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CPD > quiz 3 > Flashcards

quiz 3 Flashcards

1
Q

What are the two types of hearing loss?

A

sensorineural and conductive

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2
Q

Describe the structures involved in sensorineural hearing loss and some potential etiologies.

A 
The inner ear and the brain
hair cells and nerves
ETIOLOGIES
acoustic trauma
barotrauma
head trauma
atotoxic drugs
infection
aging
acousitc neuroma
sudden SSNHL
Meniere dz
vascular dz
Multiple sclerosis
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3
Q

Conductive hearing loss- structures involved and examples of etiologies

A 
external and middle ear
obstructed ear canal
perforated TM
dislocated ossicle
otitis media
otitis externa
otosclerosis
congenital abnormality
cholesteatoma
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4
Q

What is Mixed hearing loss

A

a combination of both conductive and sensorineural loss

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5
Q

What are two main categories of tinnitus?

A

subjective

objective

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6
Q

Describe subbjective tinnitus and list some of its etiologies

A 
audible only to pt, high frequency, damage done to hair cells
etiologies:
acoustic trauma 
barotrauma
eustacian tube dysfunction
Meniere disease
Drugs
Presbycusis
CNS tumor
infection
ear canal obstruction
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7
Q

Describe objective tinnitus and list some etiologies

A

rare, can be heard by listening directly over pts ear.
Etiology:
AV malfunction
Turbulent blood flow in carotid a or jugular v
vascualr middle ear tumor

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8
Q

What are some “other” causes of tinnitus?

A

diabetes, hyperlipidemia, allergies, HTN, hypotension ,TMJ, etc

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9
Q

What should you ask for HX on pt work up for someone with Tinnitus?

A 
Description of sound
noise exposure
head trauma
hearing problems
dizziness
los of balance
recent dental work/problems
bruxism
stress
ototoxic drug use
smoking caffeine
HTN
anxiety
insomnia
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10
Q

What would you do/check on a PE for a pt with Tinnitus?

A

otoscopic exam
CN VIII function and hearing (whisper, tuning fork)

check for: carotid artery bruits(turbulent noise in carotid)
HTN
oral exam
neck and jaw hypertonicity
TMJ dysfunction
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11
Q

What are the two types of Vertigo?

A

subjective- pt feels that they are moving in space

objective- pt feels that objects are moving around them

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12
Q

What causes true vertigo? (sensations of movement)

A

caused by assymetry in the vestibular system (CN8, inner ear, cerebellum)

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13
Q

What are the symptoms of true vertigo?

A 
either surroundings move or pt moves in surroundings
postural instabuility
nausea
vomiting
sweating
vertigo worsens when moving head
Nystagmus is common
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14
Q

What structures are involved in peripheral vs central vertigo?

A

peripheral- labyrinth or CN8

central- cerebellum, vestibular cortex in temporal lobe

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15
Q

Describe lightheadedness non-vertigo and what can cause it

A

“graying out of vision”, pallor, roaring noise in ears

hypoperfusion of the brain from:
hypotension
shock
drugs
dehydration
decrease cardiac output
sever anemia
hypoglycemia
cardiac arrythmias
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16
Q

Describe disequilibrium in non-vertigo

A

occurs only while standing or walking, unsteady without any dizziness

source of problem may be:
cerebellum
frontal lobe tumor
basal ganglia
stroke
cervical spondylosis
motor neuron diseases
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17
Q

What can cause miscellaneous non-vertigo?

A

chronic hyperventilation syndrome
new eyewear and diplopia
phobias- agoraphobia, acrophobia
extra-ocular muscular palsy reults in diplopia

18
Q

What do you ask about onset on a hx of vertigo?

A

Onset sudden or gradual?

 - sudden and vivid memories are dt inner-ear dz
 - gradual and ill-defined are most common in CNS, cardiac, and systemic diseases
19
Q

What can different durations of vertigo on a hx point to?

A

1Episodic true vertigo that lasts for seconds, associated with head or body position changes likely benign paroxysmal positional vertigo (BPPV)

  1. Sudden onset that lasts for minutes can be dt brain or vascular disease
  2. vertigo that lasts for hours or days probably caused by Meniere dz or vestibular neuronitis
20
Q

What do you do in a general examination in a PE for Vertigo?

