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EENT > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

Vestibular Neuritis affects which CN?

A

CN VIII

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2
Q

Hx: Vestibular Neuritis

A

Usu preceded by URI

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3
Q

SSx: Vestibular Neuritis

A

Sudden onset vertigo, constant, < movement, N/V

No hearing loss, No tinnitus

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4
Q

PE: Vestibular Neuritis

A

Spontaneous horizontal-torsional nystagmus AWAY from affected side, +HIT, decreased VEMPs, falling tendency toward affected side, inc. visual dependency

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5
Q

Course: Vestibular Neuritis

A

Severe/persistent vertigo becomes intermittent/positional and resolves in days-wks

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6
Q

In a pt w/ suspected Vestibular Neuritis, when is brain imaging indicated?

A

Unprecendented HA, negative head impulse test, severe unsteadiness, no recovery in 1-2 days

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7
Q

Etiology: Labryrinthisis

A

Bacterial/viral, AI (BL), ototoxic drugs

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8
Q

SSx: Viral labyrinthitis

A

Acute onset of mild-severe vertigo (assoc. w/ N/V) accompanied by concomitant ear/nose/sinus infx, tinnitus

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9
Q

PE: Viral labyrinthitis

A

Spontaneous nystagmus toward UNAFFECTED side w/ diminished/absent caloric response in affect ear, +HIT

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10
Q

DDx: Viral labyrinthitis vs. Vestibular neuritis

A

VL affects vestibular system + hearing

VN affects vestibular system ONLY

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11
Q

Risk Factors: CNS Stroke

A

Older age, HTN, DM

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12
Q

What is the Rothrock criteria used for?

A

Help determine whether pts w/ vertigo should undergo CT scan

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13
Q

Rothrock Criteria

A

Pt >60 years, new onset focal neurological deficit, HA w/ vomiting, altered mental status

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14
Q

Red flags: CNS Stroke

A

Hyperacute onset vertigo, occipital HA, gait ataxia

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15
Q

DDx: VL, VN vs. CNS stroke

A

VN - Vestibular fxn
VL - Vestibular fxn + hearing
CNS - Vestibular fxn, focal weakness, slurred speech

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16
Q

What is the MC cause of positional vertigo?

A

Benign Paroxysmal Positional Vertigo

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17
Q

SSx: BPPV

A

Brief (1 min) episodes of vertigo triggered by positional changes, no hearing loss

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18
Q

BPPV can be 2˚ to ___.

A

head trauma, dental surgery, ASOM

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19
Q

Pathophysiology: BPPV

A

Otoliths roll across hairs when the head moves, sending signals to brain causing vertigo

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20
Q

What are Ototliths?

A

Calcium carbonate precipitates in endolymph

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21
Q

PE: BPPV

A

+Dix-Hallpike (upbeat nystagmus, fatigues on repeat exam), NO hearing loss/tinnitus

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22
Q

If BPPV is 2˚ to trauma, ___

A

order X-ray to r/o temporal bone fracture

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23
Q

What population is at risk for BPPV?

A

Children w/ migraines

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24
Q

Tx: BPPV

A

Epley Maneuvers

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25
Q

DDx: BPPV vs. other conditions causing vertigo

A

BPPV is not simply made worse with position change, it is TRIGGERED by it

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26
Q

DDx: BPPV vs Central Positional Vertigo

A

BPPV - upbeat nystagmus on Dix-Hallpike

CPV - downbeat or pure tortional nystagmus on Dix-Hallpike

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27
Q

Pathophysiology: Meniere’s disease

A

Edema within endolympatic space

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28
Q

SSx: Meniere’s disease

A

Episodic severe vertigo w/ N/V and aural fullness, mb tinnitus on affected side (loud/roaring), fluctuating sensorineural hearing loss (hypersensitivity to loud noises), 90% unilateral

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29
Q

Population: Meniere’s disease

A

Middle-aged women MC

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30
Q

PE: Meniere’s disease

A

+HIT, auditory brainstem response w/ acoustic masking

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31
Q

DDx: Meniere’s disease vs. Transient Ischemic Attack

A

TIA episodes usu briefer than MD, get worse in crescendo pattern

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32
Q

Dx: Pt w/ acute audiovestibular loss who does not have typical Meniere’s disease sxs

A

Brainstem stroke

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33
Q

Bilateral vestibular failure are MC d/t __.

