Neuro Part 16

Front 1

Otitis Media =

Back 1

middle ear inf, due to Eustachain tube dysfunction.

Front 2

3 m.c. agents of OM:

Back 2

1. Strep penumo

2. H. influ.

3. Moraxella

Front 3

tympanocentesis =

Back 3

ear tap to obtain a culture

(esp. for imm-comp, R strains, refractory treatment)

Front 4

pressure equalization tube =

Back 4

small tube placed in the tympanic membrane to "vent" the middle ear and prevent negative pressure build up.

- NOT for drainage of fluid

Front 5

Bullous Myringitis =

Back 5

variant of AOM with extremely painful blisters on the outer surface of the TM

Front 6

Otitis Media with effusion (OME) =

Back 6

*chronic* eustachian tube dysfunction

~~ fluid WITHOUT inf.

Front 7

2 potential complications of AOM:

Back 7

1. Mastoiditis

2. Meningitis

Front 8

Mastoiditis =

Back 8

inf. of the air cells and bony structures in the mastoid bone

Front 9

Cholesteatoma =

Back 9

erosion +/- inf. of bony structures of middle ear

(due to negative pressure buildup that allows sloughed skin to pile up and erode bone)

Front 10

pathophys of Cholesteatoma:

Back 10

chronic negative middle ear pressure

=> retraction of part of pars flaccida back into middle ear

=> squamous epithelium of TM desquamates (nl)

=> keratinous (skin) debris builds up and accumulates

=> erodes bony structures via pressure
(with possibility of inf.)

Front 11

tympanoplasty =

Back 11

repair of the hole in the TM

Front 12

tympanomastoidectomy

Back 12

removal of growths or infected bone from inside the ear

Front 13

Ofloxacin Otic solution =

Back 13

ONLY topic antibiotic approved for AOM with tympanic membrane perforation

Front 14

Otitis externa = Swimmer's ear =

Back 14

inf. of the external auditory canal

Front 15

3 features of OE/Swimmer's ear:

Back 15

1. usually P. aeruginosa

2. pain upon traction of the pinna

3. treat with topic otic solution.

Front 16

4 causes of conductive hearing loss:

Back 16

1. swelling of external canal

2. TM perforation

3. ossicular abnormalities

4. middle ear fluid

Front 17

Sensorineural hearing loss =

Back 17

hearing loss due to the ***inner ear (cochlea) or CN 8***

- conductive hearing loss ~~ middle ear (TM + ossicles)

Front 18

Presbycusis =

Back 18

*age-related* changes of CN 8 leading to hearing loss

Front 19

Pure tone audiometry = "the hearing test", used to assess the patient's:

Back 19

hearing level

- determines hearing threshold between 250 to 8000 HZ

Front 20

air-bone gap =

Back 20

ANY blockage to sound transmission in the pathway from ear to cochlea

Front 21

Speech discrimination =

Back 21

a test of the patient's ability to understand spoken words, done by presenting phonetically balanced words (love, boat, pool) into the audiogram

Front 22

tympanometry is used to evaluate:

Back 22

the mobility of the TM and responses to pressure changes in the external auditory canal

Front 23

Otosclerosis =

(4)

Back 23

1. hereditary

2. abnormal bone growth of temporal bone/middle ear

3. esp. at footplate region of the stapes

4. => *gradual fixation of the ossification chain*

Front 24

Otosclerosis may progress to:

Back 24

bilateral deafness

Front 25

stapedectomy =

Back 25

removal of a fixed stapes ossicle and replacement with prosthesis, re-establishing ossicular continuity

- treatment of otosclerosis

Front 26

Patients suffering from noise-induced hearing loss have a:

Back 26

symmetric "noise notch" in bone-conduction thresholds at approximately 4000 Hz.