A

check vital signs, supine and standing BP, orthostatic BP, CVS

21
Q

PE for vertigo- otological exam description

A

examine ears for cerumen, discharge, foreign body, TM perforation

22
Q

Extraocular movements in a PE for Vertigo

A 
"H in space"
a. check for nystagmus
   1. horizontal plane- most common form
   2. vertical plane- always abN, brain 
        stem function disorder
   3. pendular- often congenitalor after prolonged period of  blindness
23
Q

Hearing test- PE for Vertigo

A

gross hearing- whispered voice test

Weber/Rhine to asses conductive or sensorineural loss

24
Q

Vestibular imbalance- PE for Vertigo

A

past-pointing with eyes closed, repeat

Romberg test: tend to fall toward the vestibular lesion

25
Q

What are the red flag concomitants of a Vertigo PE?

A

head/neck pain, ataxia, LOC, focal neurological deficit

26
Q

What can be some casues of Earaches?

A

external ear- impacted cerumen or foreign body, local trauma, otitis externa

middle ear- eustacian tube obstruction, OM, neoplasms
referred from TMJ, wisdom teeth
local infections (tonsilitis, enlarged adenoids, peritonsilar abscess)
27
Q

What are the red flag concomitants for earaches?

A

DM, immunocompromised pt, redness/pain over mastoid, severe swelling of canal meatus, chronic pain with head/neck symptoms

28
Q

What are some causes of ear discharge?

A 
accute:
accute OM with TM perforation
post-tympanostomy tubes
CSF leak from head trauma
OE- infxn or allergy
Chronic:
cancer of earcanal
cholesteatoma
chronic purulent OM
foreign body
mastoiditis
29
Q

Red flag concomitants for ear discharge

A

head trauma, cranial nerve dysfunction, fever, erythema of the ear, DM or immune compromised pts

30
Q

What are some etiologies of Acute Otitis Externa? What are sign and symptoms and what do you find on PE?

A

Infection
swimmers ear
forceful cleaning of the ear
trauma

itching, pain, discharge, loss of hearing possible
PE: pinna and tragus painful
external canal red and swollen
TM is normal

31
Q

What are the etiologies of Chronic Otitis externa? What is its appearance?

A

often follows psoriasis, seborrheic dermatitis, eczema
allergy, or fungus

pruritis, redness, discharge
pinna and tragus not painfulo
external canal is irritated, dry, flaky
TM is normal

32
Q

What is Perichondritis and what can cause it?

A

Inflammation of cartilage of ear

trauma, insectbites,

33
Q

What types of tumors can affect ears?

A

sebaceous cysts, osteomas, gouty deposits

basal cell and squamous cell carcinomas

34
Q

What are some risk factors for Acute Otitis Media?

A

daycare exposure, bottle feeding, smoker in the household, AOM in first year of life

35
Q

What are the signs and symptoms of AOM?

A

throbbing pain, fever, decreased hearing, nausea, vomiting, moodiness, irritability,

36
Q

What does AOM look like on a PE?

A

TM- bulging red, possible fluid line, decreased mobility on pneumatic otoscopy

37
Q

Otitis Media with Effusion- what is it and what are some risk factors?

A

Fluid in middle ear- incomplete resolution of AOM or dt inflammation

risk factors:prior tympanostomy tube placement
allergy- often dairy, oranges, apples, environmental
adenoid hypertrophy

38
Q

Otitis Media with Effusion- sign and sxs

A 
hearing impairment
mild otalgia(pain)
nasal discharge, sore throat
39
Q

Otitis media with Efusion- PE findings

A

Tm- amber, gray, intact but retracted or neutral
impaired mobility of TM
bubbles amy be seen
Chronic cervical LA

40
Q

Chronic Suppurative Otitis Media- description and etiologies and sign and symptoms

A

chronic inflammation of middle ear that lasts 6 weeks with TM perforation and otorrhea

Etiology:
acute OM resulting in perforation
trauma to ear/head

Signs & sxs: hearing loss, chronic purulent dc, painless

CPD (3 decks)

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