Adult Med

Front 1

What should normally happen w/a Weber Test?

Back 1

Sound should not lateralize.
Conductive loss-sound lateralizes to impaired ear.
Sensorineural loss-sound is lateralized to good ear.

Front 2

What should normally happen w/a Rinne test?

Back 2

AC>BC
Conductive loss-BC=AC or BC>AC

Sensorineural loss-AC>BC

Front 3

Sensory hearing loss;

Back 3

(Meniere's dz) Due to disorders in the inner ear, speifically the cochlea.

Front 4

Neural hearing loss;

Back 4

Problem w/the auditory nerve, most important cause acoustic neuroma, benign tumor that grows on the vestibular nerve, & presses on the auditory nerve.
Test-Acoustic reflex

Front 5

Conductive hearing loss;

Back 5

Results from external or middle ear problem. Causes; otitis media, cerumen impaction, & otoclerosis.

Front 6

Indications for ear lavage;

Back 6

Totally occlusive cerumen (prevents visulization of the TM), Pain, Itching, Reduced hearing, Tinnitus, Otitis externa (if ear suctioning is not available)

Front 7

Otitis Externa;

Back 7

(gram-)Pseudomonas, Proteus, Fungus. Painful manipulation of auricle & tragus. TM/Red, canal edematous, TM responds to pneumatic O. Otic ABX & steroid (make sure med can get in)

Front 8

Estacian Tube Dysfunction;

Back 8

Due to inflammitory process in; Nasopharynx, allergic manifestations, hypertrophic adenoids, benign or malignant Neoplams. Tx; Sudafed (restores patency to tube), Correction of underlying problem.

Front 9

Barotrauma;

Back 9

Damage due to pressure changes (pressure in middle ear is lower than ambient pressure), Membrane is retracted, Nasovasoconstrictor applied topically 30-60min before decent (prophylatic)

Front 10

Barotrauma Etiology;

Back 10

A transudate of blood from the vessels in the lamina propria of the mucous membran forms in the middle ear. If pressure differenc becomes great ecchymosis & subepithelial hematoma may develop in the mucous membrane of the middle ear & TM.

Front 11

Cholesteatoma Etiology;

Back 11

A benign tumor that destroys the incus, staples & malleus. During the healing of acute necrotizing otitis media, epithelium of the ear canal migrate to cover the denuded areas. Once the epithelium is established in the middle ear it begins to desquamate & accumulate resulting in a cholesteatoma.

Front 12

Cholestetoma;

Back 12

Cholestetomas actively erode bone. Hearing loss, discharge (bad smell). Tx; ABX (po & gtts), Weekly cleaning undert the surgical microscope, surgical removal.

Front 13

Otosclerosis;

Back 13

Common cause of progressice conductive hearing loss, normal bone is replaced by spongy, vascular bone that hardens (anterior oval window), addition of bone causes the stapes to become immobile & unable to transmit sound to the cochlea.

Front 14

Otosclerosis S/Sx;

Back 14

Conductive hearing loss, Pinkish or rosy tint on TM (Schwartz sign), Air-bone gap, 85% bilateral, Excellent speech discrimination, 70% tinnitus, 25% Vertigo, hears better in noise.

Front 15

Otosclerosis Tx;

Back 15

Na flouoride, hearing aids, Stapedectomy (removal of stapes) 97%-99% effective.

Front 16

Tinnitus;

Back 16

Perception of sound in its absence, Indicates sensory hearing loss, Damage to inner ear, middle ear inf, any ear disorder, Aneurysm's, hardening of arteries, Med toxicity.

Front 17

Tinnitus Tx;

Back 17

Tx underlying cause, background music, hearing aid, avoid further damage.

Front 18

Meniere's Dz;

Back 18

Characterized by; recurrent vertigo, sensory hearing loss, tinnitus, feeling of fullness in ear. Lesion on & Distention of endolymphatic compartment. Tx; empirical, surgery for severely affected people, Anticholinergic drugs, antihistamines, barbituates, Na restrictions, no caffeine, no smoking, exercise.