A

Aminoglycoside toxicity (Gentamicin, Streptomycin)

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34
Q

What % of pts with acoustic neuroma have vertigo?

A

50%

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35
Q

SSx: Acoustic neuroma

A

Slowly progressive unilateral sensorineural hearing loss, vertigo (50%), tinnitus

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36
Q

PE: Acoustic neuroma

A

Facial weakness (late), unilateral/asymmetric sensorineural hearing loss, auditory brainstem response

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37
Q

Dx: Acoustic neuroma

A

Refer to ENT for audiology, auditory brainstem response, MRI of interior auditory canal w/ gadolinium contrast

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38
Q

Vague dizziness/vertigo w/ unilateral or asymmetric sensorineural hearing loss is ___ until proven otherwise

A

Acoustic neuroma

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39
Q

DDx: Conductive Hearing Loss

A 
Genetic
Otosclerosis
Trauma
Inflammatory (ASOM, SOM)
Cholesteatoma
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40
Q

What is the MC cause of conductive hearing loss in adults?

A

Otosclerosis

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41
Q

Pop: Otosclerosis

A

Onset - early 20s, peaks 4th-5th decades, F>M

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42
Q

What is the MC form of otosclerosis?

A

Stapes fusing to malleus

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43
Q

SSx: Otosclerosis

A

Progressive conductive hearing loss, usu w/ well-preserved speech discrimination

May have sensorineural hearing loss

Carhart’s notch

Schwartze’s sign

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44
Q

Carhart’s notch

A

dip in bone conductive threshold at 2000 Hz on audiometric testing

seen in otosclerosis

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45
Q

Schwartze’s sign

A

Pink/blue hue on promontory

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46
Q

Clinical pearl: otosclerosis

A

Pts are often soft-spoken and aware that they hear better in noisy environments

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47
Q

Tympanogram: otosclerosis

A

Type As Stiff

short peak

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48
Q

Dx: otosclerosis

A

CT of temporal bone

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49
Q

What is the MC traumatic cause of conductive hearing loss?

A

Rupture of TM

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50
Q

Tympanogram: conductive hearing loss d/t trauma

A

Type Ao Disrupted

large curves, no peak

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51
Q

DDx: Peripheral vertigo

A 
Meniere's disease
Acoustic neuroma
Vestibular neuronitis
Labyrinthitis 
BPPV
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52
Q

DDx: Sensorineural Hearing Loss

A 
Congenital
Traumatic (PF)
Inflammatory (ASOM)
Neoplastic
Metabolic/Vascular
Ototoxcity
Presbycusis
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53
Q

What are non-genetic causes of sensorineural hearing loss at birth

A

Rubella, jaundice, anoxia, brain injury

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54
Q

What is often the initial complaint in patients with a traumatic cause of sensorineural hearing loss?

A

Tinnitus

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55
Q

When is sensorineural hearing loss d/t trauma irreversible?

A

When the hairs in the Organ of Corti are damaged beyond repair

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56
Q

In nose-induced hearing loss, there is a characteristic drop-off in (low/high) frequencies.

A

High

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57
Q

What types of ear infection could cause sensorineural hearing loss?

A

Strep ASOM, measles, syphilis

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58
Q

How do you rule out unilateral sensorineural hearing loss d/t neoplasm?

A

MRI

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59
Q

Auditory brainstem response: Acoustic neuroma

A

Retro-cochlear pattern (delayed V wave compared to normal ear)

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60
Q

In acoustic neuroma, hearing loss is localized in the (low/high) frequencies.

