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NBME 23 Answers

nbme23/Block 3/Question#33 (42.2 difficulty score)
A 78-year-old man has had progressive loss of ...

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submitted by mousie(211),
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dentist  VS: progressive unilateral hearing loss, doesn't affect Rinne Test, associated with NF2 and actor Mark Ruffalo Otoslcerosis is (usually....) progressive bilateral hearing loss, BC > AC. source +  
tallerthanmymom  If BC > AC in BOTH ears, why does he have hearing loss in only one ear? My logic was that he probably had otosclerosis in both ears and then something extra going on in his right ear that would make it worse than the left. I still don't understand why otosclerosis is the best answer here. +2  
dul071  Finally!!!! Someone who ACTUALLY explains what the fuck bone conduction even is and teaches the whole topic. Here's the link for anyone else who struggled to find someone who takes time to explain this concept +4  
sonofarathorn  ^ Halle-freakin-lujah +  

submitted by usmile1(105),
  • A) acoustic neuroma = sensorineural
  • B) lesion of cochlear nuclei
  • C) Loss of hair cells = Presbycusis (age-related progressive bilateral SENSORINEURAL hearing loss)
  • D) Meniere dz: triad of SENSORINEURAL hearing loss, vertigo, tinnitus

E. Otosclerosis: Slowly progressive conductive hearing loss that most commonly affects ONE ear, with the 2nd ear affected in ∼ 70% of patients as the disease progresses... [this explains the patient's complaint of worse hearing on the right]

  • pathophys: Abnormal bone growth of the bony labyrinth. Stapedial otosclerosis (most common site) β†’ fixation of stapes to oval window β†’ conductive hearing loss
  • leads to progressive CONDUCTIVE hearing loss because the ossicle's ability to vibrate becomes increasingly limited.
  • A unique feature that I have seen come up often on question is that the patients are able to hear better in noisy rather than quiet surroundings.

submitted by hello(302),
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acn eoesmon elaeps axpnlei tihs?

thomasburton  My reasoning was BC>AC so this must be a conductive problem (which to me means something middle ear or out) so usually I think something blocking air flow or impeding the ossicles. You can rule out all other answers as they are all causes of sensorineural (AC>BC). +2  
madojo  Meniere's disease is sensorineural hearing loss with peripheral vertigo due to increased endolymph within the ear. +  

submitted by ergogenic22(303),
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submitted by leaf_house(16),

In case anyone was wondering, Meniere disease is excessive endolymph buildup in the in the inner ear. It causes vertigo and sensorineural hearing loss--so not this patient's issue. (FA 2020 534)

submitted by niboonsh(338),
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