia Deflection is due to what?
Movement of perilymph
154
Balance: Vestibulo-Ocular Reflex - Balance is due to the relative process of what?
Relative pushing of the christa caused by the immobility of the perilymph
155
Balance: Vestibulo-Ocular Reflex - Input
Vestibular input
156
Balance: Vestibulo-Ocular Reflex - Output
Vestibulo-ocular output
157
Balance: Vestibulo-Ocular Reflex - Inhibits which side?
Opposite side to movement
158
Balance: Central Pathways - Vestibulospinal Tract Function
Motor output to the neck, back and leg muscles to ensure posture is maintained
159
Balance: Central Pathways - Medial Longitudinal Fasciculus and Ocular Muscles Function
Motor output to the eyes gaze stabilisation
160
Balance: Central Pathways - Medial Lemniscus and Thalamus function
Cerebrum awareness
161
Taste: Taste Bud - Components
Sensory receptor cells Support cells
162
Taste: Taste Bud - Cell life span
10 days
163
Taste: Taste Bud - Replenished by what?
Basal cells within the Taste Buds
164
Taste: Taste Bud - Taste receptor cells synapse with what?
Afferent nerve fibres
165
Taste: Taste Bud - Present mainly where? (4)
Tongue Palate Epiglottis Pharynx
166
Where do most taste buds sit in the tongue?
Papillae
167
Taste: Papillae - 4 types
Filliform Fungiform Vallate Folliate
168
Taste: Papillae - Which type of papillae does not contain taste buds?
Filliform
169
Taste: Pathway - Binding of tastants to receptor cells has what impact?
Induces a depolarising receptor potential that initiates action potentials in afferent nerve fibres to synapse with receptor cells
170
Taste: Pathway - Signals from receptor cells are conveyed to where?
Brainstem and Thalamus to eventually reach the Cortical Gustatory Areas
171
Taste: Pathway - Afferent Taste Fibres reach the brainstem via what three Cranial Nerves?
CN VII - Chorda Tympani Branch of the Facial Nerve CN IX - Glossopharyngeal Nerve CN X - Vagus Nerve
172
Ageusia
Loss of taste function
173
Hypogeusia
Reduced taste function
174
Dysgeusia
Distorted taste function
175
Olfaction: Neural Systems - 4 systems
CN I CN V Vomernasal CN 0
176
Olfaction: Neural Systems - Main Olfactory System nerve and function
CN I - mediates common odours
177
Olfaction: Neural Systems - Trigeminal Somatosensory System nerve and function
CN V - chemical and non-chemical sensor with a protective effect of sniffing something harmful
178
Olfaction: Neural Systems - Accessory Olfactory System Nerve
Vomernasal
179
Olfaction: Neural Systems - CN 0
Nervus Terminalis
180
Olfaction: Smell - Olfactory neuroepithelium is located where?
Small region of the nasal mucosa
181
Olfaction: Smell - Olfactory Cleft consists of what?
Cribiform plate and small parts of the superior and middle turbinate of the septum
182
Olfaction: Smell - Olfactory Cleft located where?
7cm into the nasal cavity from the nostril
183
Olfaction: Smell - How is flavour produced from swallowed food?
Retrograde airflow from the nasopharynx during swallowing
184
Olfaction: Pathway - Physiology during quiet breathing
Odorants reach smell receptors via diffusion as the olfactory neuroepithelium is located above the normal path of airflow
185
Olfaction: Pathway - Sniffing Process
Drawing air currents upwards within the nasal cavity with force
186
Olfaction: Pathway - Before neural conduction can occur from the olfactory cleft the brain odourant must do what? (3)
Enter the nose during active or passive processes Passes to the olfactory cleft Odourant must move from the air phase to the aqueous phase
187
Olfaction: Pathway - Role of mucous
Aids the dispersion of odourants to the olfactory receptors and from the mucous to receptors via diffusion or specialised proteins
188
Olfaction: Pathway - Olfactory neuroepithelium histology
Pseudostratified Columnar Epithelium
189
Olfaction: Pathway - Function of Bi-polar Sensory Neurones
Extends odourant receptor-containing cilia into the mucous
190
Olfaction: Pathway - Supporting Cell function
Insulates and protects olfactory neuroepithelium
191
Olfaction: Pathway - Duct Cell of Bowmans Glands function
Secretes mucous
192
Olfaction: Olfactory Receptors - Life span
2 months
193
Olfaction: Olfactory Receptors - Axons of the olfactory receptors go where?
