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97 Cards in this Set
- Front
- Back
What kind of EMG potentials are seen in regeneration of the facial nerve? |
Polyphasic potentials
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What are indications for imaging the facial nerve?
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"Progression of palsy over 3 weeks, recurrent palsy, facial hyperkinesia, development of associated cranial neuropathies (think cancer)"
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What are causes of acute facial palsy?
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"Bells (70%), Herpes Zoster (Ramsay Hunt) - 15%"
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What is the onset of Bell's palsy?
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Rapid - <48hours
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What nerves can be affected with Bell's Palsy?
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V to X
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How can Ramsay Hunt be differentiated from Bell's palsy?
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1. Cutaneous vesicles of EAC and conchal bowl 2. Otalgia 3. Higher incidence of cochlear and vestibular disturbances
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Where is the site of injury in acute facial paralysis from Bell's palsy/Ramsay Hunt?
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Meatal foramen - just proximal to the labyrinthine portion of the Facial nerve
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Which antivial is used for treating ramsay hunt?
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Valacyclovir - believed to be more effective than acyclovir
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16 causes of facial nerve palsy besides bell's and ramsay hunt
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Diabetes Mellitis Guillain-Barre Hyperthroidism Lyme disease Melkersson-Rosenthal syndrome Mobius syndrome Mononucleosis Multiple Sclerosis Mumps Myasthenia gravis Neoplasia Otitis Media Perinatal Sarcoidosis Trauma Wegener's Granulomatosis
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Cause of lyme disease?
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Borrelia burgdorferi
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Ratio of unilateral to bilateral facial paralysis with lyme disease?
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0.125694444
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Treatment of lyme disease
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Tetracycline for adults Penicillin for children
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What is Melkersson - Rosenthal syndrome?
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Unilateral facial palsy Facial edema Fissured tongue (lingua plicata)"
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What is Mobius syndrome?
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bilateral facial and abducens nerve palsies
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Why is the facial neve particular at risk perinatally?
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1. No mastoid tip 2. Compression by mothers sacrum or delivery forceps
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What is Heerfordt disease?
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uveoparotid fever - associated with sarcoidosis - uveitis, fever, parotidis and CN paralysis
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What confirms the diagnosis?
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Elevated ACE levels
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What are crocodile tears?
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Cross inervation of the lesser superficial petrosal nerve with the greater superficial petrosal nerve
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What are the audiometry options for an infant less than 6 months?
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1. ABR 2. DPOAE 3. behavioral observation audiometry (warble tones)
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What are the audiometry options for a child 6 months to 3 years?
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1. ABR 2. DPOAE 3. visual response audiometry (child localizes to an object)
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What are the audiometry options for a child 3-6 years?
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conventional play audiometry (child performs an activity every time a sound a heard)
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What are the audiometry options for a child over 6 years?
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standard audiometry
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4 common pathogens for tonsilitis?
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"S. pyogenes, S. Viridins, S. aureus, H. influenzae"
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Pathogen for adult tonsils?
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mixed infections with 3/4 having beta lactamase producing organisms
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What is a classic finding in S. pyogenes tonsilitis?
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tonsillar exudate
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What else besides S. pyogenes causes an abudant exudate with tonsilitis?
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EBV
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Treatment of tonsilitis?
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"Keflex +/- flagyl, Augmentin, Clindamycin"
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What are the indications for tonsillectomy?
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"1. 6-7 episodes of acute tonsillitis in one year, 5 episodes per year for 2 years, 3 episodes for 3 years; 2. Peritonsillar abscess; 3. Chronic tonsilitis; 4. OSA; 5. Adenotonsillar hypertrophy with dysphagia, speech abnormalities and occlusive abnormalities"
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"With caustic ingestion in kids, what causes the most esophageal injuries?"
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"Bases - sodium, potassium and ammonium hydroxide"
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What kind of damage do bases causes in esophageal injury?
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Liquefactive necrosis with full-thickness burns
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Are acids or bases worse for esophageal injury?
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Bases
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What kind of damage do acids cause in esophageal injury?
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Coagulative necrosis
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Why don’t you get esophageal full thickness burns with acids?
