FNP2 Quiz 1 Ears

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  1. Hearing screening should be done by ______.
    1 month
  2. Dx of hearing loss should be done by _________.
    3 mos
  3. Entry into early intervention services for hearing loss should be done by ______.
    6 mos
  4. Measures the initiation of sound-induced electrical signals in the cochlea.
    Auditory Brainstem Response (ABR)
  5. Measures response of inner ear to brief clicks or tones.
    Otoacoustic Emissions (OAE)
  6. Test used if child does not pass Otoacoustic Emissions (OAE).
    Auditory Brainstem Response (ABR)
  7. Measures functioning of the peripheral auditory system and neurologic pathways r/t hearing.
    Auditory Brainstem Response (ABR)
  8. At what age should a child startle to loud sounds, quiet to mother's voice, cease activity momentarily when sound is made at conversational level?
    0-4 mos
  9. At what age should a child correctly localize to a sound & begin to imitate sounds?
    5-6 mos
  10. At what age should a child correctly localize sound in ANY plane & respond to name?
    7-12 mos
  11. At what age should a child point toward unexpected sound or to familiar persons when asked?
    13-15 mos
  12. At what age should a child follow simple directions?
    16-18 mos
  13. At what age should a child point to body parts when asked?
    19-24 mos
  14. Most common culprits of acute otitis media?
    • S. pneumoniae
    • H. flu
    • M.catarrhalis
  15. Acute infection of the middle ear.
    Acute otitis media
  16. Dx of acute otitis media requires presence of what three things?
    • Recent abrupt onset  of ear pain, irritability, otorrhea, fever
    • Middle ear effusion confirmed by bulging TM, limited or decreased mobility, air-fluid level
    • S/S of middle ear inflammation: red TM, otalgia, interfering with sleep/activity
  17. In which cases of acute otitis media is observation an option rather than abx?
    • 6 mos or older: unilateral AOM w/o otorrhea
    • 2 yrs or older: bilateral AOM w/o otorrhea
  18. In which cases is abx therapy recommended for AOM?
    • AOM with otorrhea
    • unilateral or bilateral AOM with severe symptoms
    • if 6mos-2yrs: bilateral AOM w/OUT otorrhea
  19. First line tx for AOM.
    • Amoxicillin 80–90 mg/kg/day divided bid
    • Amoxicillin/clavulanate 90 mg/kg/day divided bid (center-based daycares)
  20. Concominant conjunctivitis with AOM with a blister on the ear drum (Bullous Myringitis), what is most likely the cause?
    H. flu (nontypeable)
  21. Otorrhea w/ erythematous TM should prompt what thoughts?
    • the kid has tubes or
    • perforated TM
  22. Tx for Otitis Media w/ Effusion
    • observation
    • usually clears by 3 mos
  23. Champagne bubbles means what?
    OME (otitis media w/ effusion)
  24. IF you notice redness and swelling over the mastoid process, what does this mean?
    mastoiditis and immediate hospitalization w/ IV abx
  25. Dx of otitis externa is ALWAYS assoc with what?
    edema of ear canal
  26. Pain when pulling pinna or pressure over tragus indicates what?
    otitis externa
  27. Tx for otitis externa.
    • topical otic prep/abx (quinolones)
    • acetaminophen or ibuprofen PO
    • add PO abx if fever or severe lymphadenitis
  28. Avoid ________ when treating otitis externa. Why?
    • neomycin or
    • gentamycin
    • b/c assoc ottox if they reach middle ear (esp if cannot see TM!)
  29. Itching as a precursor to pain is a s/s of?
    otitis externa
  30. Erythema, thick clumpy otorrhea; cerumen is white and soft/cheesy; palpable tender lymph nodes periauricular.
    Otitis Externa
  31. An epidermal inclusion cyst of middle ear or mastoid (cauliflower-like).
    cholesteatoma - always refer to ENT for removal
  32. _______ can occur with acute URI, eustachian tube dysfunction or before/after AOM.
  33. New onset otorrhea not due to otitis external, or on TM visualization.
  34. Mild bulging of TM and recent (less than 48 hrs) onset of ear pain or intense erythema of TM.
  35. Kids older than 6 mos should only be prescribed abx for AOM when?
    • severe symptoms
    • (like otalgia > 48 hrs or temp > 102.2)
  36. When would you use amox/clavulanate to tx AOM?
    • if has been tx w/ amox in last 30 days OR
    • has concurrent purulent conjunctivitis
  37. _______ can cause an auricular DO with calcification of cartilage/painless nodules.
    Addison's disease
  38. Painless uric acid crystal deposits in external ear.
  39. Hard nodules in the external ear can be secondary to __________.
    chronic arthritis
  40. Presents as a blue doughy mass and, if not drained, can result in "cauliflower ear"
  41. Fusion of the stapes over the oval window; common cause of hearing loss in older adults; can be surgically corrected.
  42. caused by DO of the cochlea and tretrocochlear region including the auditory nerve and its connection to the brainstem.
    sensorineural hearing loss
  43. __________ is the principal cause of cochlear damage.
    noise trauma
  44. Gradual degeneration within the cochlea; occurs with aging. How is this treated?
    • presbycusis
    • Irreversible but can be treated w/ hearing aid if some hair cells are left
  45. __________ is sensorineural hearing loss accompanied by vertigo.
  46. Retrocochlear sensorineural hearing loss involves what three things?
    • auditory nerve
    • brainstem
    • CNS
  47. ___________ can be sequelae of CNS infection, CV injury, demyelinating diseases, or neoplasms.
    Retrocochlear sensorineural hearing loss
  48. Normal threshold of hearing.
    0-20 dB
  49. At _____ dB, there is difficulty hearing faint or distant speech and requires favorable seating.
  50. At _____ dB, normal speech is understood at 3-5 feet.
  51. At _____ dB, loud voices can be heard at one foot from the ear.
  52. Rushing, pulsating, humming sound with positional changes is called _______ and can indicate what?
    • pulsatile tinnitus;
    • tumor
    • increased ICP, or 
    • vascular abnormalities
  53. Tinnitus is often accompanied by _______ hearing loss.
    high frequency
  54. Severe vertigo, n/v, aggravated by head movement; possible tinnitus & hearing loss.
  55. Most severe symptoms of labyrinthitis subside when?
    within 2-3 days; can last up to 4-5 days
  56. What symptom may recur for months with labyrinthitis?
    vertigo with sudden head movement
  57. labyrinthitis commonly occurs after what?
    URI or acute inflammation of inner ear
  58. What is often a severe symptom with labyrinthitis?
  59. ___________ can cause similar symptoms as labyrinthitis but does not affect hearing.
    vestibular neuritis
  60. ___________ is almost always present upon PE for labyrinthitis.
    • spontaneous nystagmus
    • directed in opposite dxn of affected ear
  61. Tx of labyrinthitis.
    • bed rest (side lying w/ affected ear up)
    • Meclizine 12.5-50mg q 6 hrs
    • sedatives & antiemetics PRN
    • abx if bacterial suspected (most are viral)
    • refer if not resolved in 4-6 wks
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FNP2 Quiz 1 Ears
2016-05-17 10:43:27
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