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61 Cards in this Set
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A spinning sensation accompanied by nystagmus and ataxia. |
Vertigo
Bates pg 252 What are the two main causes of vertigo? |
1) Peripheral vestibular dysfunction (approx. 40% of "dizzy" patients)
2) Central brainstem lesion ( about 10%; include atherosclerosis, multiple sclerosis, TIA, vertebrobasilar migraine) |
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A near faint from "feeling faint or lightheaded"
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Presyncope
Bates pg 252 Question: What are the causes of presyncope? |
orthostatic hypotension (s/t medication)
arrhythmias vasovagal attack |
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Unsteadiness or imbalance while walking, especially in older patients
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Dysequilibrium
Bates pg 252 Question: What are the causes of dysequilibrium? |
Fear of walking
Visual loss Weakness from musculoskeletal peripheral neuropathy (up to 15%) |
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Name three central causes of vertigo
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1) Brainstem and cerebellar dysfunction
2) Multiple Sclerosis (50% of MS patient have vertigo) 3) Migraine HA (30% of migraine HA patients have vertigo) Dains pg 155 Question: What are the common causes of brainstem and cerebellar dysfunction? |
1) Neoplasm (gradual)
2) Vascular (acute onset, long lasting, or recurrrent): TIA, stroke |
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A type of vertigo with acute onset lasting few seconds. Hearing not affected. No tinnitus. Occasional N/V and nystagmus.
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Benign Positional Vertigo
Bates pg 252 Questions: are the differences between BPV and Meniere's Disease? |
BPV: few seconds, < 1 minute
MD: several hours to > 1 day BPV: hearing not affected MD: sensorineural haring loss BPV: no tinnitus MD: present, fluctuating |
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A type of vertigo that is frequently preceded by an acute viral infection. Onset is sudden and last hours to 2 weeks. Hearing not affected. No tinnitus. N/V and nystagmus present.
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Vestibular Neuronitis
Bates pg 252 Question: what is another name for VN? |
Acute Labryinthitis
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What is a classic triad of symptoms in Meniere disease?
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Vertigo, hearing loss, and tinnitus
Bates pg 252, Dains 155 Question: what kind of hearing loss and what type of onset for MD? |
Sensorineural hearing loss
Acute onset |
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A type of vertigo that is caused by insidious compression of vestibular branch of the CN VIII (acoustic)
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Acoustic Neuroma
Bates pg 252, Dains pg 156 Question: Do hearing loss and tinnitus occur/present? What other CN might be affected too? |
Unilateral sensorineural hearing loss
Tinnitus present CN V (trigeminal) and VI (abducens) Bates pg. 252 |
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A type of vertigo that is linked to medications or ETOH
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Drug toxicity
Bates pg 252 Question: what are the medications common in this vertigo? |
Loop diuretic
Aminoglycosides Salicylates Bates pg 252 |
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Which part of the ears are affected for conductive loss and sensorineural loss?
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CL: External to middle ear
SL: Inner ear (involves the cochlear nerve and neuronal impulse transmission to the brain) Bates pg. 271 Question: what are the age onset for CL and SL? |
CL: childhood up to 40 y/o
SL: middle or later years |
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What are the causes of conductive hearing loss?
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Foreign body
Otitis Media Perforated eardrum Otosclerosis of ossicles Bates pg 271 Question: What are the causes of sensorineural hearing loss? |
Noise exposure
Inner ear infection Trauma Tremors Congenital and familial disorder Aging |
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How to perform Weber Test?
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Tuning fork at vertex
Bates pg. 271 Question: How do you perform Rinne Test? |
Tuning fork at external auditory meatus then on mastoid bone
Bates pg 271 |
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What is the result of Weber Test to dx conductive hearing loss?
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Sounds lateralizes to impaired ear (because detection of vibration improves when room noise not well heard)
Bates pg 271 Question: What is the result of the Weber Test for sensorineural hearing loss? |
Sounds lateralizes to unimpaired (good) ear. (because cochlear nerve damage impairs transmission to affected ears)
Bates pg 271 |
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What is the result for Rinne test to dx conductive hearing loss?