Afferent fibres of the olfactory nerve
194
Olfaction: Olfactory Receptors - Chemical signals converted to what?
Neural Signals - Glutamate and Dopamine
195
Anosmia
Inability to smell
196
Hyposmia
Reduced ability to smell
197
Dysosmia
Altered sense of smell
198
Phantosmia
Olfactory hallucination - smell perceived in the absence of stimulation
199
Olfaction: Conductive Smell Abnormalities Aetiologies (3)
Nasal polyps Rhinitis Nasal masses
200
Olfaction: Sensorineural Smell Abnormalities Aetiologies (5)
Viral Head Trauma Neurological Conditions - Parkinsons or Alzheimers Brain tumours Medication
201
Signs of Ear Disease: How to know if it is upper motor damage inducing facial weakness?
Forehead will still move
202
Signs of Ear Disease: How to know if it is lower motor damage inducing facial weakness?
Whole face moves
203
Dizziness
Non-specific term covering vertigo, pre-syncope and disequilbrium
204
Vertigo
Sensation of movement - normally movement
205
Dizziness: Aetiologies within the Visual System? (2)
Cataracts Diabetes Mellitus
206
Dizziness: Aetiologies within Proprioceptive System (3)
Diabetes Mellitus Arthritis Neurology
207
Dizziness: Aetiologies within Central Pathways (3)
Stress Migraine Multiple Sclerosis
208
Dizziness: Aetiologies within Cardiovascular Pathways (2)
Arrhythrmias Postural Hypotension
209
Dizziness: Aetiologies within Vestibular System (3)
BPPV Menieres Vestibular Neuronitis
210
Benign Positional Paroxysmal Vertigo: Most common cause of what?
Vertigo on looking upwards
211
Benign Positional Paroxysmal Vertigo: Aetiologies (2)
Head trauma Ear Surgery
212
Benign Positional Paroxysmal Vertigo: Pathophysiology
Otoconia from the utricle is displaced within the semicircular canals
213
Benign Positional Paroxysmal Vertigo: Most commonly in what canal
Posterior Semicircular Canal
214
Benign Positional Paroxysmal Vertigo: Clinical Presentation
Vertigo on: - Looking up - Turning in bed - First lying down - First getting out of bed - Bending forward - Rising from bending - Moving the head quickly
215
Benign Positional Paroxysmal Vertigo: Diagnostic Test
Dix Hallpike Test - patient is sat on the bed and moves into lying down with the head turned 45 degrees to the impacted side
216
Benign Positional Paroxysmal Vertigo: Dix Hallpike Test Positive Result
Torsional and Upbeating Nystagmus
217
Benign Positional Paroxysmal Vertigo: Management - Options (3)
Epley Manoeuvre Semont Manoeuvre Brandt-Daroff Exercise
218
Benign Positional Paroxysmal Vertigo: Management - Epley Manoeuvre
Sat on the bed with the head turned to 45 degrees to the affected side and quickly lie back Wait 30 seconds Turn your head 90 degrees to the other side Wait 30 seconds Turn your head another 90 degrees to the normal side Wait 30 seconds Sit up on opposite side to impacted side
219
Benign Positional Paroxysmal Vertigo: Management - Brandt Daroff Exercise Mechanism
Repositions the otoconia
220
Vestibular Neuronitis
Inflammation of the vestibular nerve
221
Labyrinthitis
Inflammation of the labyrinth
222
Vestibular Neuronitis or Labyrinthitis: Viral causes
Viral is most likely
223
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - First severe attack
Lasts hours with nausea and vomiting
224
Vestibular Neuronitis or Labyrinthitis: Clinical Presentation (4)
Prolonged vertigo - for days Malaise Headache Nausea and Vomiting
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Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Labyrinthitis is associated with what? (2)
Tinnitus Hearing loss
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Vestibular Neuronitis or Labyrinthitis: Clinical Presentation - Management
Supportive management with vestibular sedatives
227
Menieres Disease
Idiopathic disorder causing vertigo
228
Menieres Disease: Pathophysiology
Excess endolymph within the membranous labyrinth
229
Menieres Disease: Symptoms present why?
