Sensory: Hearing/Balance/Vision

Question 1

Conductive hearing loss

Answer 1

occurs in outer ear
sound unable to travel normally to inner ear
reflects audibility problem
ear canal

Question 2

sensorineural hearing loss

Answer 2

occurs in inner ear
caused by aging, illness, noise
nerves

Question 3

mixed hearing loss

Answer 3

inner & outer ear

both sensorineural and conductive loss

Question 4

inner ear hearing disorder

Answer 4

cochlear hair cell or auditory nerve dysfunction

a very common disorder

Question 5

inner ear hearing disorder systemic

Answer 5

referral crucial: to audiologist or otolaryngologist

promt management of sudden hearing loss can reverse impact

Question 6

inner ear hearing disorder cause

Answer 6

genetic
infectious
vascular
neoplastic
traumatic
toxic
iatrogenic
degenerative
immunologic/inflammatory

Question 7

weber’s test

Answer 7

512 Ht tuning fork on forehead see if sound is heard louder on one side or the other
dx: ipsilateral conductive hearing loss or contralateral sensorineural hearing loss

Question 8

rinne’s test

Answer 8

base of tuning fok on mastoid process until sound is no longer heard then vibrating top placed an inch from external ear canal
(air conduction)

Question 9

sensorineural hearing loss progression

Answer 9

damage to outer/middle/inner ear, aging process, loud sound damage
> wear/tear on hairs/nerve cells in the cochlea that send neural signals
> electrical signals can’t be transmitted efficiently
> symptoms of hearing loss

Question 10

genetic hearing loss

Answer 10

very common birth defect

s/s: nonsyndromic hearing loss (hearing loss only) vs syndromic hearing loss (also other clinical abnormalities)

Question 11

genetic hearing loss TX

Answer 11

regular audiologic monitoring
sensorieneural hearing loss (hearing aid/cochlear implant)
conductive hearing loss (hearing aid or osseointegrated hearing implant)

Question 12

noise-induced hearing loss

Answer 12

from chronic prolonged exposure to high-intensity noise or single acute exposure to intense impulse sound
s/s: acoustic trauma (sudden hearing loss maybe w/ tinnitus) usually sensorineural

Question 13

noise-induced hearing loss tx

Answer 13

amplification/assistive listening devices
education on noise-related changes in hearing
counseling/assistance coping

Question 14

NIOSH allowable hearing exposure limits

Answer 14

8 hours a day for 85-dB sound
reduction in exposure at >85 dB
60 dB = conversation 
90 = motorcycle/lawnmower
110-120 = concert/chainsaw

Question 15

conventional aids

Answer 15

amplify within canal

place in ear canal

Question 16

osseointegrated bone-conducting hearing prostheses

Answer 16

applied to retroauricular skull
provide hearing via bone conduction
dental appliance-based bone-conduction systems similar
placed on mastoid bone sticks out through skin

Question 17

implantable middle ear hearing devices

Answer 17

interface at level of ossicles & bypass eardrum

typically used for mild-moderate sensorineural hearing losss

Question 18

cochlear implants

Answer 18

directly stimulate remaining neural elements w/in cochlea

used for severe or profound hearing loss

Question 19

outer ear disorders

Answer 19

most highly treatable

typically don’t involve hearing loss except congenital outer ear malformations

Question 20

Otitis Media

Answer 20

inflammation of middle ear space
associated w/ eustachian tube dysfunction
usually dx’d in children (7 or younger) tube shorter/horizontal
URIs, allergies, auditory tube irritation
acute or chronic

Question 21

Otitis Media s/s

Answer 21

cold-like symptoms

upper respiratory problems

Question 22

Acute otitis media

Answer 22

inflammation of middle ear w/ acute onset
moderate - severe bulging of tympanic membrane
middle ear effusion
complications: rupture of tympanic membrane or temp conductive hearing loss
tx: ABX

