501. Headaches, hearing loss and vertigo

Question 1

What are the differentials for a rapiud onset headache?

Answer 1

Subarachnoid

Meningitis

Encephalitis

Post-coital headache

Question 2

What are the differentials of a subactue gradual onset headache?

Answer 2

Venous sinus thrombosis

Sinusitis

Tropical illness- malaria, typhus, flu

Intracranial hypotension

Question 3

What are the signs of raised ICP?

Answer 3

Worse on walking

Lying, bending down, coughing makes worse

Seizures, focal neurological deficits, funny behaviour

Headache

Question 4

What are the symptoms of acute glacoma?

What inital treatment is given?

Answer 4

Typically occurs in elderly, long sighted people. Pain around one eye, Radiates to forehead. Casues reduced vision, visual haloes and red congested eye

Pilocarpine and acetazolamide

Question 5

What medications cause migraine induced headaches?

Answer 5

Paracetamol and codeine/opiates

Ergotramine

Triptans

Question 6

What is the treatment for a cluster headache?

Answer 6

Keep calm,carry oxygen

Sumatriptan

Question 7

What are the causes of trigeminal neuralgia?

Answer 7

Idiopathic

Intracranial vessels

Tumour

Meningeal inflammation

MS

Zoster

Question 8

What are the triggers of a mirgraine?

Answer 8

C hocolate
H angovers
O rgasms
C heese/affeine
L ie-ins
A lcohol
T ravel
E xercise

Question 9

What are the contraindications of triptans?

Answer 9

IHD

Coronary spasm

Uncontrolled blood pressure

BP

Recent lithium

SSRI’s

Question 10

What is a vasovagal syncope?

Answer 10

Reflex bradycardia and peripheral vasodiation

Only occurs when standing up

pre-syncopal symtpoms following. sometimes seizures

Question 11

What are two exaples of situation syncope?

Answer 11

Effort syncope(usually cardiac)

and micturation syncope (usually men)

Question 12

What is carotid sinus syncope?

Answer 12

Hypersensitive baroreceptors cause excessive reflex bradycardia on minimal stimulation e.g. head turning or shaving.

Question 13

What is a stokes adams attack?

Answer 13

Transient arrythmias cause blackout.

Recovery is in seconds usually patient flushes, pulse speeds up and conciousness is regained.

Question 14

What examinations should be done on all that pass out?

Answer 14

Cardio,

neuro

Measure BP lying and standing

Question 15

What investiations should be done in those that present with a faint?

Answer 15

Cardiac assessment if recurrent

ECG and 24 hour ECG

U&E, FBC, Mg, Ca and glucose

Table tilt test

ECHO

ABG

Question 16

If someone as vertigo and hearing loss/tinnitus what does this indicate?

Answer 16

Labyrinth or CN8 involvement

Question 17

What manouvers are assocaited in benign positional vertigo?

Answer 17

Hallpike- used for diagnosis, induces nystagmus (turn head and lie down)

Epley- used to clear debris (turn head to right, put head back, lie onto bed)

Question 18

How do you treat severe vertigo?

Answer 18

Reassure

Benzos

Prochlorperazine

Question 19

What causes menieres disease?

What are symptoms

How do you treat

Answer 19

Increased pressure of the lymphatic system.

Comes with sensorineural hearing loss and tinntitus

Antihistamine if prolonged

Question 20

What drugs can cause deafness and vertigo?

Answer 20

Aminoglycosides

Loop diuretics

Cisplatin

Question 21

What condition predisposes you to vestibular schwannomas?

Answer 21

Neurofibrmatomas Type 2

Question 22

What are the differentials of conductive deafness?

Answer 22

Wax (olive oil, warm water syringe)

Otoscleoriss

Ottits media

Glue ear

Question 23

What is presbyacusis?

Answer 23

Form of chornic sensorinueral deafness

Loss of high frequency before 30, not notice until hearing or speech is affected

Hearing is most affected in presence of background noise

Question 24

What are the differentials of sudde sensorineural hearing loss?

Answer 24

NEED URGENT ENT OPINION

Noise

Gent

Mumps

Accoustic neuroma

MS

Stroke

Vasculitis

Question 25

What are the causes of tinnitus?

Answer 25

Wax, XS noise, head injury, menieries, anaemia

if pulsatile consider carotid dissection

Aspirin, loop diuretics, aminoglycasides

Question 26

What are the treatments of tinnitus?

Answer 26

Cognitive therapy- help cope

Drugs- shit

Hearing aids that play white noise