Fam Ii Test 1

Front 1

Cerumen impaction

Back 1

causes webber test to lateralize towards impacted ear

Front 2

Cholesteatoma

Back 2

white/pearly

Front 3

Otitis externa:

Back 3

swimming is a risk factor.

Front 4

Otitis media:

Back 4

Abrupt onset of s/s of pain/irritability, +/- fever
middle ear infection
cold weather, boys more than girls, tx with augmentin or amoxicillin. f/u if not improving on antibiotic. if not improving, refer to ped ENT. No labs needed. must have middle ear effusion to dx.

Front 5

Newborns hearing test

Back 5

use evoked otoacoustic emission testing or Auditory brainstem response

Front 6

Pure tone audiometry

Back 6

AAP and Bright Futures recommend pure tone audiometry at ages 3, 4, 5, 10, 12, 15, 18 years of age

Front 7

Otoacoustic Emissions(OAE):

Back 7

physiologic test. The normal ear emits sounds called OAE. These are spontaneous and are emitted when the ear is getting sound waves. may not detect auditory nerve dysfunction.
low cost, 2 minutes to test

Front 8

ABR (Auditory Brainstem Response)

Back 8

more specific than an OAE (OAE is less expensive and easy to do, if any abnormality is detected, do a full workup including an ABR). Tx needs to be started immediately bc children use sound to learn. • Measures the initiation of sound-induced electrical signals in the cochlea.
• Measures functioning of the peripheral auditory system and neurologic pathways related to hearing

Front 9

when to worry about hearing
0-4 months
5-6 months
7-12 months

Back 9

• 0-4 months: should startle to loud sounds, quiet to mother’s voice, cease activity momentarily when sound is made at conversational level
• 5-6 months: should correctly localize to a sound, begin to imitate sounds. if a child is saying a sound over and over, then have the parent repeat that sound to encourage the baby.
• 7-12 months: correctly localize sound in any plane, respond to name

Front 10

when to worry about hearing
13-15 months
16-18 months
19-24 months

Back 10

• 13-15 months: should point toward unexpected sound or to familiar persons when asked
• 16-18 months: should follow simple directions like go get your shoes, we’re going for a walk
• 19-24 months: should point to body parts when asked. can ask where their mom or dads nose or ears are. they get self conscious about themselves.

Front 11

Acute Otitis media culprits and tx:

Back 11

S. Pneumoniae: since pneumococcal vaccine, decreased by 80*
H. Influenzae: 2x increase of this type
tx: amoxicillin 90 mg/kg/day divided bid
if pcn allergic, use ceftriaxone 50 mg/kg/dose IMx1 for 3 days
tylenol or ibuprofen for pain relief

Front 12

Bullous Myringitis:

Back 12

blister. commonly see conjunctivitis. H flu nontypable is the cause and tx with augmentin 90mg/kg/day divided bid

Front 13

Otitis Media with Effusion

Back 13

Middle ear effusion lacking the “punch” of acute infection
• typically do not have symptoms besides can’t hear out of that ear or may be more restless when sleeping.
• Generally clears by 3 months in 90% of children and typically doesn’t need tx. if at the end of 3 months, antibiotics should be considered. antihistamines will not work to clear this fluid.

Front 14

Mastoiditis and tx

Back 14

requires hospitilization
intracranial complications are common
tx: mastoidectomy if abs don't tx

Front 15

Otitis externa

Back 15

Normal ear canal flora includes aerobic bacteria
Excessive wetness (swimming/bathing) or dryness (eczema/q tips) can cause skin to become more vulnerable to normal flora or exogenous bacteria

Front 16

Cholesteoma

Back 16

appearance: white pearly. Needs to be tx immediately bc if left untreated, this leads to irreversible damage to the ossicles, hearing loss, facial nerve palsys.

Front 17

what are the 2 hearing screening tests?

Back 17

OAE and ABR
OAE: 2 min, measures response of inner ear to brief clicks or tones.
Auditory Brainstem Response: more specific than OAE. Measures initiation of sound induced eletrical signals in cochlea and functioning of peripheral auditory system and neurologic pathways

Front 18

How do you tx AOM

Back 18

Amozicillin 90mg/kg/day divided bid
or
Ceftriaxone 50 mg/kg/dose IM x 1 for 3 days if allergic to PCNs

Front 19

How do you tx Otitis Externa

Back 19

conductive hearing loss from edema of ear canal
tx with external drops

Front 20

ID cholesteatomas

Back 20

White/pearly on tempanic membrane

Front 21

otorrhea

Back 21

discharge from ear

Front 22

Bilateral AOM in young children (6 months – 23 months), even without severe symptoms: tx?