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BC > or = AC
(Because air conduction through the external or middle ear is impaired, vibration through bone bypass the problem to reach the cochlea) Bates pg 271 Question: What is the result for the Rinne test to dx sensorineural hearing loss? |
AC > BC (normal finding)
The inner ear or cochlear nerve is less able to transmit impulse regardless of how the vibrations reach the cochlea |
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A 3 year old boy came in feeling irritable, pulling of his ear and having sudden onset of ear pain after having upper respiratory infection. What is the DD?
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Acute Otitis Media (AOM)
AOM often occurs in children < 6 y/o and is associated with URI Dains pg 181 Question: What are your findings on AOM in terms of the boy's TM and lymph node? |
TM: erythematous; distorted landmark; possible bulging; decreased in mobility
Swelling of the preauricular node (sometimes seen in children in AOM) |
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What are the differences between Acute Otitis Media (AOM) and Otitis Media with Effusion (OME) in terms of patient's symptoms?
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AOM: ear pain and irritability
OME: asymptomatic Dains pg 181 Question: What are you physical findings on patient with OME in terms of the TM? |
TM: dull, decreased mobility, collection of fluid that resembles mucus, air bubbles, or a fluid level.
Dains pg 181 |
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What are some prevention can a mother take to prevent her baby from having Otitis Media (OM)?
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1) Breastfeeding
2) Avoid second hand smoking 3) Avoid putting baby flat with a bottle Hollier pg 180 Question: The 3 month old baby was finally dx with AOM. What are the pharmacological and nonpharmacological interventions can you prescribe? |
Pharm:
Analgesics/Antipyretics (Antibiotics do NOT relieve pain in the first 24 hours!) Antibiotics only prescribed if dx is confirmed and the child is > 6 months old) Non Pharm: Local heat Swallowing to help the eustachian tube ventilate Family education Hollier pg 181 |
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What are the risk factors for Otitis Media (OM)?
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1) Daycare
2) Craniofacial abnormalities 3) URI 4) Allergic rhinitis 5) Second hand smoker 6) Bottle fed while in supine position 7) First AOM < 12 months Hollier pg 180 Question: What age is common for OM? What time of the year is common of OM? |
6 months to 3 y/o
Winter months |
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Where is the location of "cone of light" in TM in terms of using the clock?
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4 to 5 o'clock of the TM
Bates pg 224. Question: how do you document in the SOAP note that you saw the cone of light? |
+ light reflex
Lithgow's note |
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You were performing a "tug test" of the right ear of a patient and the patient c/o pain. What is your DD?
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Otitis Externa
Patients with OM will not c/o pain during the "tug test" Bates pg 225. Question: How do you "pull" the ears to inspect the EAC and TM of an adult and a child? |
Adult: Up and Back (remember, adults are TALL, hence UP)
Child: Down and Back (children are SHORT, hence DOWN) |
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A 20 y/o patient c/o pain and itching when touching his right ear and some hearing loss after swimming. What is the DD?
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Otitis Externa (also known as "swimmer's ear")
Hollier pg 178 Question: What do you find in your PE? |
1) Edema or erythema in the EAC
2) Purulent discharge in EAC 3) Tragal and/or pinna pain 4) Normal TM 5) Conductive hearing loss |
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A patient is c/o of ear pain, what system do you assess besides the ear?
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1) Head, Neck, Eye, Nose
2) Sinuses, esp for the maxilla and frontal 3) Mouth, teeth, pharynx 4) Lymph nodes, esp preauricular and posterior auricular 5) Neuro for TMJ 6) CN for referred ear pain. Dains pg 180-182 Question: Which CNs are associated with the anatomy of the ears? |
CN V (trigeminal) - auricle and tragus; auditory canal, and TM
CN VII (facial), CN XI (glossalpharyngeal) and CN X (vagus) - TM and EAC Dains pg 182 |
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A 50 year old man c/o of his right ear pain and right cheek pain when eating. Pain is usually worsen in the morning. Ear examination is normal and he has history of dental malocclusion.
