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Quiz 1 Flashcards

1
Q

Function - Outer Ear

A

Collect sound energy and channel it into head

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2
Q

Function - Middle Ear

A

TM captures/transmits sound energy to ossicles

Ossicles converts sound energy to mechanical energy, amplifies it, and transfers it to the oval window of the cochlea

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3
Q

Function - Eustachian Tube

A

Pressure adjustments
Drainage
Protection from nasopharyngeal secretions and bacteria

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4
Q

Eustachian tube is opened by contraction of what muscle?

A

tensor veli palantini during swallowing/yawning

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5
Q

Perilymph

A

Found in the bony labyrinth

High Na, low K (similar to CSF)

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6
Q

Endolymph

A

Found in the membranous labyrinth

Low Na, high K

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7
Q

Function - Vestibule

A

Proprioception and balance

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8
Q

Function - Cochlea

A

Conversion of sound energy into electrical energy

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9
Q

How is sound transmitted in the ear?

A

Sound is collected by the outer ear
TM captures sound, transmits to ossicles
Ossicles convert sound energy into mechanical energy, transmits to cochlea
Mechanical energy moves endolymph in membranous labyrinth, causing flow of K+ ions across negatively-charged hairs on Organ of Corti, causing synapse firing
Information is conveyed by CNVIII to auditory area of temporal lobe, where it is interpreted as sound

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10
Q

Where is the only vascularized epithelium in the body?

A

inner ear

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11
Q

Function - Stria vascularis

A

“back-up battery” for Organ of Corti

Maintains endolymph

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12
Q

DDX - Ear pain (outer ear)

A 
Lichen simplex chronicus
Seborrheic dermatitis
Contact dermatitis
Atopic dermatitis
Acute cellulitis
Erysipelas
Infectious chondritis
Relapsing polychondritis
Auricular hematoma
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13
Q

Tx: Lichen simplex chronicus

A

education, cut nails, soothing lotion

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14
Q

What are other common locations to find seborrheic dermatitis?

A

scalp, eyebrows

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15
Q

What are other common locations to find atopic dermatitis?

A

flexural folds, ear canal

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16
Q

DDX: atopic derm vs. otitis externa

A

AD - sterile, no WBC, not infected

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17
Q

Acute cellulitis and erysipelas occur secondary to ___.

A

dermatitis, trauma

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18
Q

DDX: cellulitis vs. erysipelas

A

Cellulitis: more superficial, smaller area, usu caused by GABHS

Erysipelas: deeper infection, involves entire auricle, pt will be sicker (fever, chills)

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19
Q

Infectious chondritis is usually secondary to ___.

A

erysipelas

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20
Q

DDX: Erysipelas vs. Infectious chondritis

A

IC involves cartilage

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21
Q

DDX: Relapsing polychondritis vs. Infectious chondritis

A

RP - non-infectious, bilateral, spares lobes, nasal/ocular chondritis or arthritis possible

IC - infectious, involves the lobe, systemic sxs

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22
Q

Tx: Auricular hematoma

A

Remove fluid with 18g needle and 10 cc syringe, cover w/ compression dressing for 48 hours

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23
Q

DDx - Ear pain (ear canal)

A 
Otitis externa
Malignant otitis externa
Otitis media (acute, serous)
Otic barotrauma
Impacted cerumen
Foreign bodies
Osteoma
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24
Q