Front 27

acoustic neuroma =

Back 27

*benign* tumor of the 8th CN

Front 28

cochlear implant =

Back 28

hearing aid device with *direct* stimulation of the cochlear nerve

Front 29

vertigo =

Back 29

an *illusion* of motion, primarily associated with the balance organs of the inner ear

Front 30

electronystagmography = gold standard for detecting:

Back 30

*unilateral, peripheral* vestibular disorders

Front 31

Rotatory chair testing = "gold standard" for diagnosing:

Back 31

**bilateral** vestibular weakness

Front 32

posturography =

Back 32

a method of quantifying balance

- but should not be used alone to diagnose vestibular disorders.

Front 33

benign paroxysmal positional vertigo is caused by:

Back 33

sediment, such as otoconia, that have become free-floating within the inner ear.

- when the patient turns his or her head quickly or into a certain position, this free-floating material moves the balance canal fluid (endolymph) in the inner ear and stimulates the vestibular division of CN 8

treatment = epli or semonte, Dick's maneuver

Front 34

vestibular neuronitis =

Back 34

inflammation, secondary to a viral inf., of the vestibular portion of CN 8 or the vestibular labyrinth

Front 35

treatment for vestibular neuronitis =

(2)

Back 35

vestibular suppressant meds, including

1. anticholinergics

2. antihistamines

Front 36

Ménière's dz =

Back 36

intense, episodic vertigo, usually lasting from 30 minutes to four hours, and associated with:

1. fluctuating hearing loss,

2. roaring tinnitus, and

3. sensation of aural fullness

Symptoms are secondary to a swelling/excess fluid, => distention of the endolymphatic space within the labyrinth

Front 37

Treatment for Meniere's dz =

(4)

Back 37

get CT

1. salt restriction

2. thiazide diuretics

3. vestibular ablation by instillation of ototoxic medication (i.e. Gentamicin)

4. surgical options
(e.g. endolymphatic sac decompression)

Front 38

what hearing test is used to evaluate Ménière's disease?

Back 38

electrocochleography

Front 39

Bell's palsy =

Back 39

*unilateral* facial nerve paralysis that is, by definition, idiopathic.

Front 40

Bell's palsy is also called:

Back 40

viral or herpetic facial paralysis,

since most cases ~~ herpetic infection

Front 41

Ramsay-Hunt's Syndrome = herpes zoster oticus =

Back 41

*complete ipsi facial nerve paralysis* accompanied by:

1. severe pain

2. a vesicular eruption in the external auditory canal and auricle (in the distribution of the facial nerve)

Front 42

Ramsay-Hunt is caused by _______________ and is treated with ________________________

Back 42

VZV;

antivirals like Acyclovir

Front 43

Temporal Bone Fractures may easily affect which CN?

Back 43

CN 7

=> facial paralysis

Front 44

treatment of facial nerve transection =

(2)

Back 44

1. direct re-anastomosis

or

2. interposition graft (using greater auricular or sural nerve)

Front 45

hemotympanum =

Back 45

blood collection in the middle ear

- can cause conductive hearing loss
- usually result of fracture involving the ear canal

Front 46

corneal ulceration, scarring, or permanent vision changes can result from:

Back 46

facial nerve paralysis,

b/c no eye closure = no moisture

Front 47

unilateral, foul-smelling, purulent rhinorrhea often is caused by:

Back 47

foreign body in nose

Front 48

mediastinitis = inflammation of the tissues in the mid-chest, or mediastinum; can result from:

Back 48

ingestion of button batteries,

leading to caustic damage (esp. if lodged in esophagus)

or fatal perforation

Front 49

tonsillectomies are performed on adults and peds with:

(4)

Back 49

1. recurrent or chronic tonsillitis

2. OSA

3. asymmetric tonsils

4. peritonsillar abscess

Front 50

Lemierre's syndrome =

Back 50

thrombophlebitis of the IJV

Front 51

thrombophlebitis =

Back 51

inflammation of the wall of a VEIN, with associated thrombosis

Front 52

Chronic Tonsillitis =

Back 52

chronic low-grade inf. of the tonsils

- often with large crypts within the tonsils that collect food and debris

- difficult to treat with antibiotics

Front 53

apart from lethargy and growth retardation, Obstructive Sleep Disorders are often associated with:

(3)

Back 53

1. behavioral problems

2. hyperactivity

3. nocturnal enuresis

Front 54

asymmetric tonsils are usually the result of:

Back 54

recurrent scarring from infs.

