Largest internal organ
Liver
High LFTs and jaundice ar most commonly seen in which type of viral hepatitis
Acute viral hepatitis
LFTs found in hepatocytes
ALT and AST
LFTs found in bile duct lining cells
ALP and GGT
Best, most specific liver test
ALT
Rbc degredation product that is cleared by the liver
Bilirubin
Which is more liver specific, ALT or AST
ALT
Levels of ALT/AST in viral hepatitis
Very high bc of hepatocyte damage
Levels of GGT/ALP/Bilirubin in viral hepatitis
Mildly elevated
Levels of GGT/ALP/Bilirubin in pts with gallstones
Very high
Levels of ALT/AST in pts with gallstones
Mildly elevated
3 types of hepatitis that are blood borne
B C D
95% of pigs/boars are infected with
HEV
Which types of hepatitis are fecal/orally transmitted
HAV and HEV
Is there a vaccine for HAV
Yes
Most easily transmitted type of hepatitis
HBV
- via any body fluid
Coinfects with HBV
HDV
Can you vaccinate against HBV and HDV
Yes
Worst type of hepatitis
HCV
If a patient is infected with HBV, what will show up
HBsAg and Anti-HBcAg (core)
If a patient is in recovery of HBV, what will show up
Anti-HBsAg (anti surface) and Anti-HBcAg (core)
If a patient is immunized for HBV, what will show up
Anti-HBsAg (antisurface)
Number one cause of chronic hepatitis, cirrhosis and liver cancer
HCV
Which type of hepatitis cannot be prevented with vaccine
HCV and HEV
Haptocellular Carcinoma (HCC) is related to which types of hepatitis
HBV globally and HCV US
Occurs at the end of chronic liver disease
Cirrhosis
Jaundice is first seen where
Eye
What give urine a yellow color and feces a brown color
Urobilinogen
Deals with a copper transportation problem
Wilson’s disease
New onset neuropsychiatric manifestations can be related to
Wilson’s disease
Ocular manifestations in Wilson’s disease
Kaiser-fleischer ring
Sunflower cataracts
Where/what is the Kaiser-fleischer ring
Copper in Descemet’s membrane
Where/what is sunflower cataract
Copper in ant and post capsule of the lens
What percent of patients with neurological Wilson’s disease will have kayser fleischer rings
Almost all
What percent of patients with hepatic Wilson’s disease will have kayser fleischer rings
50%
2 ways to treat Wilson’s disease
- Chelating agents
- Blocking intestinal copper absorption with zinc salts
Example of a chelating agent to lower copper levels
Penicillamine
Example of a zinc salt used in treatment of Wilson’s disease
Zinc acetate
Iron overload
Hemochromatosis
What is hemochromatosis sometimes confused with
Polycythemia Vera (PCV)
Common sign of hemochromatosis
Bronzed skin hyperpigmentation
Lab results in hemochromatosis
High serum iron and ferritin
What is cholelithiasis
Gall stones
What is cholecystitis
Inflammation of the gallbladder
Where is pain in cholecystitis
right upper quadrant
Pain is worsened by what in cholecystitis
Fatty foots
Pain and belching after fatty meal
Cholecystitis
Lab results for cholecystitis
Bilirubin/GGT/ALP are very high
AST/ALT are mildly elevated
Pancreatitis will spill what into the blood
Amylase and lipases
Commonly occurs secondary to alcohol abuse or gallstones
Pancreatitis
What is the 20% viral hepatitis rule of thumb
20% of chronic hepatitis progress to cirrhosis
20% of cirrhosis progresses to hepatocarcinoma
HBV carriers do not develop
Anti-HBsAg
Sever, liver destructive hepatitis caused by HBV
Fulminant hepatitis
Is it hard to treat HCV
No, but if not treated there is a 99% chance you will be a carrier
Which is more likely to be cured, HBV or HCV
HCV (90-98% cured, while only about 25% of HBV are cured)
Most likely complication of pancreatitis
Pancreatic cancer
Copper transport protein that may be low in Wilson’s disease
Ceruloplasmin
Levels in Wilson’s disease
Serum ceruloplasmin - low
Serum free copper - high
What causes PCV
RBC overproduction
No urine production
Anuria
Painful urination
Dysuria
Amount of plasm filtered per unit of time
GFR
Toxic waste in the blood
Uremia
How many nephrons in each kidney
1 million
How much urine is produced per minute
1.2 mL
How much urine is produced per day?
