Day 2 - Neuro4 Audiovestibular Flashcards Preview

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Flashcards in Day 2 - Neuro4 Audiovestibular Deck (10):

Observation w/o antibx in child w/ otitis media; Threshold for starting antibx

6 mo.-2 yr. old, questionable dx, illness not severe, appropriate f/u, antibx can be started promptly if worsens; > 2 yr, can be severe but as long as other criteria met fine; Start antibx if not improving by 49 hrs


Tx otitis media

High dose ampicillin; If ampicillin resistance, add clavulanic acid or use stronger cephalosporins


Red TM w/ vesicles

Bullous myringitis


Tx Bullous myringitis

Oral macrolides - arithromycin or clarithromycin (mycoplasma pneumoniae common); Topical analgesics


Dx mastoiditis

Complication of acute otitis media; Erythema, edema, tenderness behind ear, external ear displaced; Dx w/ CT scan of mastoid process


Acute labyrnthitis p/w (v. Vestibular neuritis)

Acute onset vertigo, n/v, nystagmus; Auditory fx preserved - Vestibular neuritis; Hearing loss assoc. - Labyrnthitis; Single episode (days to weeks), usually preceded by viral URI or OM; Nystagmus horizontal, suppressed with visual fixation, , fast phase away from affected side; Head thrust abnormal (rapid head movement to abnormal side - Unable to maintain visual fixation); Gait abnormality but preserved ambulation; Absence of focal neuro defects


Tx Acute labyrnthitis

Spontaneous; Corticosteroid taper; Sx - ONLY 1st 48 hrs, scopolamine, meclizine, metoclopramide, promethazine; Sx tx beyond that point is counterproductive to recovery; Vestibular rehab exercises; > age 65 headache, focal neuro, vascular risk factors, or sustained vertigo - MRI (r/o schwannoma or more serious dx)



overgrowth of desquamated keratin debris in middle ear, may erode semivesicular chain & external ear canal; Conductive hearing loss; Causes - negative middle ear pressure, chronic retraction pockets from eustachian tube dysfunction, or direct growth of epithelium from TM perforation; Assoc. chronic middle ear infx; Grayish white pearly lesion behind TM; Middle ear surgical removal


Most common cause of conductive v. sensorineural hearing loss in adults

Conductive - Otosclerosis ; Sensorineural - Presbycusis


Tx Ramsey

Herpes zoster oticus; Narcotics analgesics, Oral steroids, anti-viral w/ valacyclovir (highest efficacy) or famciclovir/acyclovir

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