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Pathology and final year > ENT > Flashcards

ENT Flashcards

1
Q

What is Ramsay hunt syndrome

A

Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the varicella zoster virus in the geniculate ganglion of the seventh cranial nerve.

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2
Q

Facial nerve palsy differentials

A

Bells palsy
Ramsay hunt syndrome
Stroke (UMN)

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3
Q

Management of Ramsay hunt syndrome

A

Oral aciclovir and corticosteroids

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4
Q

features of ramsay hunt syndrome

A

auricular pain is often the first feature
facial nerve palsy
vesicular rash around the ear
other features include vertigo and tinnitus

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5
Q

Features of vestibular neuronitis

A

recurrent vertigo attacks lasting hours or days
nausea and vomiting may be present
horizontal nystagmus is usually present
no hearing loss or tinnitus
preceding viral infection

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6
Q

Differentials for vertigo

A

Peripheral (vestibular)
BPPV
Meniers disease
vestibular neuronitis
Trauma to vestibular nerve
otosclerosis
hyperviscosity syndromes
Acoustic neuroma
Herpes zoster (Ramsay hunt syndrome)

Central
Cerebellar or brainstem lesion affecting vestibulaar nerve function
Posterior circulation stroke
tumour
multiple sclerosis
vestibular migraine

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7
Q

sensory inputs for maintaining balance

A

Vision
Proprioception
and vestibular system

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8
Q

Pathophysiology of BPPV

A

Calcium crystals in semicercular canals (otoconia) are dislodged and disrupt the flow of fluid

can be triggered by a viral infection, head trauma, aging or idiopathic

Symptoms wore after changing position as movement is required to dislodge crystals

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9
Q

features of vertigo in BPPV

A

triggered on movement
last up to 1 min
over several weeks then resolves

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9
Q

diagnostic test for BPPV

A

Hallpike maneuver

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10
Q

Pathophysiology of Menieres disease

A

excessive build up of endolymph in the semicircular canals causing a higher pressure than usual, disrupting flow

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11
Q

Associated features of Menieres disease

A

Tinnitus
Hearing loss
feeling of fullness in the ear
nystagmus

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12
Q

Features of vertigo in Menieres disease

A

NOT associated with movement- random attacks
last up to hours
deterioration of hearing between attacks

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13
Q

Pathophysiology of vestibular neuronitis

A

Inflammation of the vestibular nerve following a viral infection leading to missmatch of signalling

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14
Q

features of vertigo in vestibular neuronitis

A

lasts several weeks
acute onset

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15
Q

Features of vertigo in central pathologies

A

sustained, non positional vertigo

disruption in the interpretation of signals

16
Q

Management of BPPV

A

Epley maneuver

17
Q

Important questions to ask with ear problems

A

Pain
Itch
discharge
Hearing loss
Vertigo
Tinnitus
Recent illnesses
Neurological symptoms eg. facial nerve palsy

18
Q

Causes of sensorineural hearing loss

A

age related
Noise exposure
Menieres disease
Acoustic neuroma
Labyrinthitis
neurological; stoke, MS, brain tumour
Meningitis
Drugs

19
Q

Drugs that cause sensorineural hearing loss

A

Aminoglycosides (gentamicin)
Loop diuretics (eg. furosemide)
chemotherapy (eg. cisplatin)

20
Q

Causes of conductive hearing loss

A

Earwax
foreign body
Infection eg. otitis media/externa
GLue ear
effusion in middle ear
eustation tube dysfunction
perforated tympanic membrane
otosclerosis
cholesteotoma
benign bone growth (exosteotosis)
tumours

21
Q

Mananagement of vertigo in vestibular neuronitis

A
  1. Buccal/ IM prochlorperazine (acute vertigo relief)
  2. vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms
22
Q

What is otosclerosis?

A

Otosclerosis describes the replacement of normal bone by vascular spongy bone. It causes a progressive conductive deafness due to fixation of the stapes at the oval window. Otosclerosis is autosomal dominant and typically affects young adults

23
Q

features of otosclerosis

A

conductive deafness
tinnitus
tympanic membrane
the majority of patients will have a normal tympanic membrane
10% of patients may have a ‘flamingo tinge’, caused by hyperaemia
positive family history

24
Q

Positive Hallpike test for BPPV

A

delayed onset (few seconds) torsional nystagmus on descent facing one side only

25
Q

First line antibiotic for acute otitis media

A

amoxicillin

clarythromycin if pen allergy

26
Q

common bacterial causative organisms of otitis media

A

Streptococcus Pneumoniae, Haemophilus Influenzae and Moraxella Catarrhalis

Pathology and final year (21 decks)

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