Back 22

antibiotics

Front 23

Children older than 6 months should only be prescribed antibiotics for severe symptoms like

Back 23

otalgia lasting longer than 48 hours or a temperature higher than 39° C. (102.2° F)

Front 24

In children, age 6-23 months with unilateral AOM with non-severe symptoms (mild otalagia for less than 48 hours, temp <102.2°), tx?

Back 24

watchful waiting or antibiotic therapy. Make sure to involve the parent/caregiver in decision

Front 25

Consider tympanostomy tubes for what patients?

Back 25

◦ Three episodes in the last 6 months
◦ Four episodes in the last year, with one in the last 6 months

Front 26

How to prevent AOM?

Back 26

• Pneumococcal vaccine
• Yearly influenza vaccine
• Breastfeeding exclusively until at least 6 months old
• Avoiding tobacco exposure

Front 27

Addison's disease:

Back 27

Calcification of cartilage/painless nodules.

Front 28

Chronic arthritis:

Back 28

Hard nodules.

Front 29

Tophi:

Back 29

Painless uric acid crystal deposits, can be seen in gout patients.

Front 30

Hematoma:

Back 30

Can be due to blood disorders, trauma. Presents as a blue doughy mass and, if not drained, can result in a deformity commonly referred to as "cauliflower ear." Common in wrestlers and boxers due to trauma from the sport.

Front 31

Torn earlobe:

Back 31

Refer to plastic surgery.

Front 32

Basically, if ear infection, tx with?

Back 32

Erythromycin. Ear=ery

Front 33

types of hearing loss: 3

Back 33

Conductive
Sensorineural
Mixed

Front 34

Conductive:

Back 34

dysfunction in the mechanical conduction of external sound

Front 35

Sensorineural:

Back 35

dysfunction in the sensorineural structures and pathways to the brain

Front 36

types of conductive hearing loss: 4

Back 36

External: impacted cerumen, infection w edema
Impaired TM mobility: perf, scar tissue
Middle ear: AOM
Otoclerosis: Fusion of the stapes over the oval window. Common cause of hearing loss in older adults. Genetically inherited in 10% of population. Can be surgically corrected.

Front 37

Sensorineural hearing loss: 5

Back 37

Caused by disorders of the cochlea and retrocochlear region including the auditory nerve and its connection to the brainstem, usually from noise trauma
Presbycussis: Gradual degeneration within the cochlea, occurs with aging. symmetric, irreversible
Ototoxicity
Infection
Labyrinthitis: w vertigo
Retrocochlear: involves auditory nerve, brainstem, and CNS

Front 38

Weber:

Back 38

Tone referred to poorer ear = conductive (such as cerumen)
Tone referred to better ear means perceptive impairment

Front 39

Audiogram: Brainstem auditory evoked response (BAER)

Back 39

used to diagnose tumors and traumatic injuries

Front 40

Tennitus: what to do?

Back 40

• Stop ototoxic meds.
• Decrease noise exposure.
• Decrease caffeine and nicotine use.
• Treat the cause.

Front 41

Labyrinthisis

Back 41

often viral
S/S: severe vertigo, n/v
most resolve spontaneously
tx: bedrest

Front 42

Meniere's Disease

Back 42

Complex of four symptoms, may or may not occur spontaneously.
◦ Spinning vertigo
◦ Low-frequency sensorineural hearing loss
◦ Tinnitus
◦ Feeling of fullness in the affected ear
causes hearing loss

Front 43

how often to get ophthalmologist exams if DM?

Back 43

yearly
q6 months if problems

Front 44

Glaucoma: what is the difference between POAG (primary open angle glaucoma) and primary angle closure glaucoma?

Back 44

POAG: loss of peripheral vision
PACG: rare, unilateral HA, visual blurring, n/v

Front 45

Macular degeneration: when does it cause blindness?

Back 45

75 and up is the leading cause of vision loss - loss of central vision