1-2 L
Function of the glomerulus
Filters
- produces cell/protein free ultrafiltrate
The 3 segments of the tubule in the nephron
Proximal to loop to distal
The tubule absorbs
H20, Na and glucose
The tubule secretes
K, H, HCO3
What do the collecting ducts do
Concentrate the urine under control of ADH
How does the kidney maintain the acid/base balance
HCO3- Can be regenerated/conserved
H+ is secreted
The kidney regulates what 3 things
BP
RBC production (erythropoietin)
Calcium/phosphorus metabolism (vitD)
When do signs and symptoms first appear in kidney failure
After 75% of the nephrons fail
The GFR reflects what of the kidney
Kidney function
2 main uremia indicators
Creatinine and BUN
Urine in the blood
Uremia (renal impairment)
When the kidney function is lost, what happens to the blood levels of creatinine and BUN
Both increase
Rule of thumb for renal function
100/serum creatinine = renal function
How are BUN and creatinine levels typically related
Creatinine X 10 = BUN
Most common test for evaluating renal function
Serum creatinine blood test
The gold standard for determining GFR
Inulin Clearance
Most common GFR measure
Creatinine clearance
What will be present when you have a UTI
Leukocyte esterase
Protein
Blood
Nitrite
Significance of bilirubin in urine
Indicates liver problems
Starvation indicator
- may be present if person is on a low carb diet
Ketones
Earliest indicator of kidney damage in diabetes
Microalbuminuria
What closely reflects GFR
Creatinine
Often overestimates renal function
Creatinine
Are creatinine levels impacted by diet
No
What is creatinine concentration proportional to
Muscle mass
Often underestimates renal function
BUN
Are BUN levels impacted by diet
Yes
Normal creatinine clearance
115-125 mL/min
- think of CL as a percentage
2 types of cystic disorders
Adult polycystic disease
Child polycystic disease
When are symptoms of adult polycystic disease produces
4th decade
Where are the cysts formed in adult polycystic disease
Liver or pancreas
Most common cause of upper urinary tract obstruction
Kidney stones (nephrolithiasis)
3 types of kidney stones
Calcium (calcium oxalate)
Magnesium ammonium phosphate
Amino acids
Signs/symptoms of kidney stones
Dull, deep, achy pain in back
Or
Severe flank pain
Clammy skin, nausea, heamturia
Second most common type of bacterial infection (behind respiratory tract)
UTI
1 cause of UTI
E. coli
Type of bacteria: E. coli
Gram - rod
Lactose ferminter
Type of UTI: lower abdominal or back discomfort; burning and pain when urinating
Lower UTI
If lower UTI is not treated, what will form
Upper UTI
Type of UTI: shaking chills, moderate to high fever, look and feel sick
Upper UTI
How to diagnose a UTI
Urinalysis
- leukocyte esterase, nitrites, blood and protein
If someone with a UTI has WBC casts, what type if UTI do they have
Upper UTI
Caused by diseases that produce proliferative inflammatory responses that allow loss of BLOOD into urine
Nephritic syndromes
Caused by disorders that increase the permeability of the glomerular capillary membrane, causing massive loss of PROTEIN in the urine
Nephrotic syndrome
Leading cause of chronic renal failure in the US
Glomerulonephritis
Characteristics include RBC casts, low GFR and oliguria
Glomerulonephritis
What will be in the urine in pts with nephritic syndrome
RBCs and RBC casts
Limited proteinuria
Most common form of acute glomerulonephritis
Post streptococcal glomerulonephritis
When do symptoms usually begin with acute glomerulonephritis
1-3 weeks after infection (usually upper respiratory tract infection or pharyngitis)
Signs and symptoms of acute glomerulonephritis
Proteinuria (limited)
Heamturia (cola colored urine)
Hypertension
Edema
What percentage of children recover completely from acute glomerulonephritis
95%
What percentage of adults recover completely from acute glomerulonephritis
60%
- the rest have permanent kidney damage
Disorder that leaks large amounts of protein
Nephrotic syndrome
What are levels of certain substances in nephrotic syndrome
Massive proteinuria Hypoalbuminemia Hypogammagloulinemia Hypercoagulable (loss of AT3, so high risk of throwing a clot) Hyperlipidemia
Diabetic glomerulosclerosis is also known as
Diabetic nephropathy
Nephropathy affects how many t1d patients
30%
What is an important predictor of future diabetic nephropathies
Microalbuminuria
What is pyelonephritis
Inflammation of kidney
Acute pyelonephritis is caused by