What is your DD? |
TMJ disease
Dains pg 183 Question: How do you palpate the TMJ to confirm the dx? |
1) Place the tips of your index fingers just in front of the tragus of each ear
2) Ask patient to open his/her mouth 3) The fingertips should drop into the joint spaces as the mouth opens |
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What is otalgia?
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Earache
Question: What is otorrhea? |
Discharge from the ear, especially purulent
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What is otorrhagia?
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Hemorrhage from the ear
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A two year old boy came in with persistent right side otalgia, fever, and postauricular swelling and tenderness. The patient had recurrent OM in the past. Upon ear examination, you notice creamy and profuse otorrhea and conductive hearing loss.
What is your DD? |
Mastoiditis
Hollier pg 177 Question: when do you refer the patient to the ENT immediately? |
When symptoms of AOM persists beyond 2 weeks even if the TM appears normal
Hollier pg 177 |
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What is myopia?
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Impaired far vision (nearsightedness)
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What is presbyopia?
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Impaired near vision (aging vision)
Question: At what age does presbyopia occur? |
Middle aged and older adults
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What is diplopia?
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double vision
What are the causes of diplopia? |
1) Brainstem or cerebellum lesion
2) Weakness or paralysis of one of the EO muscles, CN III, VI, or IV 3) Cornea or lens (for diplopia on one eye) Bates pg 198 |
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What is hyperopia?
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Farsightedness
Question: what are the difference between hyperopia and presbyopia? |
Hyperopia = refractive disorder caused by flat cornea
Presbyopia = non-refractive disorder due to old age. |
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What are the differences between primary and secondary headaches?
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Primary HA = no identifiable underlying cause
Secondary HA = arise from other conditions Bates pg 197 Question: What are three common primary headaches? |
1) Migraines
2) Tension 3) Cluster |
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What are the differences among migraine, tension HA and cluster HA, in terms of their locations?
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Migraines = unilateral (70%), bifrontal or global (30%)
Tension = Bilateral; frontotemporal Cluster = Unilateral; behind or around eyes Bates pg 249 Question: What are the differences among migraine, tension HA and cluster HA in terms of their onset? |
Migraine = fairly rapid, peak in 1-2 hrs
Tension = gradual, peak over several hrs (THINK OF MUSCLE TENSION) Cluster = abrupt, peak in minutes (THINK OF VASCULAR) Bates pg 249; Dains pg 229 |
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A 25 year old male came in with headache, N/V, and visual disturbances. He described the pain as throbbing and aching and lasted for more than 24 hrs.
What is your DD? |
Migraine HA.
Note: Only Migraine HA gets N/V and visual auras. Bates pg 249 Question: What are the pharma and non-pharma interventions for this patient? |
Pharma:
1) "Triptans" (serotonin 5HT1 receptor agonists) 2) Ergotamine-caffeine 3) NSAIDs Non-Rx: 1) Darkened room 2) Quiet environment |
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An 80 year old man came in with a new onset headache with no hx or family hx of HA. Do you suspect the pt has primary HA or secondary HA?
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Secondary. New onset HA in elderly tend to have a secondary cause, such as tumor, bleed, etc
Hollier pg 425 Question: what are the common origins of secondary HA? |
1) Infectious origin
Sinusitis, dental infection, pharyngitis, OM, meningitis 2) Neurogenic Trigeminal neuralgia, optic neuritis, cervical spine disorders, temporal arteritis 3) Metabolic CO poisoning, severe hypoglycemia, drug withdrawal, dietary ingestion 4) Cerebrovascular Intracranial tumor, hydrocephalus, subdural hematoma, brain abscess, intracerebral hemorrhage Dains pg 232-233 |
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What type of HA has genetic component in it?
