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EENT > Test three (weeks 4 + 5) > Flashcards

Test three (weeks 4 + 5) Flashcards

1
Q

What constituents of belladonna cause its toxicity?

A

Anti-cholinergics; atropine, scopolamine, hyoscyamine

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2
Q

Sx of belladonna toxicity

A

Acute delirium, hallucination, tachycardia, dry mouth, retained urine, flushed skin, vomiting, dilated pupils, blurry vision

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3
Q

What is the deadly nightshade?

A

Atropa belladonna

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4
Q

How do anticholinergics work?

A

Block ach from binding to its receptors on certain nerve cells; inhibits parasympathetic nerve impulses

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5
Q

Anti-cholinergics can be used to treat

A

Nasal and chest congestion, urinary incontinence/overactive bladder

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6
Q

Themes of belladonna

A

Intense, explosive, sudden, painful, pulsing, throbbing, hot, congestive, swelling, red, violent, delirious

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7
Q

Healthy belladonna patient

A

Intense, vital, balanced

Avoid extra stimulation because internally already intense

May avoid noisy, bright places

Don’t like to be jarred

Sensitive to touch and temperature changes

May feel very hot or chilly

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8
Q

Onset of belladonna symptoms

A

Sudden onset, intensity of physical/emotional sx

Subside just as quickly as they come on

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9
Q

Temperatures belladonna

A

Deep red, hot, dry picture
Dry but thirst less
Sweat only in covered parts
Hot face with cold hands and feet

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10
Q

Belladonna sx are often left or right sided or both?

A

Right

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11
Q

Are pupils dilated or constricted with belladonna?

A

Dilated

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12
Q

Aggravating times/factors belladonna

A

3pm

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13
Q

Cravings belladonna

A

Lemons/sour

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14
Q

Aversions belladonna

A

Vegetables, fish, fruit, fat, beans

Thirstless

Touches/loud noises

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15
Q

Movements belladonna

A

Twitching, jerking, seizures

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16
Q

Emotions belladonna

A

Explosive sudden anger, red face, “wild eyed”

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17
Q

Mental sx belladonna

A

Hallucinations, esp during fever
Violent mania or psychosis, desire to bite, hit, spit; able to restrain impulses in early stages
Not really prone to anxiety

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18
Q

Fears belladonna

A

Dogs and animals in general
Ghosts

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19
Q

Belladonna is clinically used for

A

High fevers, red in face; pt VERY hot to touch (cold feet)
Excruciating/throbbing headaches and migraines
Infections/inflammation (“itis” of any times)
Sciatica
Acute arthritis
Marked HTN
Anger, rage, mania
Delirium/hallucinations
Vertigo (feels falling to left)
Intense menopause flashes
Dysmennorhea, right sided ovarian cysts, bright red blood with clots

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20
Q

ENT conditions belladonna

A

Otitis media, right sided, intense pains, bright red TM

Iritis

Pharyngitis and tonsillitis (red, swollen tonsils, right sided, worse swallowing)

Mastitis, right sided, red, painful, worse from touch or motion

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21
Q

What is a complementary remedy to belladonna?

A

Calcarea carbonica

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22
Q

Belladonna is related to what remedies?

A

Stramonium, hyoscyamus - part of nightshade family

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23
Q

Antidotes to belladonna

A

Camphor, coffea, opium, aconite

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24
Q

Acute dosing belladonna

A

Typically low dose potency and frequently

6C, 12C, 30C QD yo QID as needed

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25
Q

Chronic dosing belladonna

A

Such as mania, chronic headache, joint pain; consider ascension because of high vitality:

6C daily x 1 week
12C daily x 1 week
30C 3x/week x 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)

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26
Q

What parts of aconite are poisonous?

A

All parts of the plant, esp roots and seeds

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27
Q

What’s the main constituent present in aconite?

A

Diterpene alkaloids: isonapelline, luciculine, napelline

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28
Q

Sx aconite poisoning

A

Heart failure/arrythmia
Respiratory paralysis
Numbing of mouth and tongue
GI disturbances (N/V, abdominal pain, diarrhea)
Muscular weakness
Incoordination
Vertigo

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29
Q

What preparation can reduce the toxicity of aconite? Why?