UTIs with gram - rods
- #1 cause is E. Coli
If pt has WBC casts
Pyelonephritis
If pt has RBC casts
Glomerulonephritis
What can drugs and toxic substances do to the kidneys
Obstruct urine flow
Produce hypersensitivity reactions
3 causes of acute renal failure
- dec blood to the kidney (prerenal)
- disrupt the structures in the kidney (intrarenal)
- interfere with elimination of urine (postrenal)
What is a very common nephrotoxic drug
Aminoclycosides (gentamicin)
Number 1 cause of chronic renal failure
Diabetes
4 stages of chronic renal failure in order
Diminished renal reserve
Renal insufficiency
Renal failure
End stage renal disease
GFR is reduced to what in renal insufficiency
20-50% of normal
GFR is reduced to what in renal failure
5-15% of normal
GFR is reduced to what in end stage renal disease
<5% of normal
When do uremia, anemia and HTN begin to appear in chronic renal failure
Renal insufficiency
Most common type of kidney stone
Calcium oxalate
Earliest indicator of kidney damage in diabetes
Microalbuminuria
Leading cause of fetal complications
Preeclampsia
Leading cause of maternal mortality in the 1st trimester
Ectopic pregnancy
2nd leading cause of maternal death
Eclampsia
Characterized as a pregnant woman with HTN and protein in the urine
Preeclampsia
Characterized by a pregnant woman with HTN, protein in the urine and having seizures
Eclampsia
What must the pregnant pts blood pressure be to be considered high
140/90 or higher
An pregnancy when the fertilized ovum implants outside of the intrauterine cavity
Ectopic pregnancy
Where does implantation normally occur with ectopic pregnancies
95% int he Fallopian tubes
How often should beta-hCG double during a normal pregnancy
Every 2 days
What does a lack of doubling of beta-hCG during pregnancy mean
It is an abnormal pregnancy
An intrauterine gestational sac should be visible via TRANSVAGINA ultrasound when beta-hCG goes above what concentration
> 1,500
An intrauterine gestational sac should be visible via ABDOMINAL ultrasound when beta-hCG goes above what concentration
> 6,500
Most common risk factor for ectopic pregnancy
Pelvic inflammatory disease
What is gestational diabetes
HTN during pregnancy
- high blood sugar affects pregnancy and the baby’s health
4 complications to the baby in regards to gestational diabetes
- increased size/birthweight (can wedge in birth canal and cause injuries or require C section)
- early birth because of respiratory distress syndrome
- low blood sugar because insulin production is high (can provoke seizures)
- T2D later in life
2 risks of gestational diabetes to the mother
- HTN + preeclampsia
- future T2D
How does BPH cause problems
Bigger prostate with pinch the urethra and the bladder wall will thicken
Bladder weakens and cannot empty as well —> leads to increase in urination frequency (>8 x a day) and incontinence
Blood tests used to screen for BPH
-PSA blood test
-creatinine
-BUN
-HGB
(Also a urinalysis)
6 complications of BPH
- acute or chronic urinary retention
- blood in urine
- UTIs
- bladder damage
- kidney damage
- bladder stones
2 CNs in the pupillary light reflex
In on 2
Out on 3
What is the pathway in the pupillary light reflex
- Shining light into 1 eye activates the sensory arc through optic tracts bilaterally to pretectal nucleus
- each pretectal nucleus sens bilateral projects to left and right EW nucleus
- parasym in left and right ciliary ganglion activate constrictor in both eyes
If there is a lesion to the right optic nerve, what will the deficit with pupil testing
When the light is shined into left eye, there will be a consensual response in the right
When the light is shined into the right eye, there will be no response in either eye
**sensory arc is damaged so neither eye will react when shined into the ipsilateral eye
If there is a lesion to the right optic tract, what will the deficit with pupil testing
There will still be a normal direct and consensual response because you haven’t completely knocked out the sensory arc
If there is a lesion to the right oculomotor nerve (CN3), what will the deficit with pupil testing
It is now a motor issue, so the right eye will never constrict (in direct or consensual), however, it does sense the light, so the left will consensually response when shined into the affected eye
Abnormally asymmetrically sized pupils
Anisocoria
What can opiate drugs do to they eye
Directly inhibiting the dilator muscle —> pinpoint pupils bilaterally