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Coagulum limits the penetration of the acid and prevents full thickness burns
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How do you diagnose caustic ingestion?
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"1. Evaluate chin, lips, tongue and palate for burn evidence 2. CXR for free air 3. Esophagoscopy within 24-48 hours 4. Esophagram in kids presenting after 48hours"
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Treatment of caustic ingestions?
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"Steroids, antibiotics"
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What are two clinical tests of ciliary function?
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methelene blue and saccharin
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What is Kartagener syndrome?
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"Recurrent sinusitis, bronchiectasis and situs inversus - lack dynein side arms on A-tubules"
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What is the inheritance of cleft lip/palate?
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Multifactorial inheritance and etiology
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What are risk factors for cleft lip/palate?
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"1. Single gene transmission 2. Chromosome aberrations 3. Teratogens (ETOH, thalidomide, vit A) 4. Environmental (amniotic band syndrome, maternal diabetes"
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When does a family have the highest risk for cleft lip/palate?
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When one child and one parent have cleft (18%)
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Describe the nasal ala and caudal septal abnormality in cleft lip
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Nasal ala on affected side is displaced inferolaterally; Caudal septum displaced to contralateral side
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Describe the TVP and LVP in cleft palate
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"Levator Veli Palatini, which normally forms a sling across the palate is oriented parallel to cleft; Tensor Veli Palatini runs in a more anterior posterior direction resulting in ETD and need for tubes"
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When do you repair a cleft lip?
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"Rules of 10: 10 weeks, 10 lbs, hemoglobin of 10"
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What type of flap is used to repair a cleft lip?
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Millard rotation advancement flap
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When do you repair a cleft palate?
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10 to 18 months - when deciduous molars arrive
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What is the vascular pedicle for cleft palate flaps?
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Decending palatine
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"What are ""lengthening"" cleft palate flaps?"
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V to Y and Furlow Z plasty
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"What are ""posterior"" cleft palate flaps?"
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Pharyngeal flap and sphincter pharyngoplasty
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Inheritance pattern for cystic fibrosis?
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Autosomal recessive
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Seven features of cystic fibrosis
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1. Pancreatic insufficiency; 2. COPD/bronchiectasis/pneumonia; 3. Malabsorption; 4. Cirrhosis of the liver; 5. Nasal polyps/chronic sinusitis; 6. High sweat chloride/salt wasting; 7. Dehydration
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How do you diagnose cystic fibrosis?
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sweat chloride > 60 meq/L
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How do you manage cystic fibrosis polyposis?
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"steroids, regular sinus irrigation with tobramycin and endoscopic sinus surgery"
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What palatal muscle has poor tone in Down syndrome?
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Tensor Veli Palatini
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What is the most common inner ear abnormality in children with congenital hearing loss?
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Enlarged vestibular aqueduct
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What malformations/syndromes is an Enlarged Vestibular Aqueduct associated with?
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"Mondini malformation, Pendred syndrome, branchio-oto-renal syndrom"
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What is upper limit of normal for vestibular aqueduct?
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1.5mm
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What is the characteristic SNHL seen with enlarged vestibular aqueduct?
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Progressive SNHL that progresses in a stepwise fashion
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What anatomic abnormality can cause hearing loss that can worsen after minor trauma?
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Enlarged vestibular aqueduct
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What is the treatment for enlarged vestibular aqueduct?
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"Hearing aids, cochlear implant"
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What is esophageal atresia and tracheoesophageal fistula associated with?
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"VACTERL - vertebral, anal, cardiac, tracheoesophageal, renal, limb abnormalities"
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What are 5 types of esophageal atresia/tracheoesophageal fistula?
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1. Esophageal atresia with distal TEF (85%); 2. Esophageal atreasia w/o TEF (7%); 3. TEF w/o atresia; 4. Esophageal atresia with proximal and distal TEF; 5. Esophageal atresia with proximal TEF
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What must you rule out in a child with unilateral wheezing?
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Foreign body
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What are signs of a tracheal/bronchial foreign body in children?
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"stridor/wheezing, cough w/o associated illness, recurrent or migratory pneumonia; acute aphonia"
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What are signs of an esophageal foreign body in children?