A

Decoration; leads to a change in alkaloid composition

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30
Q

Onset of aconite poisoning

A

Within minutes to a few hours after swallowing
Severity related to onset of arrythmia

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31
Q

Themes of aconite

A

Fearful, restless, sudden, intense, overexcited

Sx after a fright, shock, trauma, exposure

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32
Q

Healthy aconite patient

A

Vital, robust
Vital ppl, flushed faces
Sympathetic
Extroverted

Although they are robust, they are vulnerable to shock or exposure and the stressors of modern life

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33
Q

Onset aconite sx

A

Sudden onset, esp after exposure or trauma

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34
Q

Temperatures aconite

A

Intense heat and fever that alternates with chills

Heat and flushing to face/ one red cheek, one pale

Thirst for cold drinks

Cold extremities

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35
Q

mental sx aconite

A

Great fear/anxiety, esp fear of death
Numbness, “out of body” detached feeling
Excessive excitability

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36
Q

Aggravating factors aconite

A

Inflammatory conditions from sudden exposure to cold, dry winds

Worse dry, cold weather, wind

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37
Q

Are pupils in aconite dilated/constricted?

A

Pupils constricted

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38
Q

Desires aconite

A

Aconite

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39
Q

Heart sx aconite

A

Chest sx, heart palpitations, heat in chest, excessive excitability vascular system

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40
Q

Clinical indications aconite

A

Shock or fright
Fear, panic attacks, anxiety disorders
Fever with fast onset after exposure
Intense pain
Vertigo
Angina, arrhythmia, stroke, MI
Bell’s palsy, neuralgia, facial numbness/paralysis
Early stages influenza, URI, pneumonia
Blindness, photophobia
Numbness of mouth/tongue, dry tongue
URI
Urinary retention
Insomnia

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41
Q

ENT indications aconite

A

URI, cough after an exposure
Early stages URI, pharyngitis, tonsillitis, otitis, conjunctivitis, influenza, pneumonia
Numbness of mouth and tongue, dry feeling on tongue
Bitter taste in mouth
Toothache from cold exposure
Blindness after a shock, photophobia

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42
Q

Complementary remedies aconite

A

Sulfur (chronic aconite)
Arnica
Coffea

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43
Q

Acute dosing aconite

A

Typically higher potencies with this remedy; consider 30C QD to QID as needed, or a single dose of 200C

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44
Q

Chronic dosing aconite

A

Consider higher potency, esp if old trauma is being treated; 30C, 200C, 1M

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45
Q

Apis mellificia comes from what

A

Domestic/European/western honeybee + their venom

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46
Q

Bee venom exposure sx

A

Redness, swelling, itching, anxiety, trouble breathing, chest tightness, heart palpitations, dizziness, nausea, vomiting, diarrhea, sleepiness, confusion, fainting, low blood pressure

Anaphylaxis in those allergic

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47
Q

What has bee venom therapy been used for historically?

A

Inflammatory diseases such as RA

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48
Q

Themes of Apis mellifica

A

Swollen, bursting, tight, burning, stinging, inflamed, allergic, sudden, intense, dry, red, hot, irritated

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49
Q

Apis healthy patient

A

Busy, task oriented
Vital, intense, strong
Workaholic, busy bee
Healthy mentally and emotionally
May become irritable and aggressive, esp if protecting their family/friends or if someone is not pulling their weight at work
Controlling and suspicious
Increased sexual desire but balanced sex life
Better exercise
Jealous
Practical

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50
Q

Better/worse apis

A

Better exercise, cold
Worse suppressed eruptions, hearing bad news, shock, 3pm, heat, warm room, touch, right sided

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51
Q

Temperatures apis

A

Better cold, worse heat
Fever with alternating sweats and dry heat
Redness that is dusky
Thirstless until very dehydrated then extremely thirsty

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52
Q

Lesions Apis

A

Swollen, tight, bursting lesions
Cystic

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53
Q

Mental sx Apis

A

After grief, anger, jealousy
Easily vexed
Awkward/dropping things

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54
Q

Clinical uses apis

A

Anaphylaxis
Angioedema
Heart conditions/pericarditis
Bee stings
Hives or skin conditions worse with heat
Inflamed, red joints
Edema, swelling with bursting, stinging quality
Allergy, hay fever
Asthma
Pharyngitis
Herpes zoster
Acute nephritis
Meningitis
Pleurisy or bronchitis
Cystitis, pyelonephritis
Amenorrhea
Ovarian cyst (right)
PMS
Rectal bleeding/hemorrhoids
Styes, allergic conjunctivitis