What is a Marcus-Gunn pupil
- afferent pupillary defect (APD)
- Impaired sensory arc
- ipsilateral impairment of both direct and consensual (when shined on affected side, neither eye dilates, but when shined on unaffected side, both eyes constrict)
Where is damage if a pt has an APD (Marcus-Gunn pupil)
ON or retina
Impaired constriction to light and accommodation
Acute adie’s pupil
Due to partial degeneration of ciliary ganglion or post-gang parasym fibers, possibly due to inflammatory damage
Acute adies pupil
Impaired constriction to light, but still constricts with accommodation
Chronic adie’s pupil
Involved ectopic reinnervation of iris by parasym projections that normal target the ciliary body
Chronic adie’s pupil
Impairment in light reflex but with preserved accommodation response is known as
Light-near dissociation
Conditions where light-near dissociation occurs
- Adie’s pupil
- neurosyphillis, accompanied by irregular shaped pupils (argyll-Robertson pupil)
- some diabetics
- parinaud’s syndrome
Damage to any part of the motor pathway involved in pupillary dilation will result in
Horner’s syndrome
How to test for horner’s syndrome
Local application of cocaine drops
- dilate the intact side, but fail to dilate the ipsilateral/affected side bc no NE is being released
2 major lesion sites that may cause horner’s syndrome
- Lateral pons infarct
- lateral medulla infarct
Ischemia of the anterior ON (part in the orbit)
Anterior ischemic optic neuropathy (AION)
A common cause of sudden vision loss
AION
Does a pt have pain in AION
No
What will be seen on an ophthalmic exam in a pt with AION
Small C/D ration
A common precursor to MS
Optic neuritis
Inflammatory de-myelination of ON
Optic neuritis
3 possible etiological of Optic neuritis
- Inflammatory process from viral infection
- pro-inflammatory chemical exposure
- vit B12 deficiency
Presentation of Optic neuritis
Monocular vision loss with eye pain
Visual loss in Optic neuritis
Central scotoma, reduced acutiy, impaired color detection
What will be seen in ophthalmic exam of a pt with Optic neuritis
Swollen and inflamed
OR
Normal
APD
EEG recording in a pt with Optic neuritis
Long latency with normal amplitude because of the demyelination
Temporal profile of Optic neuritis
- variable onset (age 30-45)
- acute, subacute, chronic
- duration <2wks with partial/full recovery (may take 6 weeks to months)
- 1/3 of pts have more than 1 recurrence
Reasons to suspect a differential diagnosis from Optic neuritis
- over 45
- no pain
- bilateral vision loss
- 1st episode lasting >2 weeks
Tx of Optic neuritis
Glucocorticoids
Autoimmune de-myelinating disorder of the CNS
MS
Autoimmune attack against oligodendrocytes by T-lymphocytes
MS
Presentation of MS
- multi focal
- 2+ attached separated in time (>1 month apart)
Epidemiology of MS
- 20-40 yo
- females
- Caucasian’s in higher latitude regions
Diagnostic criteria and confirmation of MS
- MRI with contrast showing 2+ white matter plaques (fingers extending from periventricular zones)
- CSF analysis: oligoclonal bands (have elevated lymphocytes and high levels of IgG)
Why is there oculomotor deficits seen in pts with MS
Lesion of MLF
- MR of ipsilateral eye doesn’t work
- nystagmus on contralateral side with LR is used
Short term treatment of MS
Glucocorticoids
Long term treatment of MS
Selective immunodulatory agents
- 1st line: interferons
- 2nd line: monoclonal Abs or chemotherapeutics
Factors that can trigger or intensify an attack in MS
- infection
- heat
- dehydration
- sleep deprivation
De-myelination of ON and spinal cord
Neuromyelitis optica (NMO)
Presentation of NMO
Bilateral vision loss, level down sensory and motor deficits
Auto-immune attach involving Abs to aquaporin-4
NMO
Viral infection of oligodendrocytes
- rarely symptomatic, but can lead to this
Progressive multifocal leukoencephalopathy
Temporal profile of Progressive multifocal leukoencephalopathy
- subacute and progressive
- can be fatal
- visual deficits, aphasia, unilateral weakness
- can lead to dementia
- no pain
Myelination formation is impaired or the myelin is structurally and functionally defective
Leukodystrophies
Inflammatory de-myelination of CNS, often with gray matter damage and usually happens after an infection or vaccination
Acute disseminated encephalomyelitis (ADEM)
ADEM can mimic what
Stroke or MS
Temporal profile for ADEM