- but they may harbor tumors (such as lymphoma) and should be removed for examination

Front 55

Peritonsillar Abscess =

Back 55

abscess that collects in the potential space between the pharyngeal constrictor and the tonsil

Front 56

signs of Peritonsillar abscess:

Back 56

1. fullness of the anterior tonsillar pillar

2. deviated uvula

3. "hot-potato voice" (somewhat muffled)

4. severe dysphagia

Front 57

adenoids =

Back 57

lymphoid tissue situated on the posterior pharyngeal wall and roof of the nasopharynx,

just behind the soft palate and adjacent to the torus tubarius (eustachian tube openings)

Front 58

adenoiditis =

Back 58

inflammation, infection and/or enlargement of adenoids

Front 59

symps of adenoiditis:

(3)

Back 59

1. nasal obstruction

2. chronic mouth breathing

3. snoring.

Front 60

adenoidectomy is performed in:

Back 60

older children who have

*recurrent AOM*

or

*chronic otitis media with effusion*,

*especially if effusion has returned after tympanostomy tube extrusion* (placing of tubes)

- prevent fluid accumulation

Front 61

Stridor =

Back 61

high-pitched, noisy respiration emanating from the larynx or upper trachea

- a sign of respiratory obstruction

Front 62

causes of Stridor:

(4)

Back 62

1. acute epiglottitis

2. croup

3. foreign body aspiration

4. laryngomalacia
(= floppy, narrow supraglottic structures and an omega-shaped epiglottis)

- can be life threatening

Front 63

Acute Epiglottitis =

Back 63

inf. of the supraglottic (above the vocal cords) structures that causes swelling of that portion of the larynx

- can cause rapid airway obstruction

Front 64

acute epiglottitis is usually caused by:

Back 64

H. influ type B*

Front 65

treatment of acute epiglotitis =

(4)

Back 65

1. secure airway

2. transfer to OR if compromised airway,

3. ceftriaxone and oxacillin

4. cefuroxime (single-drug therapy)

Front 66

Croup =

Back 66

laryngotracheobronchitis,

a viral inf. of the *upper airway* causing both stridor AND swelling in the subglottic area (below the vocal cords)

Front 67

treatment for croup =

(3)

Back 67

1. humidity

2. oxygen

3. if necessary, EPI/steroids

Front 68

a rigid esophagoscope is a tool used to:

Back 68

remove the foreign body from the esophagus

- If the foreign body has been aspirated, then bronchoscopy is required

Front 69

subglottic stenosis is m.c.ly caused by:

Back 69

scarring from long-term placement of an endotracheal tube

Front 70

cricoid split is a surgical technique used to:

Back 70

enlarge the airway

= vertical incision in the anterior cricoid ring,

allowing the ring to expand while an endotracheal tube remains in the airway for 7 to 10 days

Front 71

laryngotracheal reconstruction =

Back 71

grafting rib cartilage into the cricoid cartilage and upper tracheal rings to allow for a more dramatic expansion

Front 72

subglottic hemangiomas are commonly found if a child has:

Back 72

stridor

b/c stridor presents within the 2-4 month age range,
which is when hemangiomas go through a characteristic rapid growth phase

Front 73

vascular rings =

Back 73

congenital defect in which the aorta, innominate artery, or surrounding mediastinal vessels compression of the trachea

Front 74

laryngomalacia =

Back 74

= floppy, narrow supraglottic structures and an omega-shaped epiglottis

most common cause of persistent stridor in infants

Front 75

causes of neck masses in children:

(5)

Back 75

1. lymphatic malformation

2. branchial cleft cyst (lateral neck)

3. thyroglossal duct cyst (midline/hyoid bone)

4. cervical adenitis

5. suppurative adenitis

Front 76

lymphatic malformation =

Back 76

congenital lesion that is classically found in the **left posterior triangle of the neck**

Front 77

lymphatic malformation is also known as:

(2)

Back 77

lymphangioma or cystic hygroma

Front 78

branchial cleft cyst =

Back 78

congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft, found along the anterior border of the SCM.