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55
Q

ENT indications apis

A

Pharyngitis with marked redness
Swelling of uvula, better cold
Tonsillitis with swollen tonsils
Styes, allergic conjunctivitis

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56
Q

Complementary remedies apis

A

Natrum muriaticum

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57
Q

CI apis

A

First trimester of pregnancy

58
Q

Incompatible remedies to apis

A

Rhus tox

59
Q

Related remedy to apis

A

Apium virus (bee venom)

60
Q

Acute dosing apis

A

Low dose potency and frequently for acutes

6C, 12C, 30C QD to QID as needed

61
Q

Chronic dosing apis

A

Ascension because of high vitality

6C daily x 1 week
12C daily x 1 week
30C 3x/week for 2-3 weeks
200C once (or ongoing once a week for a few weeks if needed)

62
Q

Arsenicum album is made from which form of arsenic?

A

White arsenic, trioxide, by-product of copper refining

63
Q

Acute arsenic poisoning sx

A

N/V
Abdominal pain
Severe diarrhea
Encephalopathy
Peripheral neuropathy

64
Q

Large doses of arsenic can lead to

A

Dehydration, shock, abnormal heart rhythms, multiple organ failure, death

65
Q

Themes arsenicum

A

Anxious, restless, burning, acrid, putrid, exhausted, dependent, compulsive, better heat

66
Q

Healthy patient arsenicum

A

Deep remedy; most people with this remedy have some sort of pathology

67
Q

Emotional sx arsenicum

A

Anxious, proper, tense, worried, depressed
Enjoyment restricted
Sees everything from a personal standpoint

Many fears including disease, death, poisoning, cancer, poverty, being alone, worries about family, hypochondriac

Restlessness

Perfectionist, compulsive disorders, needs control, plans everything, compulsive hand washing

Impulse to kill, but fear of killing someone

Aggravating at the sea

68
Q

Arsenicum left or right sided?

A

Right sided

69
Q

What remedy is ting and saves money/is possessive with money?

A

Arsenicum

69
Q

What remedy is stingy and saves money/is possessive with money?

A

Arsenicum

70
Q

What remedy has an impulse to kill themseleves/others but fear of doing it?

A

Arsenicum

71
Q

Arsenicum better/worse

A

Worse 12-2am, cold air and drinks
Desires heat, can hardly ever be too warm, burning pains better with heat

72
Q

What remedy has acrid, excoriating discharges?

A

Arsenicum

73
Q

What remedy has a tendency to malignancy?

A

Arsenicum

74
Q

What remedy is thirstless, thirsty for frequent small sips?

A

Arsenicum

75
Q

What remedy fidgets, paces, is super restless?

A

Arsenicum

76
Q

What remedy has fever from 12-2 or 3 am or 12-2 or 3pm with delirium?

A

Arsenicum

77
Q

Temperatures arsenicum

A

Chilly, aggravated by cold air and drinks
Desires heat, can hardly ever be too warm
Burning pains with amelioration by heat
Hot heat and cold body
Fevers with delirium 12-2/3

78
Q

ENTClinical uses arsenicum

A

Iritis, severe photophobia
Conjunctivitis
Corneal ulceration
Burning eyes, acrid lacrimation
Burning lid margins
Coryza
White tongue
Pharyngitis
Ulceration of throat
Cough

79
Q

Antidotes arsenicum

A

Nux vomica
Hepar
China
Opium
Carbo veg

80
Q

Acute dosing arsenicum

A

Low potency, frequency for acutes

6C, 12C, 30C QD to QID as needed

81
Q

Chronic dosing arsenicum

A

Ascension because of high sensitivity and anxiety; pt may be afraid to take the remedy and afraid of aggravation

6C daily x 1 week
12C daily x 1 week
30C 3x/week for 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)

82
Q

Phosphorus poisoning sx

A

Severe vomiting and diarrhea (smoking and luminescence, garlic odor)