Question 23

recurrent acute otitis media (AOM)

Answer 23

3 or more episodes of AOM in 6 months
or 4 + episodes in 12 months
RF: male, passive exposure to smoking, winter season

Question 24

chronic otitis media

Answer 24

infection > 6 weeks w/ persistent effusion in middle ear space
mild- moderate conductive hearing loss
TX: topical ABX or steroids, frequent cleansing of ear canal
severe: surgery/systemic ABX, ventilation/pressure equalization tubes

Question 25

bacterial otitis media vectors

Answer 25

acute: strep, pneumonia, haemophilius influenzae & M. catarrhalis chronic: pseudomonas aeruginosea, staph aureus, fungus

Question 26

otitis media drugs of choice/ supportive therapy

Answer 26

amoxicillin (clindamycin if allergic to PCN) meds for pain/edema/inflammation/itching NSAIDs or acetaminophen corticosteroids to tx severe pain

Question 27

otitis media in infants/todderls

Answer 27

pulling at ear decreased appetite postauricular & cervical lymph node enlargement sucking aggravates pain fever @ 104 decreased pain after tympanic membrane ruptures

Question 28

mastoiditis

Answer 28

inflammation of mastoid sinus > mucosal lining of middle ear children: acute complication of acute otitis media/recurrent bacterial otitis media adults: URI or exacerbationo f seasonal allergy rhinitis preces purulent material accumulates in mastoid cavitites usually: strep, pneumoniae, staph, MRSA

Question 29

mastoiditis DX

Answer 29

children: postauricular erythema, tenderness, swelling, mass, protrusion of auricle, otalgia, fever adults: typically unilateral, otalgia, decreased/muffled hearing, sudden relief of pain/purulent otorrhea if TM ruptures

Question 30

mastoiditis TX

Answer 30

children: empiric (vancomycin or linezolid) adults: empiric (amoxicillin clavulanate or cefdinir) pathogen-specific

Question 31

mastoiditis complications

Answer 31

``` ^ pressure = thin bones may be destroyed can result in hearing loss if untreated facial nerve paralysis osteomyelitis meningitis abscess ```

Question 32

otitis externa

Answer 32

inflammation/infection of external auditory canal cause: prolonged moisture = thriving bacteria increased incidence among cotton swab users can be acute/chronic bacterial/fungal (usually if immunocompromised) most common after swimming in lakes/rivers chronic: allergies, hearing aid irritation, autoimmune disorders prevention: avoid cotton swabs/aggressive use of swabs; dry ears after swimming or apply acidic drops after swimming (1:1 vinegar solution) TX: topical ABX

Question 33

otitis externa pharmacotherapy

Answer 33

topical ABX or ABX/corticosteroid combo chloramphenicol or ciprofloxacin or cipro+dexamethasone apply ear wick (otowick) > warm bottle dropper by rolling between hands 1-2 minutes (cold could cause dizziness), instill ABX drops onto wicks, leave wick in for 24-48 hours, replace until course complete

Question 34

ear disorder pharmacotherapy assess

Answer 34

baseline hearing/auditory status or other symptoms ask about hypersensitivy (hydrocortisone, neomycin sulfate, polymyxin B) many otic meds contra in perforated eardrum (if TM is perforated don't irrigate or put anything in) chloramphenicol contra in hypersensitivity/perforation (burning, redness, rash, swelling)

Question 35

Otosclerosis

Answer 35

abnormal bone growth in middle ear space associated w/ bilateral, slowly progressive, conductive (or mixed) hearing loss alternating bone resorption/formation, genetic component, viral factors, autoimmune

Question 36

otosclerosis s/s

Answer 36

conductive hearing loss possible reduced speech recognition ability tinnitus dizzinezz/imbalance aural fullness paracusis willisii (hear better in noise environment) DX: HX, otoscopy, audiologic results, radiologic studies

Question 37

otosclerosis TX

Answer 37

