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USMLE CS Cases: PRESBYCUSIS

Discussion in 'USMLE' started by Egyptian Doctor, Jun 11, 2019.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    History :
    HPI: 75 YO M COMPLAINS OF BILATERAL HEARING LOSS FOR 1 YEAR AND IT IS
    PROGRESSIVELY WORSENING. HE HAD REMOVED CERUMEN FROM HIS EAR WITH
    MODERATE IMPROVEMENT. HE NOTES OCCASIONAL TINNITUS. HE REPORTS WORDS
    JUMBLED IN CROWDED PLACES AND WHEN HE IS WATCHING TV. HE DENIES ANY TRAUMA
    AND FOREIGN BODY INSERTION TO EAR. NO EAR PAIN, EAR DISCHARGE, NO VERTIGO, OR
    LOSS OF BALANCE. NO DIFFICULTY COMPREHENDING, OR LOCATING THE SOURCE OF
    SOUND.
    ROS: NEGATIVE.
    ALL: PENICILLIN CAUSES RASH
    MEDS: HCTZ, ASPIRIN FOR 25 YEARS
    PMH: HTN. UTI 1 YEAR AGO, TREATED WITH ANTIBIOTIC.
    PSH: NONE
    SH: NO SMOKING, NO ALCOHOL, NO ILLICIT DRUGS. RETIRED VETERAN.
    SEXUALLY ACTIVE WITH WIFE.
    FH: NO HX OF HEARING LOSS.
    Physical Examination :
    PT IS NO ACUTE DISTRESS.
    HEENT: AT/NC. PRRELA, EOMI. NO NYSTAGMUS, NO PAPILLEDEMA. NO CERUMEN. TMs WITH
    LIGHT RELEX, NO STIGMATA OF INFECTION. NO REDNESS TO EAR CANAL. NO TENDERNESS
    OF AURICLE. NO LAD AND OROPHARYNX IS NORMAL. NORMAL RINNE TEST BILATERALLY
    AND WEBER TEST WITHOUT LATERALIZITION.
    CHEST: CLEAR BREATH SOUNDS BILATERALLY
    HEART: RRR, S1/S2 WNL. NO MURMUR OR RUB.
    NEURO: CRANIAL NERVE : 2-12 INTACT EXCEPT FOR DECREASED HEARING. MOTOR:
    STRENGTH 5/5 THROUGHOUT. GAIT: NORMAL, AND -VE HEEL SHIN TEST.
    Diagnosis 1 :
    PRESBYCUSIS
    History Findings Physical Exam Findings
    1) BILATERAL PROGRESSIVE
    HEARING LOSS
    1) NORMAL RINNE TEST
    2) ADVANCED AGE 2) NORMAL WEBER TEST
    Diagnosis 2 :
    COCHLEAR NERVE DAMAGE
    Diagnosis 3 :
    Diagnostic Study/Studies - Labs
    1) AUDIOMETRY
    2) TYMPANOGRAPHY
    History Findings Physical Exam Findings
    1) PRIOR EXPOSURE TO LOUD
    NOISE
    2) BILATERAL HEARING LOSS
    History Findings Physical Exam Findings
     

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