Dysrhythmias, coma, hypotension, death

Severe burns if contact with skin

Carbonated beverages with phosphoric acid have been linked with diabetes, HTN, kidney stones, CKD

83
Q

Themes of phosphorus

A

Poor boundaries
Open
Sensitive
Excitable
Spacey
Anxious, fearful
Hard time holding in substances/thoughts

84
Q

Healthy patient phosphorus

A

Bubbly, open, outgoing, extroverted
Sparkles with intelligence, creativity, enthusiasm
Lacks strong boundaries, ungrounded
Extremely sympathetic
Flighty, squirrel brain
Loves company
Suggestible and gullible
Intuitive, clairvoyant
Anxious
Suffers with others because they can feel it

85
Q

Which remedy has a poor resistance to infection or invasion?

A

Phosphorus

86
Q

Better/worse phosphrus

A

Better with sleep
Sensitive to odors
Left sided

87
Q

Temperatures phosphorus

A

Very thirsty for very cold drinks, craves cold foods

88
Q

Which remedy has large appetites, craves cold foods and salt?

A

Phosphorus

89
Q

Phosphorus discharges

A

Nose runs/bleeds
Menses heavy
Diarrhea
Vomits, easily dehydrated
Easily bleeds bright red blood

90
Q

What remedy is easily startled/has a sensitive nervous system?

A

Phosphorus

91
Q

Fears phosphorus

A

Anxiety, fear about health and loved ones but easily reassured in moment

Doesn’t want to be alone and wants reassurance nothing bad will happen

92
Q

ENT clinical uses phosphorus

A

Compromised mucous membranes
Detached retina, retinal hemorrhage, retinitis, optic neuritis, glaucoma
Dry lips and tongue with dehydration
Hay fever
Frequent nose bleeds, esp kids

93
Q

Incompatible remedy to phosphorus

A

Causticum

94
Q

Acute dosing phosphorus

A

Low potency and frequency

6C, 12C, 30 C QD to QID as needed

95
Q

Chronic dosing phosphorus

A

30C 3x/week for 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)

96
Q

What remedy is thirsty for lots of cold water but will throw it up once it warms in their stomach?

A

Phosphorus

97
Q

Which remedy has burning pains but still better with heat?

A

Arsenicum

98
Q

Presentation BPPV

A

Paroxysmal, brief, always positional vertigo

Comes and goes as it gradually improves, may recur

NO hearing loss

99
Q

Dx BPPV

A

History
Pos dix-hallpike
Therapeutic response to epley maneuver

100
Q

Presentation vestibular neuronitis

A

Sudden onset, constant and severe vertigo (becomes intermittent as it resolves)

Better movement, often follows viral infection

No hearing loss, no tinnitus

101
Q

Dx vestibular neuronitis

A

History
Normal hearing
Spontaneous horizontal nystagmus
Resolves in hours > days
Abnormal VOR

102
Q

Labyrinthitis presentation

A

Mild to severe vertigo accompanied by concomitant ear, sinus, or nose infection

Hearing loss with tinnitus, AOM/OME

Resolves in days to weeks with resolution of acute infection

103
Q

Labyrinthitis dx

A

ENT exam
Abnormal VOR

104
Q

Meniere disease presentation

A

Episodic attacks of severe vertigo with aural fullness and sensorineural, unilateral hearing loss