``` annual hearing tests surgical procedures hearing aids fluoride calcium vitamin D ```

Question 38

Presbycusis

Answer 38

hearing loss due to aging, idiopathic, most common form of hearing loss sensorineural types: sensory (loss of hair cells/high-frequency hearing deficit) metabolic-strial (loss of stria vascularis & low-frequency hearing deficit) neural (loss of ganglion cells/variable pattern of hearing deficit) s/s: progressive decrease in hearing thresholds, decreased ability to understand speech dX: HX, complete audiologic assessment

Question 39

presbycusis TX

Answer 39

hearing aids assistive listening devices cochlear implants rehabilitation

Question 40

meniere disease

Answer 40

inner ear disorder w/ both auditory & vestibular symptoms excess endolymph w/in membranous labyringth of inner ear (abnormal fluid/ions in inner ear) s/s: intense vertigo w/ accompnaying n/v, tinnitus, pressure or fullness in ear, fluctuating hearing loss

Question 41

meniere disease DX/TX

Answer 41

2 or + spontaneous episodes for 20 min to 12 hours, testing for low-mid frequency hearing loss definitive only postmortem TX: anti-nausea, antiemetics, vestibular suppressants, low-salt diet, avoid allergens, diuretics, surgical decompression of endolymphatic sac

Question 42

ototoxicity

Answer 42

``` SE of some medications (damages sensory cells of inner ears) most widely used meds (aminoglycoside ABX, platinum-based antineoplastic meds) chochleotoxic meds (aminoglycosides-neomycin): damage cochlea sensory cells = sensorineural heaing loss usually bilateral vestibulotoxic meds (aminoglycosides-strepteomycin/gentamicin): damages sensory cells of balance system usually bilateral ```

Question 43

factors affect ototoxic effects

Answer 43

age coexisting med conditions genetic drug/dosage/schedule

Question 44

ototoxic meds in high doses

Answer 44

loop diuretics/salicylates | tinnitus/hearing loss

Question 45

ototoxic monitoring/cautions

Answer 45

establish baseline hearing/balance patient education to avoid meds hearing aids/assistive devices vestibular rehabilitation

Question 46

cerumen impaction

Answer 46

mechanical obstruction earwax accumulates in ear canal > narrows canal > interferes w/ hearing earwax removal kits high seller, but excessive earwax requiring intervention is usually very rare

Question 47

cerumen impaction TX

Answer 47

removing excess earwax (instillation of earwax softner/gentle lavage w/ tepid water) carbamide peroxide teaching: don't go overboard w/ removal, fats/oild stick to foreign particles to keep them out, antibacterial properties of ear wax

Question 48

cerumen impaction s/s

Answer 48

``` pain in ear fullness in ear constant ringing noise in ear less hearing ability in affected ear cough dizziness ```

Question 49

vestibular schwannoma

Answer 49

``` acoustic neuroma sensoineural hearing loss neurofibromatosis type 2 RF: childhood exposure to low-dose radiation (head & neck), brain tumors, noise-exposure DX: MRI ```

Question 50

vestibular schwannoma s/s and TX

Answer 50

cerebellar compression tumor progression (CNS) hearing loss/tinnitus (cochlear nerve) unsteady ambulation (vestibular) facial numbness, pain (trigeminal) facial paresis, taste disturbance (facial) TX: surgery, radiation therapy (sterotactic, proton-beam)

Question 51

visual pathway

Answer 51

light into eye by cornea > anterior chamber > pupil > lens (image inverted) > light onto retina > optic nerve via optic disc normal vision: 20/20 (can see clearly an object at 20 feet)

Question 52

dry eyes

Answer 52

red eyes: usually caused by allergies eye fatigue, over-wearing contact lenses, common eye infections (conjunctivitis)

Question 53

dry eye TX

Answer 53

topical OTC that lubricate eye (artificial tears) or vasoconstrict capillaries of eye (stops transportation of inflammatory chemicals to site of irritation) naphazoline tetrahydrozoline phenylephrine

Question 54

hordeolum

Answer 54

stye tender/red/pus-filled bump along edge of eyelid bacterial infection in oil glands at base of eyelash resolves usually in a week w/out TX (warm compress)

Question 55

chalazion

Answer 55

