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97 Cards in this Set
- Front
- Back
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What is the most common cause of LMN facial nerve paralysis? |
Bell palsy - often due to reactivation of latent herpes simplex 1 infection in most cases |
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What are the classic symptoms of Bell palsy? |
- Sudden unilateral onset - Usually after a URI - Hyperacusis - everything sounds loud because stapedius muscle is paralyzed - May be unable to close affected eye (in severe cases) - use drops to keep eye moist |
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What is hyperacusis? |
Everything sounding loud because of stapedius muscle paralysis (occurs in Bell palsy) |
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What is the prognosis for Bell palsy? |
Most cases resolve spontaneously in about 1 month, although some have permanent sequelae |
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How do you treat Bell palsy? |
May improve outcomes and lessen duration of symptoms: - Oral prednisone - Antiviral treatment for herpes (e.g., valacyclovir, acyclovir) |
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What are the other causes of lower motor neuron facial paralysis? |
- Herpes infection (Ramsay Hunt syndrome) - Lyme disease - Stroke - Middle ear or mastoid infection - Meningitis - Temporal bone fracture - Tumor (acoustic schwannoma) |
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What is the syndrome in which herpes infection causes lower motor neuron facial nerve paralysis? |
Ramsay Hunt syndrome |
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What should you look for in association with Ramsay Hunt syndrome (herpes infection --> LMN facial nerve paralysis)? |
- Vesicles on the pinna and inside the ear - Encephalitis or meningitis may be present |
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What is one of the most common cause of bilateral facial nerve palsy? |
Lyme disease |
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What signs are associated with temporal bone fractures that cause LMN facial nerve paralysis? |
- Battle sign - Bleeding from the ear |
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What tumor is classically associated with LMN facial nerve paralysis? |
Acoustic Schwannoma (ie, neuroma) of the cerebellopontine angle |
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What should you do if the cause of LMN facial nerve paralysis is not apparent or if the history or physical exam raises suspicion? |
CT or MRI of the head |
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What is the most common cause of hearing loss? |
Most common is aging (presbyacusis) |
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What are some other causes of hearing loss besides aging? |
- Prolonged or intense exposure to loud noise (eg, work related) - Congenital TORCH infection - Ménière disease - Drugs - Tumor (classically acoustic neuroma) - Labyrinthitis - Miscellaneous (diabetes, hypothyroidism, multiple sclerosis, sarcoidosis, pseudotumor cerebri) |
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What infectious sources can cause hearing loss? |
TORCH: - Toxoplasmosis - Others - Rubella - Cytomegalovirus - Herpes |
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What are the signs and symptoms of Ménière disease? |
- Hearing loss - Severe vertigo - Tinnitus - Nausea / vomiting |
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How do you treat Ménière disease? |
- Acute episodes --> benzodiazepines, anticholinergics (scopolamine), antihistamines (meclizine or dimenhydrinate) - Ongoing treatment --> diuretics - Refractory cases --> surgery |
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What drugs can cause hearing loss? |
- Aminoglycosides - Aspirin - Quinine - Loop diuretics - Cisplatin |
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What tumor classically can cause hearing loss? |
Acoustic neuroma |
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What can cause labyrinthitis? |
May be viral or follow or extend from meningitis or otitis media |
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What are the miscellaneous causes of hearing loss? |
- Diabetes - Hypothyroidism - Multiple sclerosis - Sarcoidosis - Pseudotumor cerebri |
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What is the usual cause of sudden deafness? |
Sudden Sensorineural Hearing Loss (SSNHL) |
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What happens in Sudden Sensorineural Hearing Loss (SSNHL)? |
- Acute unexplained hearing loss - Usually unilateral - Occurs over hours (usually <72 hours) - >90% report tinnitus |
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What is the cause of Sudden Sensorineural Hearing Loss (SSNHL)? |
Most cases are idiopathic but have been postulated to be caused by viral causes, microvascular events, or autoimmune causes |
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What workup should be done in a patient with Sudden Sensorineural Hearing Loss (SSNHL)? |
- Physical exam is normal - MRI is needed to rule out other etiologies such as acoustic neuroma, multiple sclerosis, or vascular insufficiency |
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How should you treat Sudden Sensorineural Hearing Loss (SSNHL)? |
- Glucocorticoids (administered orally or by intratympanic injection) - first line therapy - Antiviral agents are sometimes used, although there is not much evidence to support their use |
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What is the prognosis for Sudden Sensorineural Hearing Loss (SSNHL)?