105
Q

Meineres disease dx

A

History
Recurrences
ABR
Abnormal VOR

106
Q

Cholesteatoma presentation

A

Recurrent vertigo with hx of AOM with perforation, slow progression of sx

Conductive hearing loss

107
Q

Cholesteatoma dx

A

Usu visible on otoscopic exam

108
Q

Perilymphatic fistula presentation

A

post-traumatic vertigo that does not improve over time

Mixed or SN hearing loss

109
Q

Perilymphatic fistula dx

A

Pos fistula test
(Insufflation makes sx appear)
Valsalva

110
Q

Acoustic neuroma presentation

A

Progressive unilateral SN hearing loss with vertigo, gradual development

111
Q

Acoustic neuroma dx

A

Auditory brain stem response
MRI

112
Q

Nystagmus central v peripheral vertigo

A

Central: bidirectional, downbeat, gaze evoked, torsional, vertical

Peripheral: unidirectional, horizontal, can be suppressed by visual fixation

113
Q

Dix hallpike central v peripheral vertigo

A

Central - NONE

Peripheral - latency, adaptability, fatiguability

114
Q

Pursuit central v peripheral vertigo

A

Central - pursuit broken

Peripheral - pursuit intact

115
Q

VOR central v peripheral vertigo

A

Peripheral = + VOR, catch up saccade

Central = none

116
Q

caloric and tulios central v peripheral vertigo

A

Central - normal
Peripheral - abnormal

117
Q

Red flags with central vertigo/stroke

A

Hyper acute onset
Normal head impulse test
Focal Neuro deficits
Occipital headache, new onset headache with vomiting
Gait ataxia
Onset with valsalva
Slurred speech

118
Q

Why do endocrine/metabolic conditions affect hearing?

A

The inner ear is highly vascular, and the organ of corti and vestibular apparatus have a high metabolic rate, making them ATP dependent, mainly from glucose >

inner ear is very sensitive to anoxia and nutrient deprivation.

119
Q

What endocrine/metabolic conditions should be looked at with inner ear disorders?

A

Hypothyroid
Diabetes
Dysglycemia
Hyperlipidemia

120
Q

Weber test

A

Testing for bone conduction with 512 hz tuning fork

Lateralize to bar ear = conductive

To good ear = SN

121
Q

Rinne test

A

Air conduction v bone conduction with tuning fork

AC > BC - normal
BC > AC - conductive
AC > BC, both diminished - SN

122
Q

Audiology testing normal levels

A

0-25dB

123
Q

Electrocochlegraphy test

A

Controversial in dx of meunière/endolymphatic hydrops

Screening for hearing loss in infants

124
Q

Auditory brain stem response test

A

Time it takes impulse to get from cochlea to brain stem

Prolonged with acoustic neuroma

Test objective hearing in young children

125
Q

Types of conductive hearing loss

A

Otoscelerosis
Traumatic
Inflammatory

126
Q

Traumatic conductive hearing loss presentation

A

Type Ad (disrupted) tympanogram

127
Q

Inflammatory conductive hearing loss hx

A

AOM, OME

128
Q

Otosclerosis presentation

A

Progressive, well preserved speech discrimination

Carharts notch (dip in bone conduction)
Schwartez sign (pink/blue promontory on otoscopic)
Hear better in noisy places
Type As(stiff) tympanogram

Dx CT of temporal bone

129
Q

Types of SN/perceptive hearing loss

A

Congenital
Traumatic (starts w tinnitus)
Rubella, jaundice or anoxia at birth, brain injury
AOM (strep), measles, syphilis, VRI
Neoplasticism
Metabolic/vascular
Ototoxicity

130
Q

SNNHL presentation

A

> 30 dB loss in 3 cont frequencies < 3 days

Dx of exclusion

131
Q

Minerals for presbycusis

A

Zinc

132
Q

Minerals for aminoglycoside antibiotic toxicity

A

Magnesium

133
Q

Supplements for gentamicin toxicity

A

Glutathione

134
Q

Ototoxic substances

A

Alcohol
Caffeine
MSG
ASA
Smoking
Quinine
Loop and thiazide diuretics
Vancomycin
Erythromycin
Platinum based chemo
Heavy metals

135
Q

Circulatory/chi to middle ear

A

Ginkgo
Vaccinum, bilberry
Vinpoetine
Pycnogenol
Capsicum and ginger warming herbs
Acupuncture

136
Q

Tympanometry - define admittance and impedance

A

Admittance / compliance - how well does energy flow through middle ear system

Impedance - how much flow is blocked by the middle ear system

137
Q

Effects of admittance/impedance on audiogram

A

Inc stiffness > harder for low frequencies to transmit (dec low frequency admittance > inc low frequency impedance) > rising audiogram

Inc mass in system > harder to transmit higher frequencies (dec high frequency admittance, inc high frequency impedance) > sloping audiogram

138
Q

Otoacoustic emission

A

Response from cochlea’s active mechanic; spontaneous of elicited

Tests only to level of cochlea

139
Q

Auditory brain stem response testing

A

Automated - to screen newborns

Neuro diagnosis - potential retrocochlear pathology

Threshold - testing hearing level for pts who can’t be tested with behavioral methods

EENT (6 decks)

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