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45 Cards in this Set
- Front
- Back
Cerumen impaction
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causes webber test to lateralize towards impacted ear
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Cholesteatoma
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white/pearly
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Otitis externa:
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swimming is a risk factor.
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Otitis media:
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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. |
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Newborns hearing test
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use evoked otoacoustic emission testing or Auditory brainstem response
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Pure tone audiometry
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AAP and Bright Futures recommend pure tone audiometry at ages 3, 4, 5, 10, 12, 15, 18 years of age
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Otoacoustic Emissions(OAE):
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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 |
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ABR (Auditory Brainstem Response)
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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 |
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when to worry about hearing
0-4 months 5-6 months 7-12 months |
• 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 |
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when to worry about hearing
13-15 months 16-18 months 19-24 months |
• 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. |
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Acute Otitis media culprits and tx:
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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 |
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Bullous Myringitis:
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blister. commonly see conjunctivitis. H flu nontypable is the cause and tx with augmentin 90mg/kg/day divided bid
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Otitis Media with Effusion
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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. |
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Mastoiditis and tx
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requires hospitilization
intracranial complications are common tx: mastoidectomy if abs don't tx |
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Otitis externa
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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 |
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Cholesteoma
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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.
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what are the 2 hearing screening tests?
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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 |
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How do you tx AOM
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Amozicillin 90mg/kg/day divided bid
or Ceftriaxone 50 mg/kg/dose IM x 1 for 3 days if allergic to PCNs |
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How do you tx Otitis Externa
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conductive hearing loss from edema of ear canal
tx with external drops |
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ID cholesteatomas
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White/pearly on tempanic membrane
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otorrhea
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discharge from ear
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Bilateral AOM in young children (6 months – 23 months), even without severe symptoms: tx?
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antibiotics
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Children older than 6 months should only be prescribed antibiotics for severe symptoms like
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otalgia lasting longer than 48 hours or a temperature higher than 39° C. (102.2° F)
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In children, age 6-23 months with unilateral AOM with non-severe symptoms (mild otalagia for less than 48 hours, temp <102.2°), tx?
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watchful waiting or antibiotic therapy. Make sure to involve the parent/caregiver in decision
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Consider tympanostomy tubes for what patients?
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◦ Three episodes in the last 6 months
◦ Four episodes in the last year, with one in the last 6 months |
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How to prevent AOM?
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• Pneumococcal vaccine
• Yearly influenza vaccine • Breastfeeding exclusively until at least 6 months old • Avoiding tobacco exposure |
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Addison's disease:
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Calcification of cartilage/painless nodules.
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Chronic arthritis:
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Hard nodules.
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Tophi:
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Painless uric acid crystal deposits, can be seen in gout patients.
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Hematoma:
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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.
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Torn earlobe:
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Refer to plastic surgery.
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Basically, if ear infection, tx with?
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Erythromycin. Ear=ery
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types of hearing loss: 3
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Conductive
Sensorineural Mixed |
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Conductive:
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dysfunction in the mechanical conduction of external sound
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Sensorineural:
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dysfunction in the sensorineural structures and pathways to the brain
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types of conductive hearing loss: 4
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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. |
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Sensorineural hearing loss: 5
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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 |
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Weber:
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Tone referred to poorer ear = conductive (such as cerumen)
Tone referred to better ear means perceptive impairment |
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Audiogram: Brainstem auditory evoked response (BAER)
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used to diagnose tumors and traumatic injuries
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Tennitus: what to do?
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• Stop ototoxic meds.
• Decrease noise exposure. • Decrease caffeine and nicotine use. • Treat the cause. |
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Labyrinthisis
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often viral
S/S: severe vertigo, n/v most resolve spontaneously tx: bedrest |
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Meniere's Disease
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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 |
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how often to get ophthalmologist exams if DM?
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yearly
q6 months if problems |
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Glaucoma: what is the difference between POAG (primary open angle glaucoma) and primary angle closure glaucoma?
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POAG: loss of peripheral vision
PACG: rare, unilateral HA, visual blurring, n/v |
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Macular degeneration: when does it cause blindness?
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75 and up is the leading cause of vision loss - loss of central vision
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