``` painless lump in eyelid blockage of gland which makes tears sterile chronic inflammation hard, nontender resolves in days - week (warm compress) ```

Question 56

ptergium

Answer 56

benign growth on conjunctiva, may extend to cornea RF: high exposure to UV light, wind, airebone irritants causes for removal: unsightly, interferes w/ vision, causes discomfort

Question 57

conjunctivitis

Answer 57

viral or bacterial (highly contagious) s/s: redness, discharge, itching, burning in eye increased tearing, blurred vision, light sensitivity

Question 58

viral conjunctivitis

Answer 58

adenoviruses herpes simplex (< 5% = vision loss, blindness, keratitis) in neonates: chorioretinitis resolves 7 - 21 days

Question 59

bacterial conjunctivitis

Answer 59

resolves w/in 1 week symptoms persist up to 3 weeks TX: topical ABX

Question 60

allergic conjunctivitis

Answer 60

not contagious | treated w/ saline and/or oral & topical meds

Question 61

corneal abrasion

Answer 61

scratch or cut cornea causes: foreign body or chemical irritant, rubbing eye too hard or poking eye DX: fluorescein stain w/ wood's lamp, only after visual acuity, yellow/orange dye/stain

Question 62

external eye disorders s/s and TX

Answer 62

``` eye redness tearing eye pain blurred vision light sensitivity TX: flushing w/ water or sterile saline solution topical ABX and anti-inflammatories ```

Question 63

color blindness

Answer 63

red/green color blindness (most common) blue/yellow color blindness achromatopsia [total absence of color] (most severe) congenital or acquired

Question 64

strabismus

Answer 64

one or both eyes turn in/out/up/down if untreated = amblyopia (lazy eye) TX: occlusion therapy, vision therapy, prisms in glasses, surgery

Question 65

esotropia

Answer 65

inward turning of eye | strabismus

Question 66

extropia

Answer 66

outward turning of eye | strabismus

Question 67

myopia

Answer 67

nearsightedness refractive errors eye has long axial length, focus short of retina TX: concave glasses, contact lenses, laser surgery

Question 68

hyperopia

Answer 68

farsightedness refractive errors eye has short axial length, focus "behind" retina TX: convex glasses, contacts, lasersurgery

Question 69

astigmatism

Answer 69

refractive errors eye has elliptical shape, focus on two points in eye TX: toric glasses, contacts, laser surgery

Question 70

presbyopia

Answer 70

refractive errors decline in focusing ability of eye (ciliary muscle) TX: convex glasses

Question 71

amblyopia

Answer 71

refractive errors one or both eyes can't see clearly despite corrective lenses vision loss an be irreversible if not treated before age 8 TX: correction of refractive error & occlusion therapy

Question 72

accommodation

Answer 72

lens if flatter for distant object light and more convex for closer rays. both brought to focus on the retina

Question 73

hyperopia and myopia corrected by

Answer 73

biconvex lens or bi concave lens

Question 74

heterochromia

Answer 74

irises are different colors complete (two different colors) partial (part or both different colors) central (inner ring different than outer)

Question 75

congenital heterochromia

Answer 75

``` may be benign associated w/: horner's syndrome sturge-weber syndrome waardenbur piebaldism hirschsprung bloch-sulzberger parry romber recklinghausen bourneville ```