Risk factors: OE

A

Change in pH from acid to alkaline
Inc. temp/humidity
Mild trauma/freq. cleaning

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25
SSx: OE
TTP ear canal and auricle, aural fullness, hearing loss, unilateral or b/l
26
Risk factors: MOE
Diabetics Alcoholics Severe malnourished
27
SSx: MOE
Ear pn, purulent d/c, no fever, no swelling, granulation tissue at junction of temporal bone
28
Most important sign of MOE?
granulation tissue at junction of temporal bone
29
MC causative agent of MOE?
Pseudomonas aeruginosa
30
Complications: MOE
Osteomyeltitis, hearing loss, facial nerve paralysis, death
31
Tx: MOE
Refer to ENT, anti-pseudomonal agents
32
AOM is usu 2˚ to __.
URI
33
SSx: AOM
Usu unilateral, begins w/ sensation of blockage/hearing loss (fluid, loss of bony landmarks, red TM, small/distorted light reflex), progression to fever (>99.5˚F), < evening
34
What are the best clues for AOM in infants?
insomnia, irritability, anorexia
35
Which sign, if present, can be used to rule in AOM?
Bulging TM
36
Which sign, if absent, can be used to rule out AOM?
Immobile TM
37
Risk factors: Otic barotrauma
air travel | scuba diving
38
SSx: Otic barotrauma
Ear pn < yawning, hearing loss, dizziness
39
SSx: Impacted cerumen
discomfort to ear pn, hearing loss, dizziness, reflex cough
40
Cerumen impaction is mc in which populations?
elderly, pts w/ cognitive impairment
41
Tx: impacted cerumen
cerumenolytic agents, irrigation, manual removal
42
What is the main contraindication to ear lavage?
Perforated TM
43
Why should irrigation should not be done with beans?
They can swell.
44
What are osteomas?
Exostoses of the external auditory meatus
45
SSx: osteoma
Usu asx, occasional conductive hearing loss
46
Tx: osteoma
Surgery
47
What homeopathic is indicated for osteomas?
Hekla lava
48
DDx: Referred ear pain (normal otoscopic exam)
TMJ dysfunction (MC), molars, head/neck malignancies
49
What are red flags for serious occult cause of referred ear pain?
Smokers, alcoholics, >50 years old, diabetics
50
SSx: Serous Otitis Media (OME)
Usu painless, plugged feeling, aural fullness
51
What are the MC causes of OME?
Allergies, viral infection
52
PE: OME
``` TM yellow/amber Bubbles, fluid level Retraction Tympanogram flat-type B Little/no movement of insufflation Conductive hearing loss ```
53
Tympanometry: Type A vs B vs C
A: Normal B: early AOM, OME C: Eustachian tube dysfunction
54
Eosinophilic otitis media mainly occurs in pts with __.
bronchial asthma
55
SSx: Infectious Myringitis
Red/painful ear, no middle ear involvement, vesicles on TM (if S. pneumoniae)
56
SSx: Herpes Zoster Oticus (Ramsay Hunt Syndrome)
Otalgia, facial palsy, hearing loss, vertigo, pathognomonic vesicular rash of the pinna, ext. auditory canal, TM
57
Cause: Herpes Zoster Oticus (Ramsay Hunt Syndrome)
Reactivation of VZV
58
Hearing loss and vertigo in Ramsay Hunt Syndrome is due to ___.
movement of virus from CN VIII to CN VII
59
What is the facial nerve deficit in Herpes Zoster Oticus (Ramsay Hunt Syndrome)?
Cannot close eyelid/lift eyebrow/smile
60
DDx: Mastoiditis vs. AOM
Mastoiditis will have ear pain like AOM, but also have pain behind the ear
61
SSx: Mastoiditis
Otalgia, tender/red mastoid, bulging of TM, protrusion of auricle, spasm of ipsilateral SCM
62
Complications: Mastoiditis
Abscess into brain, meningitis, death
63
Etiology: Mastoiditis
AOM that spreads to mastoid air cells
64
What is the best way to soften cerumen prior to irrigation?
Debrox
65
Why is infectious myringitis sometimes called "bullous?
If caused by Strep. pneumoniae, there may be vesicles on TM
66
PE: AOM vs. OME
AOM - Bulging OME - Retraction
67
Hx: AOM vs. OME
AOM - Pain OME - Usu painless
68
MC cause of OE?
Excessive moisture
69
What population of pts w/ OE are more likely to need systemic tx?
Diabetics, those taking systemic corticosteroids
70
OE - Homeopathy
Hepar sulph: < heat, < touch
71
