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30 Cards in this Set
- Front
- Back
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547. Presentation/clinical features of narcolepsy?
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a. Results in Excessive Daytime Sleepiness!!!!
b. Involuntary “sleep attacks” at any time of day (during any activity, including driving) that last several minutes. c. Cataplexy, which is loss of muscle tone that generally occurs w/an intense emotional stimulus (e.g., laughter, anger). d. Sleep paralysis, in which pt cannot move when waking up! e. Hypnagogic hallucinations that are vivid hallucinations (visual or auditory)- “dreams” while awake. (going to sleep-gogic); waking/popping up “pompic”. |
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548. Variation in narcolepsy?
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a. Can range from mild to severe.
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549. Significant problems w/narcolepsy?
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a. Automobile accidents are a major problem.
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550. Treatment of Narcolepsy?
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a. Methylphenidate (Ritalin)
b. Planned naps during the day may prevent attacks. |
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551. Acute or transient causes of insomnia?
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a. Usually due to psychological stress or travel over time zones “jet lag”.
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552. 2 Chronic forms of insomnia?
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a. Secondary Insomnia (accounts for 90% of all cases)
b. Primary Insomnia: A diagnosis of exclusion. |
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553. Causes of secondary insomnia (90% of all cases)?
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a. Psychiatric conditions- depression, anxiety disorders, PTSD, manic phase of BP, Schizophrenia, OCD.
b. Meds and substance abuse c. Medical problems: i.e. Advanced COPD, Renal failure, CHF, Chronic pain. d. Other: Fibromyalgia, Chronic fatigue syndrome. |
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554. Primary insomnia (diagnosis of exclusion) DSM IV definition?
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a. DSM IV defines 1° Insomnia as either of the following:
1. Difficulty initiating or maintaining sleep 2. Non-restorative sleep that lasts for at least 1 month in the absence of other medical, psych, or other sleep disorders, and that causes clinically significant distress and social or occupational impairment. 3. Pts worry excessively about not falling to sleep and become preoccupied with it. The cause is unknown. |
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555. Tx of Insomnia?
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a. Treat underling cause, if found.
b. Consider psych evaluation if psychiatric causes or 1° insomnia is suspected. c. Use sedative-hypnotic meds sparingly and w/caution for symptomatic relief. d. Use the smallest dose possible, and avoid use for longer than 2-3 weeks. |
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556. 2 types of hearing loss?
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i. Conductive hearing loss
ii. Sensorineural hearing loss. |
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557. Conductive hearing loss pathophys?
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a. Caused by lesion in the external or middle ear.
b. Interference w/mechanical reception or amplification of sounds, as occurs with disease of the auditory canal, tympanic membrane, or ossicles creates conductive hearing loss. |
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558. Pathophys of Sensorineural hearing loss?
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a. Due to lesion in the cochlea or CN VIII (auditory branch).
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559. 3 regions of conductive hearing loss?
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1. External Canal
2. Tympanic membrane perforation 3. Middle ear: a. Effusion b. Otosclerosis c. Other: neoplasms, congenital malformations of middle ear. |
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560. 3 causes of external canal conductive hearing loss?
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a. Cerumen impaction-build-up obstructs the auditory canal (most common cause)
b. Otitis externa c. Exostoses- Bony outgrowths of external auditory canal related to repetitive exposure to cold water (e.g., scuba divers, swimmers). |
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561. Causes Tympanic membrane rupture conductive hearing loss (and most common)?
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a. Most commonly due to trauma (direct or indirect)
b. May be 2° to middle ear infection. |
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562. Causes of middle ear conductive hearing loss?
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a. Any cause of middle ear effusion (fluid in middle ear interferes w/sound conduction)- Otitis media, allergic rhinitis.
b. Otosclerosis c. Other: neoplasms, congenital malformation of the middle ear. |
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563. Otosclerosis?
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a. Bony fusion (immobilization) of the stapes to the oval window
b. It is an autosomal dominant condition (variable penetrance) c. Rarely progresses to deafness. |
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564. Treatment of otosclerosis?
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a. Surgery
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565. Most common of sensorineural hearing loss?
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a. Presbycusis.
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566. 8 causes of sensorineural hearing loss?
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1. Presbycusis (most common cause)
2. Noise-induced hearing loss 3. Infection 4. Drug-induced hearing loss 5. Injury to inner ear or cochlear nerve (e.g., skull fracture) 6. Congenital (TORCH infections) 7. Ménière's disease 8. CNS Causes |
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567. Presbycusis (type of sensorineural hearing loss) Presentation?
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a. Gradual symmetric hearing loss associated with aging-most common cause of diminished hearing in elderly patients
b. Hearing loss is most marked at high frequencies with slow progression to low frequencies. |
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568. Pathophys of presbycusis?
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a. Degeneration of sensory cells and nerve fibers the base of the cochlea.
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569. Pathophys of noise-induced hearing loss?
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a. Chronic, prolonged exposure to sound levels > 85 dB
b. Hair cells in the organ of Corti are damaged |
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570. Infectious causes of sensorineural hearing loss?
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a. Viral or bacterial infection of cochlear structures or labyrinth.
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571. What drugs can cause drug-induced hearing loss (sensorineural)?
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a. Aminoglycosides
b. Furosemide c. Ethacrynic acid d. Cisplatin e. Quinidine |
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572. Risk with aspirin and hearing loss?
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a. Aspirin can cause tinnitus and reversible hearing impairment
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573. Ménière's disease. Presentation?
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a. Fluctuating, unilateral hearing loss
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574. Features of Ménière's disease?
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a. Sensorineural hearing loss (usually unilateral)
b. Sense of pressure/fullness in ear c. Tinnitus d. Vertigo |
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575. Treatment of Ménière's disease?
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a. Vertigo usually responds to dietary salt restriction and meclizine
b. But hearing loss is progressive. |
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576. CNS causes of sensorineural hearing loss?
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a. Acoustic neuromas
b. Meningitis c. Auditory nerve neuritis (multiple sclerosis, syphilis) d. Meningioma |
