med sci exam 1 material
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| external structures of the ear | auricle, external auditory canal
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| functions of external structures | protection, helps gather and channel sound
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| middle ear structures of ear | ossicles (malleolus, incus, stapes), tympanic membrane
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| middle ear functions | sound transmission, separation of middle and external ear
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| inner ear structures | vestibule, semicircular canals, cochlea
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| inner ear structures function | transmission of sound, vestibular function
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| function of nose | odor identification, passage of air, humidification, warmth of air, resonance of laryngeal sounds
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| risk factors for hearing loss in adults | exposure to industrial or recreational noise, genetic disorders, autoimmune disorders, syphilis
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| otalgia | ear pain
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| vertigo | dizziness
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| primary otalgia | pathology from the ear
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| secondary otalgia | pathology outside of the ear
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| common causes of primary otalgia | barotrauma, FB, ETD, ear infections
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| tinnitus | ringing of the ear
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| common causes of tinnitus | hearing loss, meniere's disease, neurological conditions
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| people most at risk for tinnitus | seniors, military personnel, musicians, people who work in loud environments
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| causes of peripheral vertigo | pathology comes from the ear
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| causes of central vertigo | pathology comes from the brain
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| causes of systemic vertigo | cardiovascular, metabolic, medication related
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| internal vertigo patient description | I feel myself turning
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| external vertigo patient description | I feel the room spinning
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| general treatment of vertigo | vestibular suppressant meds, antiemetics
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| transient triggered episodes of vertigo caused by dislodged canaliths in the semicircular canals | benign paroxysmal positional vertigo
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| benign paroxysmal positional vertigo most often seen in patients aged ____ | 50-70 yo
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| characteristics of benign paroxysmal positional vertigo | no significant negative sequelae (benign), episodic lasting seconds to minutes (paroxysmal), triggered by head motions (positional), generally external in description (vertigo)
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| treatment of benign paroxysmal positional vertigo | empley maneuver & or home brandt-daroff exercises
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| spontaneous episodes of vertigo caused by inflammation of the vestibular nerve or labyrinthine organs, usually from a viral infection | vestibular neuritis
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| for vestibular neuritis : patients aged ___ | 30-50 yo
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| clinical diagnosis of vestibular neuritis | severe vertigo with nausea and oscillopsia, abnormal gait
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| treatment of vestibular neuritis | vestibular suppressant
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| inner ear dysfunction caused by excessive endolymph fluid pressure | Ménière's disease
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| Ménière's disease: patient aged ___ | 20-60 yo
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| clinical diagnosis of Ménière's disease | classic triad of severe vertigo, unilateral hearing loss and tinnitus, nausea , vomitiing
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| treatment of Ménière's disease | lifestyle changes , vestibular rehab
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| categories of hearing loss | conductive or sensorineural
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| problems transmitting sound and converting sound waves to mechanical vibrations | conductive
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| middle ear and OUT | conductive
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| problems converting mechanical sound to neuroelectric signals (or interpretation of neuroelectric signals) | sensorineural
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| inner ear and INWARD to brain | sensorineural
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| finger rub test | examiner rubs fingers together 6" from patient's ear. + test = failure to identify rub in at least 3/6 attempts
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| whispered voice test | examiner stands @ arm's length behind patient. patient occludes one ear. examiner whispers letter / number combo 6x, + test = unable to repeat 3/6 letter / number combos
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| direct question test | Y/N question to patent about whether he or she has hearing loss
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| handheld audiometry test | examiner hold device in patients ear, patient indicates awareness of each tone. + test = unable to identify 1,000 or 2,000 Hz in both ears
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| hearing handicap inventory for the elderly test | 10 item, self-administered questionnaire measuring social and emotional handicap due to hearing impairment. score >8 is abnormal
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| tabletop manual audiometry test | various models of small, portable audiometers or audiometric program designed for portable electronic devices
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| rinne test | examiner strikes tuning fork and places on mastoid bone behind ear
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| weber test | examiner strikes tuning fork and places on mid forehead
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| medical SCREAM stands for | sudden hearing loss, cerumen impaction, auditory rehab, education, assistance devices and medication
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| sudden hearing loss description | development of >30 dB hearing loss at 3 consecutive frequencies over 72 hours or less
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| cerumen impaction description | occlusive cerumen causing hearing loss, treatment includes cerumen removal
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| auditory rehab description | training and treatment to improve hearing environment
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| education description | info for patient and family