- acute to subacute onset of chief complaint (similar to stroke)
Tx of ADEM
Glucocorticoids
Do most patients recover from ADEM
Yes
HA that is of urgent/emergency likely
Acute onset
Are subacute onset HA emergent
No
3 common forms of chronic onset HA
Tension
Cluster
Migraine
If a tension HA persists it can become
Chronic and stable
Pattern of a migraine
Irregular with variable remission periods
Pattern of cluster HA
Several daily bouts with long remission periods
Patter of brain tumors
Chronic/insidious onset with steady progression
- can be asymptomatic until reaching threshold
Pain in cluster headaches
Unilateral
Ocular or retro-orbital HA are suggestive of
Ocular or nuerophthalmic causes
A focal HA can gisngal
Intracranial mass
Distribution of a tension HA
Band like or diffuse (bilateral)
Brain regions that tension HA are usually located
Frontal or occipital
Localization of cluster HA
Peri-orbital region
Localization of migraine HA
Hemi-cranial
More common, primary or secondary tumors
Secondary
Primary tumors come from
Glia, meninges, pituitary
Secondary tumors come from
Lung, breast, melanoma, prostate
Do post-natal CNS neurons go through mitosis
No
Tumors develop from cells that what
Undergo mitosis
Tumor type from pre natal neural stem cells
Neuroblastoma
Tumor type from developing cerebellum
Medulloblastoma
Tumor type from cerebral white matter
Oligodendroglioma
Tumor type from astrocytes
Astrocytoma or glioblastoma
Tumor type from ependymal cells
Ependymomas
Abs generated agains nicotinic ACh receptor
MG
What muscles are typically weak in MG
EOMs and levator palpebra
- diplopia and ptosis
Ab-mediated autoimmune attack against Ca channels coupled to ACh
Lambert-Easton syndome
Are AChase Inhibitors useful in MG
Yes
Are AChase Inhibitors useful in lamber-Eaton syndrome
No, bc the problem is ACh release
Mutation in duchesse muscular dystrophy
Dystrophin
What muscles are most affected in duchesse muscular dystrophy
Proximal limb muscles
Period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and perisistely increased activity or energy
Bipolar disorder
Pts must have 3+ of the following 7 symptoms during their mood disturbance
- inflated self esteem
- decreased need for sleep
- more talkative
- racing thoughts
- distractibility
- increase in goal-directed activity
- excessive involvement in activities with a potential for painful consequences
Main treatment for bipolar disorder
Lithium
An alternative treatment for bipolar disorder
Anti-psychotics or anti-depressants
Weight for height index used to classify weight status
BMI
What amounts of adults are overweight/obese
2/3
What amount of adults are obese
1/3
What amount of adults are extremely obese
1/20
What amount of children are overweight or obese
1/3
BMI range for healthy
18.5 -24.9
BMI range for obese
30-39.9
BMI range of overweight
25-29.9
BMI of extremely obese
> /= 40
2 Top health risks that are greatly increased by obesity
Diabetes
Gall bladder disease
(And Dyslipidemia)
Top health risk that is moderately increased by obesity
Coronary heart disease
Why are monounsaturated fats considered more healthy than polyunsaturated fats
Because they have a higher HDL value
Both have low chol and low LDL, but polyunsaturated has low HDL and monounsaturated has high HDL
Loss of control over eating and eating large amounts of food discreetly at least 1x a week
Binge eating
Diagnostic criteria for anorexia
- significantly low body weight
- intense fear of gaining weigh or becoming fat
- amenorrhea (a sense of menstration)
- bad self perception
Type of anorexia: starving
Restricting
Type of anorexia: blends with bulimia
Purging
Personality traits that contribute to anorexia
- extreme perfectionist
- OCD
- low self esteem
- high achiever
- anxiety
- depression
- cognitive impairment
2 major complications of anorexia
Bradycardia and cardiac dysrhythmias
Female athlete triad
Eating disorder
Amenstrual
Osteoporosis
Diagnostic criteria of bulimia
- recurrent episodes of bing eating (lack of control)
- recurrent inappropriate compensatory behaviors (vomiting, laxative/diuretic abuse, fasting or excessive exercise)
Type of bulimia: vomiting and misuse of laxatives/diuretics
Purging
2 major complications from vomiting-related bulimia
- Low of enamel and dentin
- fluid and electrolyte disorders
Which eating disorder is most likely associated with a Mallory-Weiss tear
Bulimia
Which eating disorder has the highest mortality rate