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"Odynophagia, drooling, vomiting/spitting, airway compromise due to posterior tracheal impingement"
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Radiographic signs of tracheal/bronchial foreign body?
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"1. Visualize FB, 2. Atelectasis on affected side, 3. Overinflation due to air trapping"
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Why do a lateral decubitus when looking for an airway foreign body?
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evaluates for mediastinal shift - uninvolved side down results in shift from gravity; involved side does not show shift due to air trapping
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Five levels at which a foreign body is likely to lodge in the esophagus?
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1. Cricopharyngeus; 2. Thoracic inlet; 3. Level of aortic arch; 4. Tracheal bifurcation; 5. Gastroesophageal junction
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What does a disc battery contain?
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"lithium, NaOH, KOH, mercury"
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What can ingesion of a disc battery cause after an hour?
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mucosal damage
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What can ingesion of a disc battery cause after 2-4 hours?
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damage to muscular layer
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What can ingesion of a disc battery cause after 8-12 hours?
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potential perforation
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What do you do with a disc battery that passed into the stomach?
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send home and monitor stool; repeat xray in 4-7 days; with larger batteries repeat xray in 48 hours; if still in stomach remove endoscopically
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What % of children are born with hearing loss?
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0.001
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What % of deaf children have normal hearing parents?
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0.9
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How long is hearing loss usually delayed in children?
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2.5 years
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What % of hereditary hearing loss is non-syndromic?
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0.7
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What % of hereditary deafness have recessive transmission?
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80% (DFNB - deafness gene B)
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What % of hereditary deafness have dominant transmission?
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20& (DFNA - deafness gene A)
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What is the most common cause of hereditary deafness with recessive transmission?
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Conexin 26 (GJB2) gene
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What is the typical audiogram for hereditary hearing loss?
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Cookie bite audiogram
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What % of hereditary hearing loss is syndromic?
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15-30%
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What are autosomal recessive syndromes with hearing loss?
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JUP Jerville-Lange-Nielson Usher Pendred
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What are 7 autosomal dominant syndromes with hearing loss?
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1. Achondroplasia 2. Branchio-oto-renal 3. Crouzon syndrome 4. NF-2; 5. Stickler 6. Treacher-Collins syndrome 7. Waardenburg syndrome
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Features of Jerville-Lange-Nielsen syndrome
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"SNHL, prolonged QT with syncopal events and sudden death"
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Features of Usher syndrome
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"SNHL, retinitis pigmentosa +/- vestibular symptoms. Most common syndrome to afffect the eyes and ears. Diagnosed with electroretinogram"
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Most common syndrome to afffect the eyes and ears?
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Usher syndrome
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Features of Pendred syndrome?
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"SNHL, euthyroid goiter. Patient have an abnormal perchlorate uptake test (reduced thyroid activity over time) - associated with mondini malformation and enlarged vestibular aqueduct"
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What abnormal test is seen in Pendred syndrome?
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Perchlorate uptake test
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"What syndrome is assoicated with SNHL, mondini malformation and EVA?"
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Pendred
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What is the most common skeletal dysplasia?
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Achondroplasia
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What is achondroplasia a disorder of?
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Endochondral bone formation
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Features of achondroplasia? |
"Skeletal dysplasia, Narrow foramen magnum, hydrocephalus, spinal canal stenosis, respiratory infections, apnea, otitis and Conductive Hearing Loss"
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Features of Branchio-oto-renal syndrome?
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"Branchail apparatus abnormalities (clefts, cysts, fistulas), preauricular pits, hearing loss (SNHL, CHL or mixed), renal abnormalities"
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Features of Crouzon syndrome?
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"CHL, craniosynostosis, maxillary hypoplasia, ocular hypertelorism with exopthalmos, mandibular prognathism"
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Features of Neurofibromatosis type 2
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Bilateral acoustic neuromas - candidate for auditory brainstem implants
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Features of Stickler syndrome:
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SNHL or mixed flattened facial appearance with Pierre Robin sequence myopia
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Features of Treacher-Collins syndrome
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Mandibulofaial dysostosis CHL, SNHL, mixed midface hypoplasia micrognathia malformed ears lower lid coloboma downward slanting eyes
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