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Migraine HA (more than 80% have + family hx)
Hollier pg 425 Question: Which type of HA is usually caused by stress and worry? |
Tension HA
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Which HA is sometimes referred to as a suicide HA?
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Cluster HA
- male gender (6:1) - age > 30 years - occurs in stressful situation - high rate of suicide or self harm during the HA cycle Hollier pg 425 |
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What type of foods and medications can cause migraine HA?
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1) Tryptophan or tyramine rich foods: cheeses, red wines, or chocolate
2) ETOH 3) Estrogen replacement 4) Missing meals Hollier pg 425 Question: what are the prevalence of migraine HA among men and women? |
Women (15%) > Men (6%)
Note: In cluster HA, Men > Women |
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A patient came in with a round or "moon" face with red cheeks, excess hair growth on the face. The patient also has
What is your DD? |
Cushing Syndrome
Bates pg 253 Question: What hormones are involved in CS? |
Pituitary adrenocorticotropic hormone (ACTH) excess (usually caused by pituitary tumor) --> over secretion of cortisol in adrenal gland --> Cushing Syndrome
Dunphy pg 857 |
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A patient came in with dull and puffy face, especially around the eyes. Her hair and eyebrows are dry, coarse, and thinned. Her skin is dry as well.
What is your DD? |
Myxedema (severe hypothyroidism)
Bates pg 253 Question: What other physical findings would you see on a myxedema coma patient? |
1) Altered mental status (profound lethargy and coma)
2) Hypothermia 3) Bradycardia 4) Hypoventilation 5) Hypoglycemia Note: it is a life threatening condition with progressive resp depression, decreased CO, and fluid and electrolytes imbalance Dunphy 852. |
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A patient came in with a "mask-like" face, fixed stare and decreased in blinking. Facial skin was oily and the patient drools.
What is your DD? |
Parkinson Disease
Bates pg 253 Question: what other physical findings would you see on this patient? |
1) Tremor with "pill rolling"
2) Increase in muscle rigidity 3) Slow and shuffling gait 4) Flexed posture and limbs Dunphy 101 |
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A patient came in with elongated head, with bony prominence of the forehead, nose, and lower jaw. The nose, lips, and ears are also enlarged.
What is your DD on this patient? |
Acromegaly
Bates pg 253 |
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What is ptosis?
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Drooping of the upper eyelid
Bates pg 256 Question: What are the common causes of ptosis? |
1) Myastenia gravis
2) damage of the oculomotor nerve 3) damage to the sympathetic nerve supply = Horner's syndrome Bates pg 256 |
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What are entropian and ectropian?
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Entropian = lower lid rolls in
Ectropian = lower lid rolls out Bates pg 255 Question: what age group commonly have these symptoms? And what causes them? |
Older adults
They are usually caused by muscular weakness under the eyes. |
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What is exophthalmos?
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Eye ball protrudes forward.
Bates pg 255 Question: what are the causes of exophthalmos? |
Bilateral = Graves' hyperthyroidism
Unilateral = Graves' disease, tumor, or inflammation of the orbit |
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What is xanthelasma?
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Slightly raised, yellowish, well-circumscribed plaques of one or both eyelids.
Bates pg 256 Question: What causes xanthelasma? |
Lipid disorder
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A patient who came in with bilateral redness, vessel-appearing, of the sclera. No discharge was noted. Pt c/o of mild stinging pain.
What is the DD? |
Episcleritis
Dains pg 344, Bates 256 Question: What are the differences between episcleritis and scleritis? |
Episcleritis = bilateral
Scleritis = unilateral E = visual acuity OK S = visual acuity variable E = mild stinging S = deep, boring pain Dains pg 344 |
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A patient came in with a homogenous, sharply demarcated, redness of the right eye. No discharge. Cornea clear. Denies pain.