What are the most important reasons for treatment to fail in Otitis externa?
Failing to clean out the canal, wrong dx (chondritis, MOE), fungal infx, underlying systemic imbalance (dermatitis)
72
MC fungal pathogens in OE?
Aspergillus nigra, Candida
73
MC bacterial pathogens in OE?
P. aeruginosa, S. aureus
74
Tx: OE d/t Aspergillus nigra
Tea tree oil 1:10
75
Complication: OE
Furuncle
76
Risk Factors for OM: Season
Fall, Winter (peaks in Feb.)
77
Risk Factors for OM: Age
Peaks 6-18 mos and 5 yrs
78
Risk Factors for OM: Food
Dairy at early age Early intro of solid foods/reliance on formula Breast feeding <6 mos Food allergy
79
Risk Factors for OM: Feeding position
Supine
80
Toynbee phenomenon
Supine bottle feeding causing aspiration into Eustachian tube
81
Risk Factors for OM: Sleep position
Prone
82
Risk Factors for OM: Environmental
``` 2nd/3rd hand smoke "Sick" buildings Sibling with URI Daycare attendance Pacifier use ```
83
Risk Factors for OM: Nutritional deficiencies
Vit A, Vit D, Zinc
84
Risk Factors for OM: Race
Eskimo, Native American
85
Risk Factors for OM: Structural
Fetal alcohol syndrome, Down's syndrome, cleft palate
86
Risk Factors for OM: Conditions
GERD Overweight Genetics
87
Risk Factors for OM: Drugs
Early antibiotic use
88
Twins studies for AOM showed higher rates for (monozygotic/dizygotic) twins.
monozygotic
89
How are children’s ears different than an adults, and how does that make them more at risk for Otitis media?
Shorter, narrower, and horizontal compared to adults
90
__% of aspirates for AOM are viral.
30
91
MC bacterial pathogens: AOM
Strep. pneumonia, H. influenza, Moraxella catarhalis
92
Homeopathy for AOM: Aconite
Early stage, non-suppurative, violent pain, after exposure to cold, < warm applications
93
Homeopathy for AOM: Belladonna
Throbbing pain, red/flushed dry face, thirstless, deranged mind
94
Homeopathy for AOM: Calc carb
Red/hot/throbbing high fever, moist head/face, sensitive to cold, mucus in chest/nose
95
Homeopathy for AOM: Chamomile
Painful ear, otitis w/ dentition capricious, intolerant, irritable, one cheek red/other white, desires to be carried
96
Homeopathy for AOM: Hepar sulph
Sensitive to touch/cold, < drafts, irritable, wants to be wrapped
97
Homeopathy for AOM: Medorrhinum
thick/green d/c, eardrums will perforate
98
Homeopathy for AOM: Lycopodium
R-sided otitis, eczema behind the auricle, irritable, < 4-8pm, > warm drinks
99
Homeopathy for AOM: Mercurius
bloody d/c, abscessed ears. mastoiditis, profuse salivation, indented tongue, child smells sick, < temp. extremes
100
Homeopathy for AOM: Pulsatilla
OE/OM, thick/yellow d/c, thirstless, mild, > open air, > sympathy, >being carried
101
Homeopathy for AOM: Ferrum Phos
High fever, red TM, R-sided, vague sxs, thirst for cold drinks, red spots on cheeks
102
Homeopathy for AOM: Kali sulph
More irritable puls.
103
Clark's rule for dosing in children
Wt. of child / 150 x Adult dose
104
NNT for antibiotics in AOM in children
20
105
When are antibiotics most beneficial for AOM?
Children <2 yo w/ bl AOM, children with both AOM/otorrhea, reducing risk of mastoiditis in populations where it is mc
106
Risks: Antibiotics for AOM
D, stomach pain/rash, increase resistance to antibiotics, inc. rate of recurrence in OME S/E: D, abd. pain, rash
107
What are the advantages of breast-feeding in preventing otitis media?
Provides sIgA, prostaglandins, better feeding position, develops musculature of the face/nasopharynx, no need for dairy/soy (common allergens), ideal mix of nutrients
108
Complications: AOM
Mastoiditis, Meningitis, TM perforation, Cholesteatoma, Chronic Suppurative Otitis Media
109
MC bacteria: CSOM
P. aeruginosa, S. aureus
110
NNT: AOM w/ otorrhea
3
111
Best antibiotic choice for empiric treatment of AOM?
Augmentin (Amoxicillin + clavulanate)
112
Supplement options: AOM
Vitamins A/C/D, Fish oil, Zinc picolinate, probiotics
113
DDx: Patulous Eustachian Tube
Superior semicircular dehiscence syndrome, perilymphatic fistula
