Capscule cases Flashcards
Typical presentations of Vestibular schwannoma and Otosclerosis ?
Vestibular schwannoma - benign lesion arising from neuronal Schwann cells of the vestibulocochlear nerve,
typically presenting as : – unilateral sensorineural hearing loss
- tinnitus.
Otosclerosis - abnormal brone growth in ear - stapes ( one of the ossicles might fuse with surrounding bone ) - fusions of ossicles. - sound no longer transmitted into inner ear well
0 present as conductive hearing loss - (most noticable at 2KHz or 2000 HZ (carhart’s notch ))
0 Mat be bilateral .
Typical presentation of Presbycusis and Meniere’s disease?
Menieres ,treatment
Presbycusis - age related hearing loss - ( loss of hair cells in the inner ear )
- sensorineural hearing loss - often bilateral - affect high frequencies (can hear low frequencies relatively well )
Meniere’s disease - condition of the inner ear
causes :
Vertigo - feeling of spinning
Tinnitus (ringing )
pressure deep
in ear.
*presents as fluctuating sensorineural hearing loss
Treatmemt
prochlorperazine- which helps relieve severe nausea and vomiting
0 oral or IV - IV given if severe and need medicine quick
antihistamines, whichhelp relieve mild nausea, vomiting and vertigo
betahistine -anti vertigo medicine- can given to reduce frequency of attacks.
Surgery if all others fail - rare
What is conductive and sensorineural hearing loss ?
Conductive - caused by damage/ disease to middle ear - lack of conduction to inner ear.
e.g. otitis media , otosclerosis
Sounds in affected ear are louder as air conduction form middle ear to inner ear is impaired not bone conduction. (lack of air conduction causes up regulation of inner ear making it more sensitive to stimuli from bone condition. - louder sound.
Also the same way sound cannot enter easily into the middle ear , sound cannot leave easily - sound louder )
Sensorineural - damage to the inner - including the hair cells.
- caused by disease of the inner ear or damage to cochlea nerve.
- In affected ear - (SNHL ) - sounds conducted by both air and bone will be quieter than unaffected ear.
What is wax impactation ?
Wax in the ear canal hardens and blocks the canal - can cause temporary hearing loss.
What does Rinner’s test tell us about what type of hearing loss is present ?
Rinner test - test bone conduction - place on mastoid bone.
Then test air conduction when taken off mastoid and place near ear,
Conductive hearing loss - able to hear when on mastoid bone (bone conduction is normal ) but not when placed near ear as air conduction is impaired )
NEGATIVE RESULT TEST.
In sensoneural HL nad normal patient air conduction is better than bone conduction - POSITIVE RINNER’S TEST
TAKE HOME MESSAGE - IF POSITIVE RESULT - AIR CONDUCTION IS BETTER THAN BONE CONDUCTION - INDICATES SENSORINEURAL
What does Weber test ?
Bone conduction in both ears
Normal - should be heard equally in both ears
- be careful as equal does not always mean normal
i. e. Bilateral conductive hearing loss or bilateral sensorineural hearing loss.
Unilateral - one side is louder
Sensorineural - lateralises to unaffected side.
(right ear damage - louder on left side)
Conductive - lateralises to the affected ear ( right middle ear damage — louder sound in ear)
Weber test - laterilisation to the right
rinne test - positive bilaterally
Weber test - this reault either indicates right conductive HL
or Left sensorinueral HL
Rinne - bilateral postive result - Air conduction is better than bone conduction
answer - left sensorineural loss.
Weber - lateralisation to the right
Rinne - negative on the right
rinne - negative in right - so air conduction is worse than bone conduction - conductive
weber - indicates right conductive or left sensorineural.
answer - right middle ear damage.
weber - no lateralisation
rinne - postive bilaterally
weber - can be heard equally.
Rinne - air conduction is better than bone conduction in both ears
Answer -either normal or bilateral sensorineurak loss.
weber - no lateralisation
rinne - negative bilaterally
weber - can be heard equally.
rinne - air conduction is worse than bone conduction 0 conductive
Answer - Bilateral conductive HL.
Treatment of Glue ear (otitis media )?
Active survellance for 3 months . (most cases resolve with 3 months )
if persistent Bilateral OME and hearing loss next step is either :
- Hearing aid - non surgical treatment - Surgical interventions -e.g. grommet * Grommet - ventilation tubes -equalize pressure on either side of tympanic membrane preventing further middle ear effusion. (under anesthesia)
What is Pompholyx ?
Pompholyx / Dyshidrotic eczema - tiny blisters develop on :
- across fingers
- palm of hand
- soles of feet sometimes.
Usually affects under 40s
What is Pitted keratolysis ?
Bacterial infection of the skin - affects soles of the feet - less of the palm of the hand.
How do you treat Topical fungal foot infection - Drug ?
0 Terbinafine 1% cream (Topical cream form)(children above 12 years of age)
0 Clotrimazole 1% cream
0 Miconazole 2% cream
0 Econazole 1% cream
- Itraconazole (oral) , ketoconazole (cream)
- you can also give oral terbinafine - but beware of hepatotoxity (can happen in people with or without pre-existing liver disease)
*periodic monitoring of
LFTs (after 4–6 weeks
of treatment) is
recommended. (should be stopped immediately - if LFT becomes deranged)- Dont prescribe in renal disease.
What is intussception - symptoms?
One part of the intestine slides into the other - causing obstruction
- most common cause of bowel blockage in infants - tend to happen btw ages 3 -18 months
- Rare and serious
- Cna lead to reduced blood flow to that part of the bowel.
Symptoms - severe abdominal pain that comes and goes (episode tends to last 2-3 mins )
- between episodes child is pale, floppy , lethargic
- Child may have :
- high temp
- swollen stomach
- faeces contain blood
and mucus
- right lower quadrant pain
- capsule said a vague abdominal mass was present.
