Presentations

Question 1

Which facial palsy is a diagnosis of exclusion?

Answer 1

Bells palsy

Question 2

Anatomy of facial nerve- Intracranial and extracranial branches

Answer 2

arises in PONS (separate sensory and motor roots) fuse together in facial canal intracranial branches: greater petrosal nerve, nerve to stapedius and chorda tympani

exits facial canal via stylomastoid foramen

extracranial branches: posterior auricular nerve, nerve to digastric and nerve to styloid.

Question 3

presentation of Bells plasy

Answer 3

LMN weakness of facial muscles

Inabilty to close eye

metallic taste

reduced lacrimation

Question 4

how is the cause of a facial palsy distinguished (UMN or LMN)?

Answer 4

forehead sparing in patient with UMN palsy

Question 5

how is severity of facial palsy graded?

Answer 5

House-brackmann classification

Question 6

Differentials of Bells palsy?

Answer 6

UMN causes: stroke, subdural heamatoma, brain tumour

LMN causes: infective (acute OM, cholesteatoma, viral infection, parotid malignancy, trauma/ iatrogenic

Question 7

Management of Bells palsy?

Answer 7

Eye care: lubricating drops hourly/ ointment at night

Oral steroids

Surgical referral of recurrent/ diagnostic uncertainty - botox injections, nerve graft

Question 8

complications of Bells palsy

Answer 8

85% fully recover

poor prognosis: complete palsy, >60yrs, Ramsay Hunt Syndrome, Assoc DM, Hypertension, pregnancy

Question 9

what causes Ramsay Hunt Syndrome

Answer 9

unilateral facial palsy caused by reactivation of varicella zoster virus from the geniculate nucleus (nucleus of facial nerve)

Question 10

presentation of Ramsay Hunt Syndrome

Answer 10

mod-severe ear pain → unilateral facial palsy w ipsilateral vertigo, tinnitus

vesicles visible in latter period (covers concha/ ant 2/3rd of tongue/ soft palate

only 10% completely recover

Question 11

diagnosis and treatment of Ramsay Hunt Syndrome?

Answer 11

clinical diagnosis. Treat with prednisolone and aciclovir.

Question 12

investigation for patient presenting with hoarse voice?

Answer 12

flexible nasal endoscopy (FNE) to allow visualisation of larynx and vocal cords

(Stroboscopy is used in specialist voice clinic)

Question 13

innervation of the true vocal cords?

Answer 13

recurrent and superior laryngeal nerve

Question 14

benign laryngeal cord lesions?

Answer 14

vocal cord nodules, muscle tension dysphonia, polyps, reinkes oedema, laryngeal papillomas

infective: laryngitis, acute epiglottitis

Question 15

which nerve palsy can cause a hoarse voice?

Answer 15

recurrent laryngeal nerve

causes by: thyroid/ lung malignancy, MS, stroke, aortic aneurysm

Question 16

possible causes of neck lump?

Answer 16

infective: lymphadenopathy, sialadentis
neoplastic: lymphoma, head & neck cancer, mets, skin lump
vascular: carotid body tumout
inflammatory: sarcoidosis
traumatic: haematoma
autoimmune: thyroid disease

congenital

Question 17

congential causes of neck lumps?

Answer 17

cystic hygroma

thyroglossal cyst

branchial cyst

dermoid cyst

Question 18

investiation for neck lump?

Answer 18

US +/- FNA

CT/ MRI if further imaging needed

Question 19

a 1 year old presents with a soft, fluctuant painless mass in the neck. Whats the likely diagnosis?

Answer 19

Cystic hygroma

surgical excision to treat

Question 20

pulstaile painless neck lump with a bruit. can be moved side to side but not up and down. Likely diagnosis

Answer 20

carotid body tumour: benign neuroendocrine tumour from preganglion cells of carotid body

manage conservativiely or with surgica resection

Question 21

a teenage boy presents with a painless midline mass that moves up with protrusion of the tongue. whats the likely diagnosis?

Answer 21

<20yrs old = Thyroglossal cyst

surgical resection

Question 22

a palpable mass in the neck anterior to the sternocleidomastoid is likely ot be what?

Answer 22

Branchial cyst

US guided FNA is important prior to excision to rule out SCC met from heand & neck region

Question 23

under what circumstances would someone presentign with tinnitus be reffered as an otological emergency?

Answer 23

sudden onset pulsatile tinnitus

signifcant neurology

severe vertigo

secondary to head trauma

unexplained sudden hearing loss

Question 24

investigations for someone with tinnitus

Answer 24

pure tone-audiogram, tympanometry, BP, FBC, TFT and BG

Question 25

management optiosn in tinnitus

Answer 25

tinnitus retrainign therapy, CBT

hearign aids in some patients

Question 26

which benign tumour arises from schwann cells commonly found at the cerebellopontine angle?

Answer 26

acoustic neuroma (vestibular schwannoma)

derive from abnormalities in TS gene on chromosome 22

Question 27

bilateral vestibular scwannomas are associated with which condition?

Answer 27

neurofibromatosis type 2

Question 28

unilateral hearign loss, tinnitus and vertigo is the triad classically seen in which condition?

Answer 28

vestibular schwannoma

Question 29

maagement of vestibular scwhannoma

Answer 29

MRI head with contrast to monitor growth

stereotactic radiosurgery

surgical removal for large tumours

Question 30

what causes BPPV

Question 31

what can be given during attacks of menieres to try and help with symptoms?

Answer 31

prochlorperazine

Question 32

vertigo lastign for days is likeluy to be what?

Answer 32

vestibular neuritis