Clinical Medicine I
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| Where is Cerumen produced | glands in the EAC
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| Sxs caused by a cerumen impaction | Conductive HL, dizziness, aural fullness, tinnitus, peri-aural anesthesia
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| What is crucial in preventing ear infections | ventilation to the ear canals
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| At home tx for cerumen removal | Mineral oil drops, Murine (OTC), Debrox to loosen prior to manual removal
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| Ways to manually remove cerumen | cerumen curette, alligator forceps (experts), otomicroscope exam
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| TM perforation causes | Traumatic, Tube perf, COM
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| Tx of TM perforation | keep ear dry to avoid infx, ear drop Abx: Cipro, Floxin
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| Will a TM perf heal? | Traumatic will usually heal, tube and COM probably won’t heal, REFER
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| How long do we give the TM to heal? Tx if doesn’t heal? | 2-3m, Tympanoplasty
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| Causes of auricular hematoma | wrestlers, blunt trauma, seroma-as blood clot absorbed, plasma remains
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| Tx of auricular hematoma | I&D/aspirate, Bolster pressure dressing, and Abx to cover S. aureus
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| Complication of untreated auricular hematoma | Cauliflower ear: dense hard fibrous tissue
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| Removal of Foreign Body in ear canal | Try once, then refer to ENT/surgery: otomicroscope, suction, irrigation, drops, cerumen loops
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| Tx for complex pinna laceration | YOU can suture it! Approximate cartilage and skin, pressure dressing, Abx for complex
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| BPPV | Benign Proxismal Positional vertigo
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| 4 main causes of vertigo | BPPV, Meniere’s, Vestibular neuronitis/labyrinthitis, Migrane associated vertigo
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| Causes of BPPV | >50% idiopathic, otoconia (stone) is displaced into PSCC
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| Hallpike maneuver | dx for BPPV, head back 30 degrees laying flat with head turned sideways:vertigo
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| Tx BPPV | can fatigue it with the hallpike maneuver/sitting up, Epley, sermount maneuvers, Brandt-Daroff exercises
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| 4 sxs of Meniere’s dz | Intermittent vertigo, low frequency: fluctuating SNHL, buzzing (low frequency) or roaring tinnitus, aural fullness (feels plugged)
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| Causes of Meniere’s Syndrome | Autoimmune diseases
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| Non-destructive tx of Meniere’s | Diet, meds: diuretics, betahistine, IT steroids, ELS decompression
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| Destructive tx of Meniere’s | IT gentamicin, labryrinthectomy, vestibular neurectomy
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| Sudden onset of severe vertigo, lasting days to weeks, No HL or pain | Vestibular Neuronitis (inflammation of vestibular nerves) Common
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| Severe vertigo + hearing loss | Labyrinthitis, bacterial (or viral) infx inner ear
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| Why is labyrinthitis so dangerous | has direct route to CNS can cause meningitis
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| Spinning, nausea, Nystagmus, Inner ear dysfunction | Vertigo
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| Lightheaded, imbalance, gait disturbance, orthostatic hypotension, medical | Dizzy
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| Progressive or sudden SNHL, low discrimination, imbalance | Acoustic Neuroma
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| Dx of Acoustic Neuroma | MRI or CT
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| Diff b/w Meniere’s Dz and syndrome | syndrome has an identifiable cause, dz idiopathic
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| Predisposing factors of OM | Viral URI, allergy, Eustachian tube dysfunction
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| RF’s for OM | Cleft palate, premature birth, males, NA, socioeconomic status, genetics, Fhx, day care, no breast feeding
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| Questionable RF’s for OM | supine bottle feeding, eliminating pacifier after age 6m, household smoking
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| Main pathogens in OM, MC? | MC: S. pneumonia, H. flu, M cat.
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| Describe an infected tympanic membrane | Bulging and opaque w/ edema and erythematous, and loss of landmarks
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| Sxs of OM in kids | Fever, Irritable, crying, tugging at ear, guarding of the ear, turning away, otorrhea
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| Non-pharm tx | observe healthy children over 6m old for 48-72 hrs based on pt assessment
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| Pharm tx | acetaminophen 10-15mg/kg q 4-6 hrs, or ibuprofen 5-10mg/kg q 6-8hrs, Amoxicillin 80-90mg/kd/day, Augmentin, Bactrum
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| Etiology of serous effusion of TM | post AOM, fluid goes from purulent to serous, retracted ear drum, prominent anatomical features
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| Sxs for serous effusion of the ear | fullness sensation, no fever, no pain, kids may still be guarding, tugging on ear
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| Most accurate way to dx serous effusion | typanogram
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| PE tubes | pressure equalization tubes (into eustacian tubes )
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| Indication for PE tube\s | >3mos OME, or Recurrent AOM: >4 episodes AOM/yr
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| Complications of OM | meningitis, mastoiditis, lateral sinus thrombosis, temporal bone abscess, facial nerve paralysis, TM perf, COM, cholesteatoma
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| Erythema and Pit edema w/ possible pain in post auricular area | Acute mastoiditis w/ subperiosteal abscess
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| Collection of squamous epithelium in the middle ear space, rectraction of TM pocket where a cyst will form | Cholesteatoma
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| Signs of cholestatoma | odorous painless otorrhea, HL, tx: surgical
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| Longstanding recurrent COM/ Chronic mastoiditis causes what | TM perf (usually very large)
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| Sxs of acute otitis externa | Severe pain, swelling and redness of EAC (skin)
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| Pathogens of swimmer’s ear | Pseudomonas aeruginosa (lives in ear canal) and S. aureus
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| Tx of AOE | Topical: Cipro w/ dexamethasone drops, Ear wick, analgesis (narcs?)
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| If AOE resistant to drop Cirpro, try what | Oral Cipro
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| Widening of the Eustachian tube, causes autophony | Patchulus Eustachian tube, dt wt. loss
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| Causes of COE | Psoriasis, Type I DM, :can lead to necrotizing external otitis: bone scan dx REFER, Allergies, Fungus
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| MC pathogen for fungal COE, tx | Aspergillus: cotton w/ black spores tx: lotrimin anti-fungal
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| Signs for TMJ | Crepitus, unilateral ear pain, malocclusion, bruxism,
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| Frequent throat clearing, lump in back of throat, and ear pain | think Laryngeal pharyngeal reflux
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| Imaging for Acoustic neuroma and COM | AN: MRI, COM: CT
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| Idiopathic facial paralysis | Bell’s Palsy, dx of exclusion
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| Inflammation of CN 7 at labyrinthine segment, HSV, tx? | Bell’s Palsy, tx w/ steroids and Valtrex (anti-viral)
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| Severe pain, HL, vertigo caused by Herpes Zoster | Ramsey-Hunt syndrome tx: steroids and Valtrex
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| AOM bacterial or viral | usually bacterial, but can clear w/o Abx
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| 40 you female w/ 20 yr hx of painless otorrhea L ear, HL, developing vertigo | Cholesteatoma, could be eroding into lateral semicircular canal
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| 26 yo male w/ deep R ear pain, ear exam nl, no HL, clenches teeth at night, crepetis | TMJ syndrome
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