This page is dedicated to organizing various examples of standardized exam questions whose answer is acoustic neuroma. While this may seem a odd practice, it is useful to see multiple examples of how acoustic neuroma will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acoustic neuroma.
- Hearing loss: typically gradual loss in nature.
- Vertigo: patients may have difficulty keeping balance and their history may be notable for difficulty walking.
- Loss of facial sensation: can occur due to damage to CN V (facial nerve)
- Facial paresis: a facial droop/loss of nasolabial fold may be present
Question # 1
A 36 year old female is seen in clinic because she is complaint of moderate hearing loss that began 4 months ago. She has become aware of an annoying ringing sound in her right ear. She denies having any recent ear infections, fevers, runny nose, or any sick contacts. She explains that she does not use Q-tips and has never had any head trauma. Her family history is notable for her father who had bilateral hearing loss that was attributed to old age. A physical exam reveals that both auditory canals are patent, and that the tympanic membranes are grey in color and each have a well visualized light reflex. Hearing is dimisnehd on the right side during the finger rub test. A neurological exam reveals right sided facial numbness, right sided facial drooping, and a decreased afferent and efferent corneal reflex on the right side. What might be responsible for the patient’s symptoms?
Explanation # 1
Hearing loss + facial paresis + absent corneal reflex + facial numbness = acoustic neuroma (in cerebellopontine angle, affecting CNV, CNVII, and CNVIII)
Question # 2
A 50 year old female comes to the clinic because she has been experiencing gradual hearing loss in her left ear for the past 5 months. She also explains that for the past few months she has had difficulty keeping her balance when walking because she feels that the room is spinning. About 8 months ago the patient had a severe urinary tract infection that required IV antibiotic therapy. A physical exam shows a decrease in the left nasolabial fold, and she has an asymmetric smile, however she is able to raise both eyebrows symmetrically. Her gait is normal, however she is unable to perform tandem walking. She has hearing loss on the left side and can not hear the examiner rubbing their fingers on the left side. What might explain this patient’s symptoms?
Explanation # 2
Hearing loss + facial paresis (central pattern) + vertigo = acoustic neuroma
Question # 3
A 75 year old male comes to his PCP because he has been experiencing progressive hearing loss in his right ear for the last 6 months. He also has noticed a ringing in the same ear, and feels unsteady when walking. He has a history of hyperlipidemia, a past myocardial infarction, and also has a mitral valve prolapse. He explains that he sustained a cerebral infraction 5 years ago. He is currently on aspirin and a statin medication. His vitals are currently stable. A neurological exam reveals that he has decreased moment on the right side of his face. A Weber test localizes to the left ear, and a Rinne test shows air conduction that is greater then bone conduction on both sides. His muscle strength is normal throughout the upper and lower limbs. The rest of his neurological exam is normal except for the loss of temperature sensation on the right side of his face, and an unsteady gait on tandem walking. What might this patient be suffering from?
Explanation # 3
Hearing loss (sensory pattern) + facial paresis + loss of facial sensation + unsteady gait = acoustic neuroma
Question # 4
Explanation # 4
TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
- Most common location: Intracranial schwannomas (i.e. acoustic neuromas) are most commonly found a the cerebellopontine angle (between the cerebellum and the lateral pons).
- Associated conditions: bilateral acoustic neuromas are found in neurofibromatosis type 2 (and are essentially diagnostic of this condition).
Page Updated: 04.05.2017