Neuro And ENT Flashcards
What are two signs that can be elicited in a patient with meningitis?
Kernig’s and Bragzinski’s signs
What is kernig’s sign, what is a positive sign?
With patient laying on their back and hip and knee flexed at 90 degrees, slowly extend knee- resistance or pain and inability to extend knee past 135 degrees is positive sign
What is a Brudzinski’s sign?
With patient laying on their back, flex the neck bringing chin to chest. Postive sign is involuntary flexing of hips and knees
How can headaches be classified by causes?
Primary, secondary and painful cranial neuropathy
What percentage of patoents with GCA have symptoms of polymyalgia rheumatica?
50%
What pain relief is avoided in headaches? Why?
Opioids, they can make the pain worse
What medication can be given for chronic tension headache if lifestyle advice not working?
Low dose amytriptilline
What is the management for migraines?
Trigger avoidance (headache diary) + lifestyle changes, simple analgesia and/or triptans, anti-emetic
What medication can be used for prevention of migraines? Which one is safe in pregnancy?
Propanolol, topiramate, amitriptylline
Propanolol safe in pregnancy
What is status migrainosus?
Migraine lasting longer than 72 hours
How often would a patient be taking paracetamol for you to consider medication overuse headaches?
Over 15 days in a month
How often would a patient be taking opioids/triptans for you to consider medication overuse headache?
More than 10 days in a month
What does HiNTs stand for?
Head impulse test, nystagmus, test of skews
How would the presentation of labrythitis differ to that of vestibular neuronitis?
Labrynthitis would have hearing symptoms as well as the virtigo
What does dysmetria mean?
Past pointing
In what condition would you see a ‘cafe au lait’ spot?
Neurofibromatosis type 2
In neurofibromatosis type 2, what conditio causing sensorineural hearing loss is more common?
Acoustic neuroma
What are common symptoms in menieres disease?
Aural fullness, roaring tinnitus, rising sensorineural hearing loss and vertigo
What are the common presenting symptoms for acute otitis media?
Ear pain, temporary conductive hearing loss, fever
What are signs of acute otitis media on otoscopy?
Tympanic membrane is red/cloudy and may be bulging
How is acute otitis media managed?
Regular simple analgesia, consider anitbiotics if systemically unwell or at high risk of complication (amoxicillin/clarithromycin 5-7 days)
What is chronic suppurative otitis media?
A chronic suppurative middle ear infection usually with persistently perforated tympanic membrane
What are symptoms of CSOM (chronic suppurative otitis media)
Otorrhoea >2 weeks wihtout fever/pain, hearing loss, Hx of otitis media
What features in a patient with CSOM would warrant urgent referral?
Fever vertigo and otalgia as need exclude intracranial/intratemporal complcations
How would CSOM be managed?
Not in primary care.
Secondary care often antibiotics, steroids and intensive cleaning of ear
What are symptoms of mastoiditis?
Pain/swelling/redness behind ear, discharge, fever, headache, hearing loss
What are the signs in mastoiditis?
Ear sticking out, fever. If infection is bad then HR high, BP low
What would otoscopy show in mastoiditis?
Erythema, bulging tympanic membrane, cloudy/fluid filled middle ear
How is mastoiditis managed?
Antibiotics
What are the symptoms of a dry tympanic perforation?
Hearing loss, otalgia, itching, fever, tinnitus
What advice would you give to a patient/ parent with acute otitis media?
Use warm/cold flannel on ear, keep ear dry and avoid putting anything in ear. Reassure it normally resolves in a few days, max a week