114
What type of dizziness might pts describe as "being on a merry-go-round or on a boat"?
Vertigo
115
What is difficult about diagnosing CO poisoning?
Vital signs are not helpful
116
DDx: dizziness d/t hypovolemia vs. autonomic dysfxn
Hypovolemia = drop in SBP 15-20 mmHg w/ increased pulse rate Autonomic = drop in SBP 15-20 mmHg w/ low pulse rate
117
MC neurologic causes of syncope or pre-syncope
SAH, stroke, TIA
118
Impaired balance when walking
Disequilibrium
119
What is the MC cause of disequilibrium?
Multiple Sensory Deficit
120
Why is it so important to recognize Multiple Sensory Deficit?
Common in geriatrics, inc. risk of falls
121
What type of dizziness might pts describe as "in my legs, not my head"?
Disequilibrium
122
Imaging when stroke needs to be ruled out?
MRI (CT too insensitive)
123
Lab testing identifies the cause of vertigo in __% of cases.
less than 1%
124
Location of problem: Peripheral vs. central vertigo
Peripheral: middle/inner ear Central: CNS (brain stem, cerebellum)
125
DDx (Peripheral vs. Central vertigo): Vestibular Ocular reflex
P: Corrective saccade if 40% vestibular fxn difference between ears C: Intact
126
How is the Vestibular Ocular relex elicited?
Rapid head impulse test
127
DDx (Peripheral vs. Central vertigo): Spontaneous nystagmus direction
P: Unidirectional, primarily horizontal, slow phase in direction of defunct labyrinth C: Bidirectional, rotational/downbeat/pure vertical
128
DDx (Peripheral vs. Central vertigo): Spontaneous nystagmus suppressed w/ visual fixation
P: Yes C: No
129
DDx (Peripheral vs. Central vertigo): Smooth pursuit on EOM
P: Intact C: Broken
130
DDx (Peripheral vs. Central vertigo): Dix-Hallpike
P: Latency, Adaptability, Fatiguability C: None of the above
131
How long can the latency be in BPPV before nystagmus occurs in Dix-Hallpike test?
20 seconds
132
DDx (Peripheral vs. Central vertigo): Diminished hearing, tinnitus
P: Common C: Rare
133
DDx (Peripheral vs. Central vertigo): Caloric test
P: Abnormal C: Normal
134
DDx (Peripheral vs. Central vertigo): Tullio's phenomena
P: Abnormal C: Normal
135
What is Tullio's phenomena?
Nystagmus and vertigo after a loud noise
136
What are the MC causes of vertigo?
BPPV, Meniere's disease, vestibular neuritis
137
Normal findings: Caloric testing
Unilateral nystagmus w/ fast component away from cold water and slowly back, dizziness
138
Abnormal findings: Caloric testing
In peripheral lesions, lack of nystagmus or no effect on spontaneous nystagmus
139
Hennebert's sign
Vertigo after pushing on tragus and external auditory meatus + in perilymphatic fistula
140
If symptoms and/or nystagmus are elicited by insufflation, this is a sign of ___.
perilymphatic fistula
141
Inability to complete past pointing exam suggests ___.
cerebellar lesion
142
If Romberg test is positive with eyes open, suspect ___.
cerebellar disorder
143
If Romberg test is positive with eyes closed, suspect ___.
peripheral neuropathy or vestibular disorder
144
DDx (Peripheral vs. Central vertigo): Type of nystagmus elicited by Dix-Hallpike
P: upbeat (BPPV) C: downbeat
145
What three things should be noted with spontaneous nystagmus?
direction, plane, ability to suppress
146
What tool can be used to prevent visual fixation?
Frenzel lens
147
What other way can visual fixation be eliminated other than Frenzel lens?
Blank sheet of paper
148
If valsalva causes pre-syncope, suspect ___.
cardiovascular reason instead of vestibular
149
Red flags for stroke with vertigo
Hyperacute onset vertigo, occipital HA, gait ataxia
150
DDx (VEMPs): sensorineural vs. conductive hearing loss
Conductive: obliterates VEMPs Sensorineural: No change in VEMPs
151
What is the only test to differentiate unilateral and bilateral hearing loss?
Caloric testing (as part of VNG)
152
What is the gold standard for testing inner ear function?
Videonystagmography

EENT (3 decks)

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