Increase endolymphatic pressure due to dysfunctional sodium channels
230
Menieres Disease: Clinical Presentation - Triad
Severe Paroxysmal Vertigo Sensorineural hearing loss Tinnitus
231
Menieres Disease: Clinical Presentation - Vertigo
Recurrent spontaneous rotational vertigo with at least 2 episodes lasting >20 minutes
232
Menieres Disease: Clinical Presentation - Ear symptoms (2)
Change in hearing or tinnitus around the time of dizzy spell Sensation of ear being full
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Menieres Disease: Lifestyle Advice
Reduce salt Avoid chocolate and caffeine Avoid stress
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Dizziness: Timing - Most likely if Seconds
BPPV
235
Dizziness: Timing - Most likely if Hours
Menieres
236
Dizziness: Timing - Most likely if Days
Vestibular Neuronitis
237
Dizziness: Timing - Most likely if variable timing
Migraine-associated Vertigo
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Dizziness: Most likely if associated with rolling over in bed
BPPV
239
Dizziness: Most likely if associated with Nausea and Vomiting
Vestibular Neuritis
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Dizziness: Most likely if associated with light sensitivity during dizzy spells
Vestibular migraine
241
Dizziness: Most likely if ear feels full or changes in hearing present
Menieres Disease
242
Hearing Aid
Sound amplifier
243
Hearing Aids: Mechanism of action
Passes from the microphone through an electronic processer to amplify the sound and pass them to the receiver
244
Hearing Aids: Types of fitting (3)
Behind the ear In the ear In the canal
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Hearing Aids: 4 parts of the hearing aid
Body Elbow Tubing Ear mould
246
Hearing Aids: Open Fitting Hearing Aid - Benefit
Do not occlude the ear canal completely to allow natural sound
247
Hearing Aids: Indication
Patients with any auditory difficulty with demonstrable hearing loss
248
Hearing Aids: Open Fitting Hearing Aid - Concern with cochlear or retro-cochlear hearing loss
Sound can become distorted
249
Hearing Aids: Telecoil - Function
Telecoil induction loop systems have telephone receivers that are fitted in public locations
250
Hearing Aids: Telecoil - Mechanism of Action
Sound causes distortion in a magnetic field that is picked up by the hearing aid and converted back into sound
251
Hearing Aids: Telecoil - Problem
Hearing aid microphone is switched off so cannot hear anything else
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Hearing Aids: Problems (3)
No or Insufficient Sound Excessive amplification of sound Pain or discomfort
253
Hearing Aids: Causes of pain or discomfort (3)
Ear mould poorly inserted or fitted Allergy to the ear mould material Otitis externa secondary to occlusion of the ear canal
254
Hearing Aids: Problems - Feedback definition
Whistling noise caused by amplified sound being picked up by the microphone
255
Hearing Aids: Problems - Feedback may be caused by what? (4)
Wax in the external acoustic meatus Earmould not inserted correctly Misfitting earmould Leakage of sound through a hole in the tubing or elbow
256
Hearing Aids: Problems - Why may patients be unable to wear conventional hearing aids?
Recurrent discharge Absence of stenosis of the ear canal
257
Hearing Aids: Problems - What can be used for patients that cannot use conventional hearing aids?
