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Neurology > 20 Jan Ent > Flashcards

20 Jan Ent Flashcards

1
Q

Presbycusis CF

A

Hear well in one on one conv in a quiet room
Competing sounds impair hearing loss (speech discrimination)
High frequencies affected first
Cant hear high pitched voices (women children)

Vs conductive hearing loss :

paradoxically improved speech understanding in background noise

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2
Q

Presbycusis Mech

A

👣Age related cochlear hair cell loss and cochlear neuron degeneration
👣Age related brain atrophy contributes
Hence speech discrimination in older pts vs younger with SNHL

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3
Q

Ttt of presbycusis

A

▶️Education of patient and family
▶️Limiting background noise
▶️Looking directly at patient when speaking to them
▶️Mayb hearing aids

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4
Q

TMD RF

A

Joint trauma (injury , bruxism)
Psych illness. ( anxiety , abuse)

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5
Q

TMD CF

A

➡️Facial pain. (worse with jaw motion)
➡️Ear pain , tinnitis
Otalgia in the setting of normal ear exam is likely referred otalgia
➡️Headache (UL, worse on awakening)
➡️Jaw dysfunction

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6
Q

TMD dx

A

Clinical imaging not needed
Tenderness of mastication muscles
Tooth wear (evidence of bruxism)
Crepitus or clivking with jaw motion

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7
Q

Management of TMD

A

🛖Education (avoid trigger , soft diet)
🛖Dental splints (if bruxism)
🛖NSAIDS (naproxen)

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8
Q

Nectrotizing otitis externa RF

A

NOE is osteomyelitis of the skull base
Commonly caused by pseudomonas
RF:

Elderly
Diabetic
Aural irrigation (cerumen removal)

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9
Q

NOE CF

A

Lifethreatening infection of ear canal extending to skull base

👉🏼 severe unremitting ear pain (worse at night & chewing)
👉🏼 deficits with CN 7,9,10
👉🏼 granulation tissue in external auditory canal
👉🏼 edematous external auditory canal with purulent drainage
👉🏼 ⬆️ ESR

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10
Q

Ttt of NOE

A

🛞IV pseudomonal antibiotics (cipro)
Prologed course for 6-8weeks
(Despite inc risk of tendon rupture in elderly)
🛞Surgical debridement

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11
Q

Pt on CPAP with nose bleed and crusting ttt

A

Warming and humidification of air throughCPAP machine
Nasal saline irrigation
Lubricating jelly to anterior septum

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12
Q

Aspirin exacerbated resp disease CF

A

🚨Asthma
🚨Bronchospasm or nasal congestion
🚨Chronic rhinosinusitis with nasal polyp

Bland tasting food due to anosmia

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13
Q

AERD Pathophys and ttt

A

Pseudoallergy as it is not mediated by IgE
Related to overproduction of leukotrienes

Ttt;

😡Manage asthma
😡Manage rhinosinusitis
🤬Leukotriene modifying agents
🤬Aspirin desensitization (in pts with comorbidities)

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14
Q

Juvenile nasal angiofibroma

A

Teenage boy
Benign neoplasm of nasopharynx
Causes nasal obstruction and nasal drainage
Results in epistaxis

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15
Q

Leukoplakia RK and Cf

A

RF:
Older pt
Tobacco
Alcohol

CF:
Painless white mucosal patch
Cannot be wiped off
(Candida is easily scraped off)

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16
Q

Risks for cancer in leukoplakia

A

Non homogenous gross appearance
Large size >4cm
Dysplasia seen on biopsy

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17
Q

Manangement of leukoplakia

A

😶‍🌫️ biopsy (at diagnosis and if appearance changes)
😶‍🌫️ RF modification (tobacco cessation)
😶‍🌫️ close monitoring and freq oral exams
😶‍🌫️ surgical excision

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18
Q

Oral hairy leukoplakia signs

A

Young Age
Painless white mucosal lesions on lateral tongue
Multiple homogenous lesions
Corrugated (folded or wrinkled appearance -hairy)
Cannot be scraped off

H/O fatigue ,unintentional weight loss ,
Cervical adenopathy
HO immunodef esp HIV

19
Q

Oral hairy leukoplakia cause

A

Intense EBV and HIV

Do HIV testing

20
Q

Ttt for OHL

A

No ttt
Resolves with treatment of underlying immunodef (antiretroviral ttt)

21
Q

Otitis externa RF

A

🦵🏾Water exposure
🦵🏾loss of cerumen
🦵🏾Trauma (cotton swabs, ear candling)
🦵🏾Foreign material (hearing aid, headphones)
🦵🏾Derma conditions (eczema, contact dermatitis)

22
Q

Otitis externa microbiology

A

Pseudomonas
Staphylococcus

23
Q

Otitis extern CF

A

Skin and soft tissue infection if EAC
Hence pain with manipulation and erythema

🧇Otalgia , pruritis , discharge , hearing loss
🧇Pain with auricle manipulation
🧇Ear canal eythema ,edema ,debris
Indurated plaque like rash …..tympanic mem spared (clear , not inflamed, no middle ear fluid)

24
Q

Otitis externa Ttt

A

🚑Remove debris
🚑Topical antibiotic (FQ) drops
🚑Topical glucocorticoid
🚑Consider wick placement to facilitate medication delivery

Keep ear dry
Avoid further trauma

25
Q

Ototoxic medicines

A

Aminoglycosides
Cisplatin
High dose salicylates
Furosemide (loop diuretic)

26
Q

Meniere dx CF

A

⛱Episodic vertigo (20mins to 24hrs) ass with NV

⛱SNHL : fluctuating and varying in severity worsening over time (affecting low freq first and progressing to permanent loss over all frequencies)

⛱Low freq TINNITIS in affected ear

⛱aural fullness

27
Q

Meniere dx pathophys

A

Incr volume and pressure of endolymph (endolymphatic hydrops )
Defective resorption if endolymph fluid
Distension if endolyphmatic system causes damage to both vestibular and auditory components of inner ear.