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2/3 of patients recover, although the resolution is often not complete; among those who recover, hearing usually returns within 2 weeks |
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What is the most common cause of acquired hearing loss in children? |
Bacterial meningitis |
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What testing should all children who have recovered from bacterial meningitis get? |
Hearing test - most common cause of acquired hearing loss in children is bacterial meningitis |
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What are the common causes of vertigo? |
- CN VIII lesions (Ménière disease, tumor, infection, multiple sclerosis) - Benign positional paroxysmal vertigo |
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What are the signs/symptoms of benign positional paroxysmal vertigo? |
Vertigo is induced by certain head positions, may be accompanied by nystagmus, and is not associated with hearing loss |
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What is the prognosis / treatment for benign positional paroxysmal vertigo? |
- Often resolves spontaneously - No treatment is required - Epley maneuver or modified Epley maneuvers may help with resolution of symptoms |
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How is a deviated nasal septum treated in patients with recurrent sinusitis? |
Surgically |
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What are the three common causes of rhinitis? |
- Viral - Allergic - Bacterial |
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What are the causes of viral rhinitis? |
- Rhinovirus (most common cause)
- Influenza - Parainfluenza - Coxsackie virus - Adenovirus - Respiratory syncytial virus - Coronavirus - Echovirus |
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How can you treat viral rhinitis? |
Symptomatic - Vasoconstrictors such as phenylephrine can be used for short-term relief, but can cause rebound congestion when discontinued |
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How do you recognize allergic rhinitis (hay fever)? |
- Seasonal flare-ups - Boggy and bluish turbinates - Onset before 20 years of age - Nasal polyps - Sneezing - Pruritus - Conjunctivitis - Wheezing or asthma - Eczema - Positive family history - Eosinophils in nasal mucous - Elevated serum IgE - Skin tests may identify an allergen |
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How do you treat allergic rhinitis (hay fever)? |
- Avoid known antigens (e.g., pollen) - Antihistamines - Nasal steroids - Cromolyn for more severe symptoms - Desensitization |
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What are causes of bacterial rhinitis? |
- Group A Streptococci - Pneumococci - Staphylococci |
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What symptoms make rhinitis to be more likely bacterial in nature? |
Coexisting sore throat, fever, and tonsillar exudate |
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How should you manage a patient you suspect of having bacterial rhinitis? |
Obtain streptococcal throat cultures and treat with antibiotics, if appropriate |
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What causes nosebleeds? |
- Trauma - eg, nose picking - most common - Local tumor (nasopharyngeal angiofibroma) - Leukemia - Other causes of thrombocytopenia (e.g., idiopathic thrombocytopenia purport, hemolytic uremic synrdome) |
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What tumor can be a cause of nosebleeds? What is the typical presentation? |
Nasopharyngeal Angiofibroma - Adolescent boys with no history of trauma or blood dyscrasia - Signs include recurrent nosebleeds and/or obstruction |
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What signs/symptoms in a patient with nosebleeds might make yo think of leukemia? |
Fever and anemia / pancytopenia |
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True or false: a neck mass is more likely to be benign in a child than in an adult? |
True - roughly 75% of neck masses are benign in children; whereas 75% are malignant in patients >40 years of age |
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What are the common cause of a neck mass in a child? |
- Thyroglossal duct cysts - Brachial cleft cysts - Cystic hygroma - Cervical lymphadenitis - Leukemia or lymphoma |
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What should you think of in a child with a midline neck mass that elevates with tongue protrusion? |
Thyroglossal duct cyst Branchial Lateral, Midline ThyroglossalBL,MT (alphabetical order) |
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What should you think of in a child with a lateral neck mass that may become infected? |
Branchial cleft cyst Branchial Lateral, Midline Thyroglossal BL,MT (alphabetical order) |
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What type of tumor should you think of that can cause a neck mass? Associations? Treatment? |
Cystic Hygroma - benign tumor also known as lymphangioma - Associated with Turner syndrome - Treat with surgical resection Also leukemia and lymphoma can cause cervical lymphadenopathy |
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What are the common causes of cervical lymphadenitis in children? |
- Streptococcal pharyngitis - Epstein-Barr virus (common in second and third decades) - Cat scratch issues - Mycobacterial infection (scrofula) |
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What are the causes of neck masses in adults? |