Bone anchored hearing aids
258
Hearing Aids: Bone Anchored Hearing Aids - How are they fitted?
Pure titanium screw is placed in the skull and a metal abutment screws into this and passes through the skin - the hearing aid is attached to the abutment to give amplification without occluding the ear canal or requiring air conduction to the cochlea
259
Hearing Aids: Vibrant Soundbridge - Mechanism
Works by direct stimulation of the ossicles and round window - converts sound into electrical signals which are transmitted around the skin to the implant via induction
260
Hearing Aids: Vibrant Soundbridge - Indications (2)
Unable to wear conventional hearing airs Do not wish to wear a device in their ear
261
Hearing Aids: Vibrant Soundbridge - Disadvantages (2)
Risk of middle ear and mastoid surgery Risks of anaesthesia
262
Hearing Aids: Cochlear Implants - Mechanism of action
Electrical stimulation of neural structures in the cochlea and is transmitted to the brain where it is perceived as sound
263
Hearing Aids: Cochlear Implants - Indicated when?
Severe to profound sensorineural hearing loss when conventional hearing aids do not benefit the patient
264
Ear Drops: Applications
Anti-inflammatory Antibiotics Wax solvents
265
Bacterial Infection: Most common pathogenic bacteria in Otitis externa (3)
Pseudomonas aeruginosa Proteus species Staphylococcus aureus
266
Ear Drops: Options for bacterial infections (4)
Neomycin Gentamicin Polymyxin B Framycetin - used in Otitis Externa with a steroid
267
Common fungal causes of Otitis Media (2)
Aspergillus niger Candida albicans
268
Ear Drops: Options for fungal Otitis Externa (2)
Clotrimazole Nystatin
269
Ear Drops: Wax Solvents - Options (3)
Sodium Bicarbonate Olive Oil Almond Oil
270
Ear Drops: Application method
Turn the recipients ear upwards Straighten the ear canal by pulling the pinna upwards and backwards in an adult or directly upwards in a child Instil the drops Press the tragus repeatedly over the introitus of. theear canal to encourage passage down the canal
271
Ear Drops: Disadvantage of Gentamicin
Ototoxic
272
Ear Drops: Side Effects (2)
Dizziness Ototoxic
273
Ear Drops: Side Effects - When may dizziness occur?
When the temperature of the drops is not close to the ear - Lateral Semi-circular canal is stimulated by temperature difference in the Caloric Effect
274
Ear Drops: Side Effects - What increases the risk of Ototoxicity?
Use of aminoglycoside
275
Pure Tone Audiometry
Painless non-invasive hearing test that measures a persons ability to process different sounds, pitches or frequencies
276
Pure Tone Audiometry: Aim
Find the hearing threshold - the quietest sound that an individual can hear across a range of different frequencies
277
Pure Tone Audiometry: Pure Tone
Single specific frequency determined by frequency, amplitude, phase and duration
278
Pure Tone Audiometry: When are Warble Tones used?
In patients with Tinnitus or children <5 years old
279
Pure Tone Audiometry: Audiometers - Calibrated to what?
Measure air conduction thresholds between 125-8000 Hz and bone conduction thresholds between 250-6000 Hz Measure air conduction thresholds of 120dB and bone conduction of 70dB maximum
280
Pure Tone Audiometry: Audiometers - What happens if set to 70dB for conduction?
Produce distortions
281
Pure Tone Audiometry: Audiometers - 3 main transducers that are used to present tones (3)
Headphones Insert headphones Bone conductor
282
Pure Tone Audiometry: Audiometers - Air conduction thresholds assessed by what? (2)
Headphones or Insert Earphones Assess the entire auditory pathway
283
Pure Tone Audiometry: Audiometers - Bone conduction thresholds assessed by what?