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| assistive devices description | technology to augment hearing, including over the counter assistive devices
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| medications description | evaluating and mitigating medications with ototoxicity
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| auricular hematoma MOI | direct blow to ear, common sports injury
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| auricular hematoma can cause ____ if not treated | cauliflower ear
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| auricular hematoma treatment | surgical damage
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| foreign body of the pinna most commonly caused by | embedded pierced earrings
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| foreign body of EAC | insects, cotton swab pieces at any age. any other object kids less than 6 yo
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| cerumen function | repels water, antimicirobial activity, protective barrier. secreted in the distal 1/3 of EAC
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| cerumen impaction presentation | decreased hearing, feeling of fullness in ear, otalgia, tinnitus
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| otitis externa is aka | swimmers ear
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| otitis externa | inflammation of EAC secondary to infection
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| otitis externa common causes | pseudomonas aeruginosa, staphylococcus aureus, fungal , polymicirobial
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| otitis externa presentation | otalgia, pruritis, decreased hearing
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| treatment of otitis externa | antimicrobial ear drops
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| risk factors for developing otitis externa | anatomic abnormalities, canal obstruction, breach in EAC integrity, dermatological conditions, water in EAC
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| pressure within middle ear must ____ for TM to vibrate normally | match environment
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| Eustachian tube dysfunction | blockage of ET within nasal cavity leading to fluid accumulation in middle ear
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| ear barotrauma | prolonged / difficulty overcoming differences in pressure between the middle ear and external environment
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| clinical presentation of ear barotrauma | clogged feeling, otalgia, vertigo, hearing loss, perforation of TM, blood behind TM
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| causes of barotrauma | flying, scuba diving, hyperbaric oxygen chamber use, skydiving, blast injuries
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| diagnosis of ear barotrauma uses ___ | TEED scale
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| anything that causes nasal mucosa edema can cause | eustachian tube dysfunction
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| middle ear efflusion | serous fluid build up behind TM, may become chronic, leading to DECREASED HEARING
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| diagnosis of middle ear efflusion | clinical with audiometry testing
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| typical organisms of acute otitis media | streptococcus pneumonia, haemophilus influenza, viruses, moraxella catarrhalis
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| risk factors of acute otitis media | anything that causes ETD, immunodeficiency, lack of vaccination
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| the _____ the patient, the more likely to have a bacterial cause of acute otitis media | YOUNGER
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| acute otitis media presentation | fussiness, poor oral intake, poor sleep, decreased hearing, fever, vomiting
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| indications for tympanostomy tubes | middle ear efflusion >3 months
hearing loss > 30 dB or speech delay
recurring episodes of acute otitis media
(>3 episodes in 6mo, >4 episodes in 12 mo)
complications of acute otitis media
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| tympanic membrane perforation | hole in the eardrum, establishing communication between middle and external ear
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| causes of tympanic membrane perforation | acute and chronic OM, trauma
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| acute mastoiditis | suppurative infection of the mastoid air cells with symptoms of less than 1 month duration
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| pathophysiology of acute mastoiditis | complication of AOM
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| complications of acute mastoiditis | abscess formation, facial nerve paralysis, hearing loss, meningitis, osteomyelitis
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| clinical presentation of acute mastoiditis | otaliga, postauricular tenderness, erythema, edema, mass formation
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| common nose / sinus complaints | nasal pain/trauma/FB, nasal congestion, nasal discharge
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| episitaxis | nosebleed
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| sinusitis | sinus pain
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| nasal trauma may be associated with | head and neck trauma
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| patients with __________ should be urgently referred | septal hematomas, CSF rhinorrhea, malocclusion, extra ocular movement defects
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| causes of episitaxis | inflammatory, structural, traumatic, tumors, systemic
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| inflammatory epistaxis | chronic siinnusitis, environmental irritants
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| structural epistaxis | septal deviation or perforation
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| traumatic epistaxis | cocaine use, FB, nasal fracture, nose pcking
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| epistaxis description | common, less than 10 yo or 45-65 yo
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| epistaxis divided into 2 categories | anterior and posterior
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| anterior epistaxis makes up ____% of epistaxis | 90%
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| posterior epistaxis makes up _____% of epistaxis | 10%
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| anterior epistaxis originates from | kiesselbach's plexus (picking zone)
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| anterior epistaxis description | UNILATERAL, no sensation of blood at back of throat
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| treatment of anterior epistaxis | stepwise: compressive, directive, then topical and nasal packing
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| posterior epistaxis originates from | branches of internal maxillary, sphenopalatine and descending palatine arteries
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| posterior epistaxis more common in | elderly
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| posterior epistaxis description | BILATERAL, profuse bleeding with significant amount of blood draining down posterior pharynx (patient usually admitted to hospital)