What is your DD? |
Subconjunctival hemorrhage
Bates pg 257. What are the differences between subconjunctival hemorrhage and conjunctivitis, in terms of pattern of redness, pain, ocular discharge, and causes. |
Subconjuctival H = homogenous, sharply demarcated (leakage of blood outside of the vessels)
Conjunctivitis = diffuse dilatation of conjunctival vessels SH = unilateral C = bilateral SH = no pain C = mild discomfort SH = no discharge C = watery, mucoid, or mucopurulent SH = trauma, bleeding disorder, increase in venous pressure (cough) C = bacterial/viral infection, allergy |
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A patient came in with eye pain and redness. The patient c/o decreased in vision. You inspected the eyes and found ciliary injection.
What are three common DD? |
1) Corneal injury/infection
2) Acute iritis 3) Glaucoma Bates pg 257 What are the differences in terms of pain, ocular discharge, pupil, and cornea? Which one is considered emergency? |
Corneal injury = mod to severe, superficial pain
Acute iritis = mod, aching, deep pain Glaucoma = severe, aching pain CI = watery/purulent DC AI and G = absent of DC CI = not affected AI = small, and irregular with time G = dilated fix CI = changes depending on cause AI = clear or slightly clouded G = steamy, cloudy Glaucoma = emergency due to acute increase in intraocular pressure |
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What is cataract?
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Opacities of the lenses visible through the pupil. Common in old age
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What are the colors of macular (the mat), the disk (dish), and the cup?
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Macular = red
Disk = yellow Cup = white |
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What is A-V Nicking?
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The vein is compressed by an arteriovenous crossing.
Question: what causes A-V nicking? |
hypertension, arteriosclerosis, or other vascular conditions.
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What are tapering and banking in AV crossing?
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Tapering = the vein tapers down either side of the artery
Banking = the vein is twisted on the distal side of the artery and form a dark, wide knuckle. Bates pg 263 |
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How do you document the eyes in ROS?
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Eyes = denies visual loss, diplopia, trauma or inflammation
Questions: How do you document the eyes in PE? |
Eyes = Visual field intact. PERRL. Conjunctiva clear. Sclera white, anicteric. EOMI, no ptosis. fundi: RR +. Discs flat w/ sharp margins, vessels present w/o crossing or retinal hemorrhage.
Note: Anicteric = no jaundice EOMI = extraocular motor intact |
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How do you rate the tonsils?
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1+ to 4+
1+ = easily visibility of the gap between the tonsils 4+ = tonsils that touch in the midline with the mouth wide open Bates pg 818 |
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Erosion of teeth are commonly seen in which patients?
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Bulimia (due to regurgitation of stomach contents)
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Conjunctival injection. What does "injection" mean?
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Injection = of or relating to a blood vessel that is visibly distended with blood
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How do you document the throat in ROS?
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throat = denies ST, hoarseness, voice changes, or URI
Note: ST = sore throat Question: How do you document the throat in PE? |
Throat = pharynx non-injected, palate rises symmetrically, gag present
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What diseases cause diffuse enlargement of the thyroid?
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1) Graves' disease
2) Hashimoto's thyroiditis 3) Endemic goiter Which type of thyroid enlargement is more likely a neoplastic process? Single nodule or multinodular goiter? |
Single nodule (may be benign or malignant)
Note: multinodular suggest more of a metabolic process. However, positive family hx might cause additional risk factor for malignancy. |
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How do you document the mouth in ROS?
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Mouth = denies sores, gingival bleeding, abnormal taste, or jaw pain.
How do you document mouth in PE? |
Mouth = Buccal mucosa moist and intact. Tonsils present, dentition intact, no caries. Tongue midline w/o fasciculations
Note: fasciculations = involuntary contraction or twitching |
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How do you document nose in ROS?
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Nose = denies discharge, obstruction, or epistaxis
Question: How do you document nose in PE? |
Nose = nares patent, no deformity, septal deviation or perforation.
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How do you document ear in ROS?
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Ear = denies deafness, tinnitus, discharge or pain.
Question: how do you document ear in PE? |
Ear = TM's non-injected, good light reflex, no protrusion or retraction. Weber midline, Rinne AC > BC, Whisper test 3:3
Note: non-injected = no erythematous or bulging |
