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Pathophysiology and Pharmacology 2 > Sensory: Hearing/Balance/Vision > Flashcards

Sensory: Hearing/Balance/Vision Flashcards

1
Q

Conductive hearing loss

A

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

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2
Q

sensorineural hearing loss

A

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

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3
Q

mixed hearing loss

A

inner & outer ear

both sensorineural and conductive loss

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4
Q

inner ear hearing disorder

A

cochlear hair cell or auditory nerve dysfunction

a very common disorder

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5
Q

inner ear hearing disorder systemic

A

referral crucial: to audiologist or otolaryngologist

promt management of sudden hearing loss can reverse impact

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6
Q

inner ear hearing disorder cause

A 
genetic
infectious
vascular
neoplastic
traumatic
toxic
iatrogenic
degenerative
immunologic/inflammatory
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7
Q

weber’s test

A

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

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8
Q

rinne’s test

A

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)

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9
Q

sensorineural hearing loss progression

A

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

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10
Q

genetic hearing loss

A

very common birth defect

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

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11
Q

genetic hearing loss TX

A

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

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12
Q

noise-induced hearing loss

A

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

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13
Q

noise-induced hearing loss tx

A

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

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14
Q

NIOSH allowable hearing exposure limits

A 
8 hours a day for 85-dB sound
reduction in exposure at >85 dB
60 dB = conversation 
90 = motorcycle/lawnmower
110-120 = concert/chainsaw
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15
Q

conventional aids

A

amplify within canal

place in ear canal

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16
Q

osseointegrated bone-conducting hearing prostheses

A

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

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17
Q

implantable middle ear hearing devices

A

interface at level of ossicles & bypass eardrum

typically used for mild-moderate sensorineural hearing losss

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18
Q

cochlear implants

A

directly stimulate remaining neural elements w/in cochlea

used for severe or profound hearing loss

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19
Q

outer ear disorders

A

most highly treatable

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

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20
Q

Otitis Media

A

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

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21
Q

Otitis Media s/s

A

cold-like symptoms

upper respiratory problems

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22
Q

Acute otitis media

A

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

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23
Q

recurrent acute otitis media (AOM)

A

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

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24
Q

chronic otitis media

A

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

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25
Q

bacterial otitis media vectors

A

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

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26
Q

otitis media drugs of choice/ supportive therapy

A

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

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27
Q

otitis media in infants/todderls

A

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

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28
Q

mastoiditis

A

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

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29
Q

mastoiditis DX

A

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

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30
Q

mastoiditis TX

A

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

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31
Q

mastoiditis complications

A 
^ pressure = thin bones may be destroyed
can result in hearing loss if untreated
facial nerve paralysis
osteomyelitis
meningitis
abscess
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32
Q

otitis externa

A

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

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33
Q

otitis externa pharmacotherapy

A

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

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34
Q

ear disorder pharmacotherapy assess

A

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)

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35
Q

Otosclerosis

A

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

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36
Q

otosclerosis s/s

A

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

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37
Q

otosclerosis TX

A 
annual hearing tests
surgical procedures
hearing aids
fluoride
calcium 
vitamin D
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38
Q

Presbycusis

A

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

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39
Q

presbycusis TX

A

hearing aids
assistive listening devices
cochlear implants
rehabilitation

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40
Q

meniere disease

A

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

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41
Q

meniere disease DX/TX

A

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

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42
Q

ototoxicity

A 
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
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43
Q

factors affect ototoxic effects

A

age
coexisting med conditions
genetic
drug/dosage/schedule

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44
Q

ototoxic meds in high doses

A

loop diuretics/salicylates

tinnitus/hearing loss

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45
Q

ototoxic monitoring/cautions

A

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

46
Q

cerumen impaction

A

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

47
Q

cerumen impaction TX

A

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

48
Q

cerumen impaction s/s

A 
pain in ear
fullness in ear
constant ringing noise in ear
less hearing ability in affected ear
cough
dizziness
49
Q

vestibular schwannoma

A 
acoustic neuroma
sensoineural hearing loss
neurofibromatosis type 2
RF: childhood exposure to low-dose radiation (head & neck), brain tumors, noise-exposure 
DX: MRI
50
Q

vestibular schwannoma s/s and TX

A

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)