Anorexia nervosa
Inadequate intake of both protein and calories
Marasmus
Dietary deficiency of protein only
Kwashiokor
Age of onset of kwashiorkor
Pre school (1-5 yo)
Age of onset of marasmus
Weaned infants (<1 yo)
What is ascites
Abdominal swelling
Which malnutrition disorder will have ascites
Kwashiorkor
What type of genetic disorder is: marfans
Autosomal dominant
What type of genetic disorder is: neurofibromatosis
Autosomal dominant
What type of genetic disorder is: familial adenomatous polyposis (FAP)
Autosomal dominant
What type of genetic disorder is: hemophilia a
Mothers are carriers and pass to their son
What is CHRPE
Congenital hypertrophy of theretinal pigment epithelium
What are bear tracks
Multiple areas of grouped retinal pigment epithelium hypertrophy
Ocular hallmark of familial adednomatous polyposis (FAP)
4+ bear tracks in multiple areas
What mutation causes bear tracks to be autosomal dominant and not recessive
Mutation of APC hydroxylase gene
Inheritance of a single mutation results in a given condition
Autosomal dominant
Inheritance of 2 mutations results in a given condition
Autosomal recessive
Inheritance limited to the inheritance of the affected X chromosome
X linked (sex linked)
Disorders often involve structural proteins and usually appears later in life
Autosomal dominant disorders
Chance of inheritance of autosomal dominant disorders
50%
Chance of inheritance of autosomal recessive
25%
Autosomal recessive disorders often involve disorders of
Enzymes
What mutation causes bear tracks to be autosomal recessive and not dominant
MYH glycosylase gene
Are females usually affected by x linked disorders
No
Color blind and hemophilia a are examples of
X linked disorders
Factor 8 clotting factor deficiency
Hemophilia a
Monosomy
A missing chromosome
Trisomy
An extra chromosome
Triploidy
And extra copy of all chromosomes
Chromosomes break and swap pieces
Translocations
Loss of genetic material
Deletions
Chromosome breaks and piece reattached in opposite orientation
Inversions
Agents associated with causing abnormalities during embryonic/fetal development (harmful to fetus)
Teratogens
Period of embryonic development when teratogens are most likely to cause major congenital anomalies
1st trimester
What is karnofsky’s law
Anything at the right time of pregnancy, at the right dosage, in the right species can be teratogenic
Maternal infections that can be teratogenic (TORCH)
Toxoplasmosis Other Rubella Cytomegalovirus Herpes
Primary risk of a deficiency of folic acid during pregnancy
Teratogenicity
- neural tube defects
(Affect both mom and fetus)
- uses fluid
- performed after 1st trimester
- less invasive than CVS
Amniocentesis
- uses tissues
- performed during first trimester
- invasive
Chorionic villi sampling (CVS)
Characterized by disfiguring neurofibromas and 6+ areas of dark pigment
Neurofibromatosis 1
Criteria of fetal alcohol syndrome
- growth retardation
- CNS involvement
- dysmorphic facial features (short palpebral fissures, thin upper lip, elongated and flattened midface)
Top 3 methods used for fetal diagnosis
Ultrasound
Amniocentesis
CVS
Age related hearing loss
Presbycusis
Most common condition that affects both vision and hearing
Usher syndrome
Toddlers do this to a line and preschoolers do it to a circle
Draw
Locomotion of a toddler
Walk
An eye problem observed in usher’s syndrome
Retinitis pigmentosa
Out of sight, out of mind observed in infants <9mo
Permanence
An infant can do this to ID an object of interest
Point
What sounds are you less able to detect/discriminate when presbycusis
Sounds in the higher frequency range
The perception of motion caused by a dysfunction of the vestibular system
Vertigo
Pt feels like the world is spinning
Objective vertigo
Pt feels that they are moving
Subjective vertigo
The perception of a sound in your ears in the absence of an externally applied stimulus (ringing in the ear)
Tinnitus
Is the cause of 10% of hereditary deafness
Usher’s syndrome
Infection of inflammation of the ear (ear infection)
Otitis media
Age range: first stand
Infant
Age range: points to objects
Infant
Age range: object permanence
Infant
Age range: take first steps
Toddler
Age range: kicks ball
Toddler
Age range: feeds itself
Toddler
Age range: drive tricycle
Preschool
Age range: draw stick figures
Preschool
Age range: have friends and can play with them
Preschool
Age range: can tell detailed stories (legends)
Preschool