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| complications of epistaxis | infection, sinus perforation, tissue necrosis, airway compromise (greater risk with posterior bleeds)
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| epistaxis prevention | humidity, discontinue any offending meds, saline nasal spray, avoid nose picking or forceful blowing, sneeze with mouth open
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| 3 causes of rhinosinusitis | infectious, allergic, noninfectious / nonallergic
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| infectious rhinosinusitis | bacterial, viral
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| allergic rhinosinusitis | occupational, perennial, seasonal rhinitis
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| noninfectious / nonallergic rhinosinusitis | drug induced, emotional, gustatory, irritant, reflux-induced rhinitis
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| rhinitis | inflammation of the nasal mucosa leading to nasal discharge and or nasal congesting
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| sinusitis | inflammation of the lining of the paranasal sinus cavities
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| acute viral rhinosinusitis | common cold
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| acute bacterial rhinosinusitis | sinus infection
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| acute infectious rhinosinusitis | nasal congestion, rhinorrhea, facial pain, fever
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| use antibiotics for _____ only | ABRS
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| laryngitis | lost voice
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| pharyngitis | sore throat
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| tonsillitis | inflamed tonsils
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| tonsillar hypertrophy | enlargement of the tonsils
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| coarse, scratchy sound that frequently correlates with irregularity of the medial, or vibratory edge of the true focal fold | hoarseness
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| term describing the perception of excessive air escape during phonation, in which the voice sounds or feels weak | breathiness
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| degradation in vocal quality and loss of control of vocal quality with extended periods of voice use | vocal fatigue
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| causes of hoarseness | laryngitis, benign vocal cord lesions, laryngeal cancer, neurological disease, vocal cord paralysis
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| acute laryngitis | inflammation of the larynx
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| causes of acute laryngitis | vocal strain, infections (URI*, viral, bacterial), tobacco/alcohol use, gastroesophageal reflex
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| presentation of acute laryngitis | hoarseness, aphonia
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| supportive treatment examples for acute laryngitis | vocal rest, humidifier, hydration, remove / treat underlying causes
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| most common viral causes of pharyngitis / tonsillitis | rhinovirus, coronavirus, EBV
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| most common bacterial causes of pharyngitis / tonsillitis | group A beta-hemolytic streptococcus
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| presenting symptoms of pharyngitis / tonsillitis | sore throat, fever, erythematous, enlarged tonsils with or without exudate, lymphadenopathy
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| treating strep throat helps prevent | spread of rheumatic and local complications
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| Epstein-barr virus | Infection is most often asymptomatic, When symptomatic - Clinical syndrome of Infectious Mononucleosis (IM)
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| EBV - infectious mononucleosis most common in | adolescents and young adults
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| presentation of EBV- infectious mononucleosis | typical is acute exudative pharyngitis / tonsillitis, lymphadenopathy. less common is splenomegaly
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| common complications of infectious mononucleosis | ampicillin-associated rash, upper airway obstruction, chronic EBV infection, increased risk for hodgkin lymphoma, hepatitis, splenic rupture
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| diagnosis of EBV infectious mononucleosis | rapid mon-spot test, atypical lymphocytosis on CBC
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| strep throat is most common in patients aged | 5-15 year olds , very uncommon in kids less than 3
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| presentation of strep throat | + fever, sore throat with exudative pharyngitis/ tonsillitis, lymphadenopathy
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| diagnosis of strep throat | rapid strep test, throat culture
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| scarlet fever | atypical presentation of strep throat , delayed - type skin reactivity to pyrogenic exotoxin. diffuse, erythematous, 1-2 mm papular eruption that blanches with pressure. strawberry tongue
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| complications for group A beta- hemolytic strep pharyngitis | recurrent strep throat infections, peritonsillar abscess, pneumonia, rheumatic fever, post-streptococcal glomerulonephritis
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| deep neck infections commonly arise from | septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, sinuses. uncommon since use of antibiotics
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| types of deep neck infections | peritonsillar abscess, Ludwig's angina
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| peritonsillar abscess | localized infection, purulent fluid accumulates between fibrous capsule of the tonsils and superior pharyngeal constrictor muscle
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| presentation of peritonsillar abscess | worsening sore throat, fever, odynophagia, drooling, muffed 'hot potato' voice, foul-smelling breath, deviation of uvula
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| diagnosis of peritonsillar abscess | CT scan
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| treatment of peritonsillar abscess | surgery and antibiotics
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| complications of peritonsillar abscess | airway obstruction, aspiration, pneumonia, life-threatening hemorrhage, post-strep sequelae
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| Ludwig's angina | bilateral cellulitis of the submandibular and sublingual spaces with associated tongue elevation
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| Ludwig's angina is commonly associated with | dental infections or recently extracted tooth
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| presentation of Ludwig's angina | severe mouth pain, fever, forward-leaning posture, "bull neck"
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| treatment of Ludwig's angina | airway protection and IV antibiotics
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