51
Q

visual pathway

A

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)

52
Q

dry eyes

A

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

53
Q

dry eye TX

A

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

54
Q

hordeolum

A

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)

55
Q

chalazion

A 
painless lump in eyelid
blockage of gland which makes tears
sterile chronic inflammation
hard, nontender
resolves in days - week (warm compress)
56
Q

ptergium

A

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

57
Q

conjunctivitis

A

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

58
Q

viral conjunctivitis

A

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

59
Q

bacterial conjunctivitis

A

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

60
Q

allergic conjunctivitis

A

not contagious

treated w/ saline and/or oral & topical meds

61
Q

corneal abrasion

A

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

62
Q

external eye disorders s/s and TX

A 
eye redness
tearing
eye pain
blurred vision
light sensitivity
TX: flushing w/ water or sterile saline solution
topical ABX and anti-inflammatories
63
Q

color blindness

A

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

64
Q

strabismus

A

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

65
Q

esotropia

A

inward turning of eye

strabismus

66
Q

extropia

A

outward turning of eye

strabismus

67
Q

myopia

A

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

68
Q

hyperopia

A

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

69
Q

astigmatism

A

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

70
Q

presbyopia

A

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

71
Q

amblyopia

A

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

72
Q

accommodation

A

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

73
Q

hyperopia and myopia corrected by

A

biconvex lens or bi concave lens

74
Q

heterochromia

A

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

75
Q

congenital heterochromia

A 
may be benign
associated w/: 
horner's syndrome
sturge-weber syndrome
waardenbur
piebaldism
hirschsprung
bloch-sulzberger
parry romber 
recklinghausen
bourneville
76
Q

acquired heterochromia

A 
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
77
Q

cataracts

A

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

78
Q

glaucoma

A

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)

79
Q

glaucoma risk factors

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

ocular hyptension

A

> 22 mmHg pressure but not s/s of glaucoma

81
Q

glaucoma vision

A

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

82
Q

open angle glaucoma

A 
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
83
Q

open angle glaucoma TX

A

eye drops lower production of aqueous humor/increase outflow

84
Q

close angle glaucoma

A

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

85
Q

close angle glaucoma s/s

A 
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
86
Q

close angle glaucoma TX

A 
medical emergency = surgery 
can loos vision in 2-3 hours from onset
miotic eye drops
carbonic anhydrase inhibitors
acetazolamide
irridectomy
87
Q

glaucoma pharmacology

A

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

88
Q

glaucoma meds

A

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)

89
Q

latanoprost

A

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

90
Q

timolol

A

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

91
Q

uveitis

A

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

92
Q

uveitis TX

A

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)

93
Q

uveitis s/s

A

eye redness
pain
blurred vision

94
Q

retinopathy

A

any disorder/damage to retina

95
Q

diabetic retinopathy (types, DX)

A

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

96
Q

retinal detachment

A

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

97
Q

diabetic retinopathy

A

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

98
Q

non-proliferative DR

A

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

99
Q

poliferative DR

A

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

100
Q

retinal detachment s/s

A

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

101
Q

retinal detachment patho/etiology

A

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

102
Q

retinal detachment TX

A 
scleral buckles (tiny synthetic band attached to outside of eyeball to gently push wall of eye against detached retina)
maybe vitrectomy if necessary
103
Q

retinal detachment vision

A

spots of black

some corners hidden

104
Q

age-related macular degeneration etiology/patho

A

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

105
Q

age-related macular degeneration RF

A 
age
genetics
smoking
Caucasian
obesity
diet
106
Q

age related macular degeneration TX

A

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

107
Q

macular degeneration vision

A

object obstruction
blurry
blurry blocks

108
Q

nystagmus

A

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

109
Q

acquired nystagmus

A

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)

110
Q

ocular trauma

A

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

111
Q

lateral canthotomhy

A

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

Pathophysiology and Pharmacology 2 (27 decks)

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