Other OSCE bits Flashcards
Anterior triangle of neck borders
- Superior = inferior border of mandible
- Medial = midline of neck
- Lateral = anterior border of sternocleidomastoid
Posterior triangle of neck borders
- Anterior = posterior margin of sternocleidomastoid
- Posterior = anterior margin of trapezius
- Inferior = middle 1/3 of clavicle
What type of tuning fork is used for Rinne’s and Weber’s test and why?
512Hz
- best balance between time of deceay and tactile vibration
Describe Rinne’s test + results for:
- normal
- conductive hearing loss
- sensorineural hearing loss
- Place a vibrating 512 Hz tuning fork firmly on the mastoid process - this tests bone conduction
- Confirm pt can hear sound of tuning fork and ask them to tell you when they can no longer hear it
- Then move tuning fork in front of external auditory meatus to test air conduction
- Ask pt if they can now hear sound again - if they can then suggests air conduction > bone conduction, which is a normal result (Rinne’s positive)
.
- Normal: air conduction > bone condition (Rinne’s +ve)
- Conductive hearing loss: bone conduction > air conduction (Rinne’s -ve)
- Sensorineural hearing loss: air conduction > bone conduction (Rinne’s +ve)
Describe Weber’s test + results for:
- normal
- conductive hearing loss
- sensorineural hearing loss
- Tap a 512Hz tuning fork and place in the midline of the forehead
- Ask the patient“Where do you hear the sound?”
.
- Normal: sound hear equally in both ears
- Conductive: sound heard louder in affected ear
- Sensorineural: sound heard louder in normal ear
What are the Dix-Hallpike test and Epley manoeuvre used for?
- Dix-Hallpike test = diagnostic manoeuvre used to identify BPPV and confirm the affected side (if pt experiences vertigo in brief episodes (< 1 min) with changes of head position)
- Epley manoeuvre = used to treat BPPV (usually of the posterior canal)
Contraindications for Dix-Hallpike test and Epley manoeuvre (absolute and relative)
What is a positive result for the Dix-Hallpike test?
- what does rotatory nystagmus suggest?
- what does horizontal nystagmus suggest?
If test is positive, (patient claims vertigo and nystagmus is observed) characteristics of the nystagmus should be observed and consider performing Epley’s manoeuvre.
.
- Rotatory nystagmus (most common) - suggests involvement of the posterior semicircular canal
- Horizontal nystagmus - suggests involvement of lateral semicircular canal
What are some complications of otitis media?
- mastoiditis, tympanic membrane perforation, facial nerve palsy
- meningitis (most common itnracranial complication)
Otosclerosis management
- Conservative: hearing aids
- Surgical: stapedectomy or stapedotomy
.
(Stapedectomy = removing entire stapes bone and replacing with prosthesis)
(Stapedotomy = removing part of the stapes bone and leaving the base of the stapes (the footplate) attached to the oval window)
What is the HINTS exam used for?
HINTS - head impulse, nystagmus, and test of skew
- used to distinguish between a peripheral and central cause of vertigo
(must be done in a currently symptomatic patient with a normal full neurological exam)
HINTS exam - What does a +ve result of the head impulse test indicate?
- disruption to the vestibulocochlear-ocular reflex so eyes move with the head and saccade rapidly back
- this indicates there is a problem with the vestibulocochlear nerve on the ipsilateral side, so the cause is peripheral not central which is reassuring
HINTS exam
- What does an unidirectional nystagmus indicate?
- What does a nystagmus that changes direction or is vertical indicate?
- What does a bidirectional nystagmus indicate?
- unidirectional nystagmus - indicates peripheral origin (reassuring)
- if nystagmus changes direction or is vertical - indicates central pathology
- bidirectional nystagmus —> specific for stroke
HINTS exam - what does any abnormal movement (eg. vertical diplopia) indicate?
any abnormal movement (vertical diplopia) is specific for a central cause of vertigo