Malignancy - Lymphoma or metastatic neoplasm (usually squamous cell carcinoma) - Tumor - eg, thyroid cancer |
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How should you workup an unknown cancer in the neck? |
Triple Endoscopy and Triple Biopsy: - Random biopsy of the nasopharynx, palatine tonsils, and base of tongue - Laryngoscopy, bronchoscopy, and esophagoscopy (with biopsies of any suspicious lesions) |
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What are the components of the Triple Endoscopy and Triple Biopsy? |
- Endoscopy: laryngoscopy, bronchoscopy, and esophagoscopy - Biopsy: nasopharynx, palatine tonsils, base of tongue |
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What is the scientific name for "swimmer's ear"? |
Otitis Externa |
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What are the common causes of Otitis Externa? |
Most often Pseudomonas aeruginosa |
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What are the symptoms of Otitis Externa? |
- Pain with manipulation of auricle - Erythematous, swollen skin in auditory canal - Foul-smelling discharge (may be present) - Conductive hearing loss (may be present) |
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How do you treat Otitis Externa? |
Topical antibiotics - ofloxacin, neomycin, polymyxin B Topical steroids to reduce swelling |
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What are the common causes of Otitis Media? |
- Streptococcus pneumoniae - Haemophilus influenzae - Moraxella catarrhalis |
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What are the signs/symptoms of Otitis Media? |
- No pain with manipulation of the auricle - Earache - Fever - Erythematous and bulging TM (light reflex and landmarks are difficult to see with otoscope) - Nausea and vomiting |
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What are potential complications of Otitis Media? |
- Perforation of TM (bloody or purulent discharge) - Mastoiditis - Labyrinthitis - Palsies of CN VII and VIII - Meningitis - Cerebral abscess - Dural sinus thrombosis - Chronic Otitis Media --> Cholesteatomas w/ marginal perforations that require surgical excision |
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What are the signs of a perforated TM with Otitis Media?
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Bloody or purulent discharge |
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What are the signs of mastoiditis as a complication of Otitis Media? |
- Fluctuance and inflammation over mastoid process - Roughly 2 weeks after onset of OM |
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What can cause Chronic Otitis Media? |
Permanent perforation of TM |
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What can patients with chronic Otitis Media develop? Treatment?
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Cholesteatomas with marginal perforations that require surgical excision |
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How do you treat Otitis Media? |
- Amoxicillin - 2nd gen. cephalosporins such as Cefuroxime or a macrolide |
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What is the problem with recurrent otitis media? |
Canc cause hearing loss with resultant developmental problems (speech, cognitive functions) |
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What pediatric problems can lead to hearing loss with resultant developmental problems (speech, cognitive functions)? |
Recurrent otitis media (along with prolonged secretory otitis, a result of incompletely resolved otitis media) |
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How should you treat patients who have recurrent otitis media? |
- Treat with prophylactic antibiotics or tympanostomy tubes - Adenoidectomy is controversial, but may help in some cases; it is thought to help prevent blockage of the eustachian tubes |
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What is infectious myringitis? |
AKA Bullous Myringitis - inflammation of the tympanic membranes |
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How do you diagnose infectious myringitis? |
Otoscopy reveals vesicles on the TM |
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What are the classic causes of infectious myringitis (inflammation of TM)? |
- Mycoplasma species - Streptococcus pneumoniae - Viruses |
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How should you treat infectious myringitis (inflammation of TM)? |
- Erythromycin - Clarithromycin Covers Mycoplasma species and S. pneumoniae |
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What are the common bacterial causes of sinusitis? |
- S. pneumoniae - H. influenzae - Streptococcal - Staphylococcal |
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Signs/symptoms of bacterial sinusitis? |
- Tenderness over affected sinuses - Headache - Purulent nasal discharge (yellow or green) - Toothache (maxillary sinusitis) |
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How do you confirm the diagnosis of sinusitis? |
Radiographs or CT --> show opacification of sinuses, classically with an air-fluid level in acute sinusitis CT scans preferred to evaluate chronic sinusitis or suspected extension of infection outside the sinus (watch for high fevers / chills) Culture is not necessary unless the patient fails to respond to antibiotics |
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How should you treat bacterial sinusitis?