Front 19

Acoustic Neuroma;

Back 19

Derived from schwann cells, account for 7% of intracranial tumors, tumor presses on 5th & 7th cranial nerve. S/Sx; Sensorineural Hering loss & tinnitus, dizzinesss (no true vertigo), >impairment of speech discrimination, Acoustic reflex decay, marked vestibular hypoactivity. MRI & gadolinium enhancement. Tx; Surgery.

Front 20

Prebycusis;

Back 20

Sensorineural hearing loss ocurs as pt ages, (>65) Men>women.
Tx; hearing aid

Front 21

Purulent Labyrinthitis;

Back 21

Invasion of the inner ear by bacteria. Frequently followed by meningitis. May be secondary to Acute OM or Purulent meningitis. Characterized by; Severe vertigo, Nystagmus, Complete hearing loss, Cholesteatoma, Facial Paralysis. Tx; IV ABX & Labyrinthectomy to drain the inner ear or radical mastoidectomy.

Front 22

Noise Trauma;

Back 22

Any noise >85dB is damaging. High freq tinnitus usually accompaines hearing loss.

Front 23

Vestibular Neuronitis;

Back 23

Benign disorder, Viral, 1st attack of vertigo is severe, (nausea & vomiting) for 7-10days. Nystagmus on affected side, self limiting. Tx; Anticholinergic drugs, antihistamines, barbituates, Na restrictions, no caffeine, no smoking, exercise. IV fluids & electrolytes for fluid replacement PRN.

Front 24

Drug of choice for Acute Otitis Media?

Back 24

High dose Amoxicillin90mg/kg qd divided q 8-12hrs.
Nasal decongestionant helps w/sx.

Front 25

Mastoiditis;

Back 25

Bacterial inf in the mastoid process. Extension of acute purulent otitis media, can cause destruction of mastoid process. Streptococcal mastoiditis proceeded by perforation of TM & profuse otorrhea. Pneumococcal mastoiditis may be less symptomatic. Onset >2wks p untreated acute OM, Abscess, Pinna is displaced laterally & inferiorly, creamy profuse d/c.

Front 26

Mastoiditis Tx;

Back 26

ABX (same as for OM), C&S to determine ABX, IV therapy, Mastoidectomy, Meningitis.

Front 27

Acute otitis media;

Back 27

Inflammation of middle ear w/rapid onset of sx. Pathogens; Strep, Pneumoniae, & HiB.

Front 28

Acute otitis media S/Sx;

Back 28

Are nonspecific & often result from an URI. Decreases TM mobility, Bulging TM, Impaired visibility of ossicular landmarks, TM red or yellow, Exudate on the membrane & bullae.

Front 29

Acute otitis media complications;

Back 29

Tympanosclerosis, Adhesions, Ossicular erosions, Perforations, Cholesteatoma, Mastoiditis, Osteomyelitis, Meningitis, Sinus Thrombosis, Facial Paralysis.

Front 30

Serrous otitis media;

Back 30

Auditory tube remains blocked for a prolonged peroid. Neg pressure results in transudation of fluid. Plugged ear feeling.

Front 31

Serrous otitis media findings;

Back 31

Visualization of air-fluid levels, clear or amber middle ear fluid, diminished membrane mobility, Air bubbles, conductive hearing loss.

Front 32

Serrous otitis media Tx;

Back 32

Po corticosteroids, Po ABX, if no improvement Ventilation tubes.

Front 33

Chronic Otitis Media;

Back 33

Develops as a result of recurrent otitis media. Bacteria; Pseudomonas aeruginosa, Proteus, Staph aureus & mixed anaerobin inf. Purulent aural d/c.

Front 34

Chronic Otitis Media Tx;

Back 34

Removal of debris, no H2O exposure, Topical ABX (only floxin indicated for perforated TM. Surgical repair of TM.

Front 35

Perforated TM;

Back 35

May repture as result of untx TM, due to increases pressure. Complications; Conductive hearing loss, exacerbations of otorrhea, labyrinthitis, facial paralysis, intracranial suppuration. Tx; ABX, C&S, Surgical removal of debris (& cholesteatoma) middle ear reconstruction.