28
Q

Menier dx workup

A

Clinical Dx
Audiometry
MRI to rule out CNS lesions

29
Q

Non allergic / vasomotor. rhinitis CF

A

Nasal congestion
Rhinorrhea
Sneezing
Postnasal discharge
Later onset (age >20)
No obv allergic trigger
Perennial symptoms (may worsen with season change )
Erythematous nasal mucosa

30
Q

Non allergic rhinitis ttt

A

Mild : IN glucocorticoids / antihistamine(olopatadine, azelastine)/
IN ipratropium

Moderate to severe:
Combination therapy

31
Q

NAR identification

A

No sneezing or allergic conjuctivitis
No allergic triggers
Behavior triggers ; walking into cold air , eating)

32
Q

Allergic rhinitis SS

A

➡️early age of onset
➡️watery Rhinorrhea
Nasal congestion
Sneezing
Nasal itching
➡️Cough sec to post nasal drip
➡️ocular itching & tearing
➡️ seasonal pattern
➡️pale/blue nasal mucosa
➡️ during peak season pts exp fever and psych symptoms - fatigue irritability)
➡️ related to atopic disorders- allergic rhinitis , hay fever, asthma , eczema , eustachian tube dysfunction

33
Q

Allergic rhinitis Physical exam

A

👃🏽 allergic shiners (infraorbital edema and darkening
👃🏽 allergic salute ( transverse nasal crease)
👃🏽 pale blue enlarged turbinates
👃🏽 pharyngeal cobblestoning
👃🏽 allergic facies (high arched palate, open mouth breathing)

34
Q

Allergic rhinitis ttt

A

Allergen avoidance
Intranasal corticosteroids -
Fluticasine , mometasone
Non sedating oral antihistamines

35
Q

Herpes zoster oticus pathophys

A

Reactivation of VZV from geniculate ganglion disrupting motor fibers of cranial nerve 7 with subsequent spread to cranial nerve 8.

Painful erythematous vesicular rash on auditory canal or auricle
IL facial paralysis
Vertigo NV
Hearing and taste disturbance

Ttt : valacyclovir

36
Q

Vestibular neuritis CF

A

🛖NV
🛖Gait impairment
🛖UL hearing loss (labyrinthitis)
🛖Nystagmus suppressed by visual fixation
(Peripheral)
🛖Postive head thrust test(vestibulo ocular reflex) indicating peripheral vestibular lesion.

37
Q

Vestibular neuritis ttt

A

Vestibular suppressants (meclizine)
Antiemetics
Corticosteroids
Vestibular rehab for imbalance

38
Q

Vestibular neuritis pathophys

A

Self limiting inflammation of vestibular branch of 8th nerve following a viral infection.
Vestibular neuritis plus UL hearing loss = labyrinthitis.

39
Q

Perilymphatic fistula cause

A

Head injury or barotrauma casuing fluid to leak from semicircular canal

SS
Vertigo
Hearing loss
Tinnitus
Symptoms triggered by sneeze , straining , loud noise.

40
Q

Meniere dx lifestyle modifications

A

Lifestyle modifications are first line ttt

  1. Dietary salt restriction: (2-3g per day)
    Sodium restriction reduces endolymphatic fluid helping to reduce endolymphatic hydrops

2: Limit caffeine and nicotine:
Vasoconstrictors reduce blood flow to ear

  1. Limit alcohol:
    Alcohol causes fluid shifts
  2. Avoid allergy triggers :
    Allergies lead to inc fluid extravasation in endolymohatic sac

Refractory cases :
Vestibular suppressant drugs

Thiazide diuretics
Antiemetics (promethazine )
Benzodiazepines
Vasodilator (betahistine)
OCPs: for pts with premenstrual exacerbations to blunt hormonal fluctuations

41
Q

Rhinitis medicamentosa

A

Nasal congestion after prolonged use of decongestant sprays.

42
Q

Rhinitis medicamentosa Mech

A

Oxymetazoline (vasoconstrictor) leads to rapid relief of nasal congestion but in as few as 3-5 days injures endothelium causing REBOUND CONGESTION
Patients keep using it consistently leading to BEEFY RED nasal mucosa.

Ttt: cessation
Sig counseling to discontinue
Short course of nasal steroid for severe cases

43
Q

Peripheralvertigo CF and dx

A

▶️Non focal neurologic exam
▶️Unidirectional nystagmus : does not reverse direction, horizontal/torsional , not pure vertical
▶️worse with head position , prominent NV

Dx.
No additional testing req

44
Q

HINTS exam for central vs peripheral vertigo

A

Central vertigo signs:

Head impulse : Normal - Eyes remain on target as head moves side to side

Nystagmus. : Changes with lateral gaze

Test of Skew. : Vertical eye shift when covered eye is uncovered.

Neurology (19 decks)

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