Question 76

acquired heterochromia

Answer 76

``` eye injury bleeding in eye swelling iritis or uveitis fuch's heterochromic cyclitis acquired horner's glaucoma litisse (med for glaucoma or eyelash growth) pigment disbursement syndrome ocular melanosis diabetes chediak-higashi iris ectropian syndrome ```

Question 77

cataracts

Answer 77

cloudy or opaque discoloration of lens causes: age-related, trauma, congenital anomalies, systemic disease, pharmacologic triggers DX: opthalmologic exam TX: limit exposure to UV light, surgery, artificial lens, ultrasonic vibrations, capsulotomy s/s: blurred vision

Question 78

glaucoma

Answer 78

increased intraocular pressure normal: 12- 22 mmHg slow, painless progressive loss of vision/optic nerve damage/visual-field loss leading cause of preventable blindness open-angle or close-angle both b/c of buildup of aqueous humor (excessive production of blockage of outflow)

Question 79

glaucoma risk factors

Answer 79

``` long-term use of some medications (glucocorticoids, antihypertensives, antihistamines, antidepresssants) hypertension migraine headaches severe near/far sightedness normal aging (>80) ```

Question 80

ocular hyptension

Answer 80

>22 mmHg pressure but not s/s of glaucoma

Question 81

glaucoma vision

Answer 81

curtain like black edges, can clearly see central only extreme is worse than advanced

Question 82

open angle glaucoma

Answer 82

``` peripheral vision affected first then central 90% of cases usually bilateral develops slowly over years asymptomatic at first (bloind spots, ptaches of vision losss) if untx = blindness iris does not cover opening dx: routine eye exam ```

Question 83

open angle glaucoma TX

Answer 83

eye drops lower production of aqueous humor/increase outflow

Question 84

close angle glaucoma

Answer 84

acute/narrow-angle glaucoma 5% of cases usually unilateral iris pushed over drainage area = angle narrows/closes causes: stress/impact injury/meds, sudden increase in IOP

Question 85

close angle glaucoma s/s

Answer 85

``` abrupt onset steamy looking cornea redness dull-to-severe eye pain HA bloodshot eyes foggy vision w/ halos bluging iris fixed pupil dilation DX: measure IOP w/ tonometer/pupils ```