Bone conductor
284
Pure Tone Audiometry: Masking - Function
Ensures a true threshold of the worse ear is gained by preventing the working ear from picking up any tone
285
Pure Tone Audiometry: Masking - 3 rules
1 - Masking is required at any frequency where the difference between the left and right not masked AC thresholds is >40 dB when using headphones or 55 dB when using insert earphones 2 - Masking is required at any frequency where the not masked BC threshold is better than the AC threshold of either ear by >10 dB - the worse ear would be the test ear and better ear would be the non-test ear and BC cannot be below the AC threshold 3 - Masking will be required where rule 1 hasn't been applied but where BC threshold of one ear is more acute by 40 dB or 55 dB than not masked AC threshold attributed to the other ear
286
Pure Tone Audiometry: Masking - Consequences of not masking (5)
Inaccurate measure of threshold Incorrect diagnosis May lead to inappropriate treatment options Difficulty in later interpretation of test results
287
Pure Tone Audiometry: Audiogram - Symbol for right ear
Circle
288
Pure Tone Audiometry: Audiogram - Symbol for left ear
Cross
289
Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the right ear
Triangle
290
Pure Tone Audiometry: Audiogram - Symbol for Masked air conduction in the left ear
Square
291
Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the right ear
<
292
Pure Tone Audiometry: Audiogram - Symbol for unmasked bone conduction in the left ear
>
293
Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the right ear
[
294
Pure Tone Audiometry: Audiogram - Symbol for Masked bone conduction in the left ear
]
295
Pure Tone Audiometry: Audiogram - Symbol for no response
Arrow down
296
Pure Tone Audiometry: Audiogram - Normal hearing in dB
20 to -10 dB
297
Pure Tone Audiometry: Audiogram - Pitch relationship with Frequency
Low pitch has a lower Hz frequency High pitch has a higher Hz frequency
298
Pure Tone Audiometry: Audiogram - Loudness relationship with dB
Loud has higher dB
299
Pure Tone Audiometry: Audiogram - Mild Hearing Loss Threshold
20-40 dB
300
Pure Tone Audiometry: Audiogram - Moderate Hearing Loss Threshold
41-70 dB
301
Pure Tone Audiometry: Audiogram - Severe Hearing Loss Threshold
71-95 dB
302
Pure Tone Audiometry: Audiogram - Profound hearing loss Threshold
>95 dB
303
Pure Tone Audiometry: Audiogram - For sensorineural hearing loss
No significant air-bone gap on audiogram - trend decreases with increased frequency
304
Pure Tone Audiometry: Audiogram - For conductive hearing loss
Significant air-bone gap - the bone conduction is within normal limits
305
Pure Tone Audiometry: Audiogram - For Mixed Hearing Loss
Parts of significant air-bone gap and others that bone conduction suggest a sensorineural hearing loss
306
Sensorineural Hearing Loss: Pathophysiology
Damage to the hair cells within the cochlear or hearing nerve, or both
307
Presbycusis
Age-related hearing loss
308
Sensorineural Hearing Loss: Aetiologies (5)
Regular and prolonged exposure to loud sounds Ototoxic drugs Rubella - and other infections Complications at birth Benign tumours on the auditory nerve
309
Conductive Hearing Loss: Pathophysiology
Sound not being able to pass freely into the inner ear usually due to an abnormality in the outer and middle ear
310
Conductive Hearing Loss: Aetiologies (3)
Ear infections Middle ear fluid - Glue ear Perforated ear drums
311
Mixed Hearing Loss: Pathophysiology
Combination due. todamage in both the outer or middle ear and the inner ear
312
Mixed Hearing Loss: What disease may cause mixed hearing loss?
Otosclerosis
313
Mixed Hearing Loss: Characteristic feature of Otosclerosis
Carharts Notch at 2 kHz
314
Tympanometry: Objective test of what?
Middle ear function - tests the condition of the middle ear, mobility of the ear drum and conduction of the ossicular chain
315
Tympanometry: Enables a distinction between what?
Sensorineural and conductive hearing loss
316
Tympanometry: Important in the diagnosis of what?
Otitis media

Otolaryngology (4 decks)

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