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What is Schwartze's sign?
A blush behind the TM due to hypervascularity on the promontory due to otosclerosis
What are some things that can cause pulsatile tinnitus and how can they be distinguished on exam?
Glomus tumor, carotid artery disease, stnotic aortic valve: auscultate the neck and chest
What's the eye look like in a 3rd nerve palsy?
Usually laterally deviated due to unopposed action of the lateral rectus, mydriatic from loss of parasympathetic input, and ptotic from loss of levator tone.
How can the ptosis of Horner's be distinguished from 3rd nerve palsy by looking at the lid?
In Horner's, the loss of function of Muller's muscle leaves the superior orbital crease intact. In 3rd nerve palsy relaxation of the levator aponeurosis insertion can obliterate the fold.
How does the eye look with a 4th nerve injury? What's the function of the 4th nerve on the eye?
Extorsion and hypertropia of the affected eye (pt can partially compensate by tipping head toward the unaffected side). Superior oblique rotates eye downward and causes inward torsion.
What muscles are controlled by V3?
temproalis, masseter, medial and lateral pterygoid, mylohyoid, anterior belly of digastric, tensor veli palatini, tensor tympani.
What is the implied gap in a negative rinne with a 512 Hz tuning fork? What are the sensitivity and specificity?
25-30 dB; sensitivity 60 to 90%, specificity 95-98%.
Describe the Bing test
Tuning fork placed on mastoid and EAC alternately occluded an opened. A patient with CHL will note no change in intensity. Normal patients or those with SNHL will find the tone louder with occlusion. Not as sensitive as Rinne.
Describe testing of the corneal reflex
If possible, have the patient turn their eyes to the opposite sitde to expose as much sclera as possible. "walk" a fine wisp of cotton across the sclera (should be non-reactive) toward the cornea (should react). Bilateral blink indicates intact ipsilateral V1 and bilateral VII. Contralateral blink indicates loss of VII on tested side. No response indicates loss of V1 on tested side or loss of VII bilaterally.
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