EarEyes-Table 1 Flashcards
- What is the process by which muscle contraction protects the cochlea from loud noises? What is it called?
Tensor tympani pulls eardrum inward, tightening it; stapedius reduces mobility of stapes
Tympanic reflex
How is sound produced?
Vibration of ossicles by tympanic membrane, transmitted through oval window and then vibration of basilar membrane under hair cells
An older patient is no longer able to hear the tea kettle whistling when it is done, what type of hearing loss is this associated with? What is this hearing loss called where high frequency is lost first?
Sensorineural hearing loss (AC>BC)
Presbycusis
What are the three types of hearing loss?
Conductive, sensorineural, mixed
A patient has received a treatment of gentamycin, what may he/she come back with complaints of? Specifically, what type?
Ototoxicity, sensorineural hearing loss
A patient has come into your office complaining of dizziness x2 weeks and an occasional hearing loss of low-frequency sounds. He also states that there seems to be a sense of fullness and ringing in his ear. What are you thinking this may be? Treatment/plan?
Meniere’s Disease
Low Na diet; restricted water intake, caffeine, chocolate, alcohol restriction for prevention
Can use Diazepam zonk for an acute phase…as well as so many other things
Surgery may be end result (shunt/decompression, nerve resection)
A patient comes in to your office complaining of suddenly not being able to hear out of his left ear. Upon inspection the canal is patent, clear of cerumen, and no significant findings seen…what should you do with this patient?
Refer to otolaryngology
True or False: Tympanometry can be utilized as a screening test for middle ear dysfunction and requires patient response.
False…it is a screening test, but no patient response required
Patient is complaining of ear pain and frequently swims. What is most likely going on? What is the most likely organism? How do you treat it? What happens if it is fungal? Most common fungal cause?
Otitis externa Staph aureus/maybe pseudomonas aeruginosa Oflaxacin most common, analgesia Acidification and consider clotrimazole Aspergillus
A 24 year old patient returns to your clinic after an ear ache has now moved to “behind her ear” and really hurts when she touches it. She is an avid swimmer and recently had an otitis externa infection. What would be on the differential for this and why is this so worrisome?
Mastoiditis/necrotizing or malignant OE
Mastoiditis is continuous with the brain; high mortality rate, even with treatment (surgical debridement and prolonged abx)
A 30 year old man comes into the office in January complaining of ear pain and some hearing loss. His vitals show a low grade fever, bulging TM, and opaque fluid seen behind it. What is this patient experiencing and how would you treat it?
Acute otitis media
Primary treatment = Amoxicillin 500 mg PO TID x10days
Secondary Augmentin 875/125 PO BID x10 days
2nd or 3rd gen cephalo x10 days
The 30 year old patient above also brought his 4 year old son in experiencing identical symptoms, but just finished a 10 day course of Amoxicillin 90mg/kg/day. PE shows TM perforation and a fever. How should you manage this patient?
Refer…(emergency ENT?)
In regards to the macula (in vestibular apparatus), what does it do?
Perceive linear acceleration for dynamic equilibrium
True/False: Otoliths add to the density and inertia and enhance the sense of gravity and motion.
True
True/False: The crista ampullaris, located in the semicircular ducts of the cochlea, can be stimulated by rotation in different planes. This shows angular movement.
True
What is the Dix-Hallpike maneuver useful for?
Benign positional paroxysmal vertigo by moving the head through different planes and thus checking the semicircular ducts…patients eyes will remain open so also looking for nystagmus
What is the most common cause of a “red eye”?
Conjunctivitis
Patient comes into the office with a complaint of a red eye and not being able to open their eyes very easily in the mornings, have to wipe “gunk” off. PE shows conjunctival injection and mucopurulent discharge. What is the most likely diagnosis and cause?
Bacterial conjunctivitis and pneumococcus most common in temperate zone
Treat with topical antibiotics
You have an 18 year old male patient come into your office complaining of a red eye and painful urination. What are we thinking and what is the eye component associated with it?
Reiter’s (Reactive) arthritis and bilateral sterile conjunctivitis
A frequent boater comes into your office complaining of a red “thing” on the side of his eye near his nose and slightly impaired vision in that eye. He wants to know what it is. PE shows a vascular lesion on the medial side of the eye that is encroaching on the cornea. What do you tell him it is and what should be done?
Pterygium
Surgical excision; can lead to blindness
A patient comes in with pain in the eye, photophobia, and ocular redness. His history is positive for juvenile idiopathic pauciarthritis. PE shows iritis with pupillary contraction and abnormal visual exam. Fundoscopic results show a slightly cloudy anterior chamber. What is the most likely cause?
Uveitis
PS, 25 year old male, comes into your office with complaints of painful bump on their left eye around the lashes. What is on the differential and what is the organism usually associated? What
Hordeolum
Staph infection of the Meibomian glands or Glands of Zeis or Moll
What is a complication of an untreated hordeolum? What happens?
Orbital cellulitis
Swollen, red eyelids with chemosis, pain, exophthalmos, fever, leukocytosis
Refer ophthalmologist where it is treated aggressively
DD, 23 year old female, comes into the office complaining of pain and redness in her right eye with cloudy vision. PE shows ciliary flush in the right eye, with a mid-dilated and fixed pupil. Tonometry shows IOP of 22 mmHg. What is the most likely cause?
Acute glaucoma Note: can treat with Acetazolamide (PO or IV), topical ß-blockers, pilocarpine to induce miosis. Laser can be used at treatment failure to create a hole in the peripheral iris