Question 86

close angle glaucoma TX

Answer 86

``` medical emergency = surgery can loos vision in 2-3 hours from onset miotic eye drops carbonic anhydrase inhibitors acetazolamide irridectomy ```

Question 87

glaucoma pharmacology

Answer 87

goal: prevent damage to optic nerve by lowering IOP if IOP 21 - 30 mmHg = begin tx many antiglaucoma drugs affect autonomic nervous system

Question 88

glaucoma meds

Answer 88

prostaglandins (dilate trabecular meshwork = ^ AH outflow) beta-adrenergic blockers (decrease AH production/SE: bronchoconstriction/dysrhthmias/hypotension) alpha-adrenergic agonists (decrease AH production) carbonic anhydrase inhibitors (decrease AH production) cholinergic agonists (miotics) (constrict pupil = more outflow) osmotic diuretics - mannitol (reduce formation of aqueous humor)

Question 89

latanoprost

Answer 89

antiglaucoma drug (prostaglandin) reduces IOP by increasing outflow of AH 1 drop in affected eye in evening (peak affect in 12H) SE: conjuctival edema, tearing, dryness, burning, pain, irritation, itching, feeling of foreign body in eye, photophobia, visual disturbances, eyelashes thicker/darker, change in iris color contra: pregnancy, lactation, intraocular infection, conjunctivitis, closed-angle glaucoma interx: thimerosal (causes precipitation) C

Question 90

timolol

Answer 90

antiglaucoma drug (beta-adrenergic blocker) reduces formation of AH requires 2-4 weeks for effect SE: local burning/stinging upon application, temp blurred vision, if misapplied = hypotension, disrhythmia contra: ashtma, severe COPD, sinus bradycardia, second/third degree AV block, heart failure, cardiogenic shock interx: other beta-blockers, anticholinergics, nitrates, methyldopa, verapmil ]= hypotension/brady; w/ epinephrine = HTN followed by severe bradycardia C

Question 91

uveitis

Answer 91

inflammation in one or more tissues composing uvea (iris, choroid, cilliary body beneath cornea/sclera) anterior/posterior or both

Question 92

uveitis TX

Answer 92

meds most common surgery (vitrectomy) to remove small amount of vitreous humor corticosteroids (prednisolon Q4-5 hrs x2Days then taper) sometimes ABX immunosuppressive/cytotoxic drugs (severe bilateral cases)

Question 93

uveitis s/s

Answer 93

eye redness pain blurred vision

Question 94

retinopathy

Answer 94

any disorder/damage to retina

Question 95

diabetic retinopathy (types, DX)

Answer 95

non-porliverative vs proliferative (PDR) DX: through opthalmologic exam TX: fluorescein angiography & laster

Question 96

retinal detachment

Answer 96

retina separates from underlying structures often described as "hanging curtain" RF: significant myopia, cataract surgery, trauma

Question 97

diabetic retinopathy

Answer 97

disorder of retina's blood vessels caused by glucose destruction (post 20 yrs of DM 99% of T1, 60% T2) asymptomatic in early stages s/s: blurred vision, floaters, distored vision, dark areas, poor night vision, novascularization in retina (new vessels) TX: tight control of diabetes, laser surgery, vitrectomy

Question 98

non-proliferative DR

Answer 98

structural&functional abnormalities of retinal vessels; basement membrane of retinal blood vessels thickened

Question 99

poliferative DR

Answer 99

appearance of new vessels sprouting on surface of either optic nerve or retina (neovascularization)

Question 100

retinal detachment s/s

Answer 100

painless but w/ warning signs sudden appearance of many floaters curtain-like shadow over visual field floaters diminish gradually over weeks/months but don't go away completely

Question 101

retinal detachment patho/etiology

Answer 101

etiology: inflammation, fluid build up, vascular injuries, trauma liquefied vitreous humor seeps through tear detached retina sends wrong messages to brain thru optic nerve = blurred then failed vision

Question 102

retinal detachment TX

Answer 102

``` scleral buckles (tiny synthetic band attached to outside of eyeball to gently push wall of eye against detached retina) maybe vitrectomy if necessary ```

Question 103

retinal detachment vision

Answer 103

spots of black | some corners hidden

Question 104

age-related macular degeneration etiology/patho

Answer 104

low perfusion & inflammation distortion/loss of central vision dry - non-exudative (most common) = blurry/wavy central vision, normal peripheral vision wet - exudative (more severe) = new blood vessels grow around macula causing bleeding, scarring, photoreceptor atrophy

Question 105

age-related macular degeneration RF

Answer 105

``` age genetics smoking Caucasian obesity diet ```

Question 106

age related macular degeneration TX

Answer 106

no cure delay progression/improve vision depends on if dry or wet (can lead to serious vision loss) wet = stopping abnormal BV growth w/ photodynamic light therapy monthly ranibizumab injections

Question 107

macular degeneration vision

Answer 107

object obstruction blurry blurry blocks

Question 108

nystagmus

Answer 108

rapid, involuntary eye movement latent (rare, RF amblyopia/strabisumus) congenital (most commonly horizontal/fixed in direction)

Question 109

acquired nystagmus

Answer 109

peripheral (disruption of normal function of sensory cells in peripheral balance system; horizontal in direction ; abducens cranial nerve palsy) central acquired nystagmus (can be vertical rotary, horizontal, oblique, may be faster when eyes are open vs closed)

Question 110

ocular trauma

Answer 110

globe rupture (pupil forms "tear drop" shape/points to rupture area) fractures to orbital bones/floor (can result in impingement, eye cannot move, increased IOP) lateral canthotomy

Question 111

lateral canthotomhy

Answer 111

surgical intervention to allow the eye to bulge out/help relieve IOP