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10-14 day course or for up to 6 weeks in chronic cases: - Amoxicillin - Trimethoprim-Sulfamethoxazole - 2nd or 3rd gen. cephalosporin - Macrolide - Amxocillin-Clavulanate Operative intervention (drainage procedure, sinus obliteration) for resistant cases |
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By what age are the frontal sinuses well developed in children? |
~10 years |
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What is the most common cause of progressive conductive hearing loss in adults? |
Otosclerosis |
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What is the most common cause of sensorineural hearing loss in adults?
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Presbyacusis (age related hearing loss) |
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What is otosclerosis? |
- Otic bones become fixed together and impede hearing - Most common cause of progressive conductive hearing loss in adults |
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How should you treat otosclerosis? |
Hearing aid or surgery |
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What can cause parotid gland swelling? |
- Classic cause is mumps - Neoplasms - Sjögren syndrome - Sialolithiasis - Sarcoidosis - Bulimia - Alcoholism - Lymph node enlargement |
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How do you treat mumps? |
Prevention through immunization |
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What is the potential complication of mumps? |
Infertility |
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What malignancy can cause parotid gland swelling? |
Pleomorphic adenoma of the parotid gland |
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What is the term for a stone in the parotid duct? |
Sialolithiasis |
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What structure is within the parotid gland that can become enlarged leading to the appearance of enlarged parotid glands? |
Lymph nodes |
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How do you recognize a nasal fracture?
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Radiographs or CT scan |
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What complications should you watch for in patients with nasal fractures? |
Septal hematoma - must be removed surgically to prevent pressure-induced septal necrosis |
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What is the Weber test used to evaluate? |
Compare bone conduction in the two ears |
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How do you test the bone conduction in the ears? |
Weber test - vibrating tuning fork is placed on the forehead and the patient is asked where the vibrating sound is best heard Normal response: hear vibration in middle (or equally in both ears) Conductive hearing loss: sound is best heard in the affected ear Sensorineural hearing loss: sound is best heard in unaffected ear |
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What are the results of the Weber test in patient with conductive hearing loss? |
Sound is best heard in the affected ear |
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What are the results of the Weber test in patient with sensorineural hearing loss? |
Sound is best heard in unaffected ear |
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What is the Rinne test used to evaluate? |
Compares air conduction with bone conduction |
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How do you compare the air conduction with bone conduction? |
Rinne test - Vibrating tuning fork is placed on the tip of the mastoid process - When the patient can no longer hear the sound, the tuning fork is removed from the mastoid and placed next to the auditory meatus of the external ear and patient is asked if the sound can be heard - Air conduction is normally greater than bone conduction --> patients can hear tuning fork when it is placed next to auditory meatus (air conduction) even after they can no longer hear it vibrating on the mastoid bone (bone conduction) |
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What are the results of the Weber test in patient with conductive hearing loss? |
Bone conduction is greater than air conduction; thus they cannot hear the tuning fork when it is placed next to the external auditory meatus |
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What are the results of the Weber test in patient with sensorineural hearing loss? |
Both air and bone conduction are impaired, but the normal ratio (air conduction > bone conduction) is maintained They still hear the tuning fork next to the ear after they can no longer hear it on the mastoid |