- the cyst can occasionally become infected and swell, only to respond to antibiotic therapy, shrink, and then recur

Front 79

thyroglossal duct cyst =

Back 79

a fibrous cyst that forms from a persistent thyroglossal duct

- found at the midline, usually over the thyrohyoid membrane.

=> due to proximity to hyoid bone, these cysts move with swallowing

Front 80

cervical adenitis =

Back 80

infected cervical LN's,

usually with Staphylococcus or Streptococcus

Front 81

retropharyngeal cellulitis or abscess =

Back 81

a cervical adenitis that occurs in the space behind the pharynx,

=> stiff neck (meningismus) and fever

Front 82

suppurative (leaking pus) adenitis
WITHOUT associated constitutional symptoms ~~

Back 82

cat-scratch disease or atypical mycobacterial infection

(constitutional symptoms = fever, malaise, localized tenderness)

Front 83

Lymphoma, esp. Hodgkin's, can present as:

Back 83

cervical adenopathy.

Front 84

dermoid cyst =

Back 84

a cystic *teratoma*

Front 85

encephalocele = congenital herniation of the intracranial tissues =

Back 85

neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull

Front 86

glioma =

Back 86

heterotopic brain tissue, can be a congenital nasal mass

Front 87

tracheotomy =

Back 87

operation of cutting into trachea for surgical airway

Front 88

criothyrotomy =

Back 88

preferred method of emergent surgical airway (through cricothyroid membrane)

Front 89

macroglossia =

Back 89

large tongue

Front 90

micrognathia =

Back 90

small jaw

Front 91

Pierre Robin Syndrome =

Back 91

sequence of 3 characteristic congenital malformations:

1. cleft palate

2. micrognathia

3. glossopthosis
(tongue protruding back into airway)

Front 92

Ludwigs Angina =

Back 92

abscess in floor of mouth; can cause airway obstruction from tongue being pushed back

Front 93

angioneurotic edema = hereditary angioedema =

Back 93

functional or quantitative deficiency of C1 esterase inhibitor

=> dramatic swelling of tongue, lips, pharyngeal tissue, and subglottic airway

Front 94

mucormycosis =

Back 94

fungal (Rhizpos) inf.in imm-comp hosts (typically with diabetes);

- shows up as blackened eschar on nasal exam;

Front 95

treatment of mucormycosis =

(2)

Back 95

1. surgical debridement

2. IV Amphotericin B

Front 96

epistaxis =

Back 96

nose bleed

- typically from Kiesselbachs plexus (anterior septum);
- commonly by digital trauma

Front 97

Juvenile nasopharyngeal angiofibroma =

Back 97

dx for recurrent nosebleeds in teenager (typically male) until proven otherwise

Front 98

Malignant Otitis Externa/Necroti =

Back 98

severe inf. of external auditory canal

- typically in diabetics

Front 99

most important sign of Malignant Otitis Externa/Necroti =

Back 99

granulation tissue at bony-cartilaginous junction on exam

- can spread to involve temporal bone, leading to osteomyelitis or brain abscess

Front 100

treatment of Malignant Otitis Externa/Necroti =

Back 100

IV Q's

Front 101

treatment for Sudden Sensorineural Hearing Loss =

(2)

Back 101

1. start steroids immediately

2. anti-virals (acyclovir/fancyclovir);

(cause unknown but thought to be viral; most resolve)

Front 102

causes of stridor:

(

Back 102

1. vascular rings

2. laryngomalacia

3. check

Front 103

symps of acoustic neuroma:

(5)

Back 103

1. unilateral hearing loss

2. imbalance

3. vertigo

4. facial numbness and tingling, which may be constant or come and go

5. facial weakness