A

High

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61
Q

Which clinical and sub-clinical endocrine/metabolic conditions should be considered in sensorineural hearing loss?

A

Hyperlipidemia, Hypercholesterolemia, DM, hypothyroidism

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62
Q

What are risk factors for hearing loss in women?

A

Obesity, inactivity

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63
Q

What are the MC ototoxic drugs?

A 
ASA
Quinine
Aminoglycosides (gentamicin, neomycin, streptomycin)
High-dose erythromycin
Loop diuretics
Thiazide diuretics
Platinum-based chemo
CO
Nicotine
EtOH
Heavy metals
INF-alpha
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64
Q

What is the first sign of sensorineural hearing loss d/t ototoxicity?

A

Tinnitus

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65
Q

Definition: Sudden sensorineural hearing loss

A

Loss of >30 dB in three contiguous frequencies in a period of <3 days

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66
Q

SSx: Presbycusis

A

Gradual, bilateral, symmetrical hearing loss

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67
Q

Presbycusis often begins with loss of ___

A

high frequencies

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68
Q

Audiogram: Presbycusis

A

Drop-off at higher frequencies

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69
Q

Risk factors: Presbycusis

A

Age, M, White, FHx, service/blue collar occupation, exposure to loud noises, lower education level, smoking, hyperhomocysteinemia, low folic acid intake, HTN, diabetes

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70
Q

SSx: Perilymphatic fistula

A

Post-traumatic vertigo that does not improve over time, mixed sensorineural hearing loss

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71
Q

PE: Perilymphatic fistula

A

+Fistula test (< insufflation), < valsalva

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72
Q

SSx: Cholesteatoma

A

Progressive unilateral conductive hearing loss w/ vertigo

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73
Q

What is the best use of tuning fork tests?

A

Differentiate conductive vs. sensorineural hearing loss

Not screening tools for hearing loss

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74
Q

Rinne test: AC > BC =

A

Normal

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75
Q

Rinne test: BC > AC =

A

Conductive HL

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76
Q

Rinne test: AC > BC, but both diminishsed =

A

Sensorineural HL

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77
Q

A hearing threshold above ___ dB is considered profound hearing loss.

A

91

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78
Q

Normal hearing threshold is ___ dB.

A

0-25

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79
Q

Bone conduction is a measure a ___.

A

cochlear function

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80
Q

Audiology: air conduction is measured with a ___

A

earphones

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81
Q

Air conduction is a measure of ___

A

the entire auditory system

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82
Q

Bone conduction is measured with a ___

A

vibrating oscillator

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83
Q

Speech audiometry measures ___.

A

the threshold that speech can be accurately heard

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84
Q

Typanometry measures ___.

A

tympanic membrane mobility (impedence)

also an indirect measure of middle ear pressure

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85
Q

Electrocoholeography measures ___ and is particularly helpful in what disease?

A

electrical potentials of the cochlea

Meniere’s disease, hearing loss in infants

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86
Q

Auditory Brainstem Response measures ___ and is prolonged in ___.

A

time for impulse to travel from cochlea to brainstem

acoustic neuroma

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87
Q

Outpatient screening for hearing loss

A

Ask patient if they’ve noticed hearing loss

Whispered voice test

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88
Q

What minerals are useful in presbycusis?

A

Zinc (include Cu if long-term use)

Vit C/E, alpha lipoic acid

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89
Q

What nutrients are protective against aminoglycoside antibiotics?

A

Magnesium, Vit C/E

Glutathione (Gentamicin)

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90
Q

What nutrient is useful in Meniere’s?

A

B6

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91
Q

What deficiency is associated with sensorineural hearing loss?

A

Vitamin A

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92
Q

What deficiency is associated with sensorineural hearing loss, BPPV, and otosclerosis?

A

Vitamin D

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93
Q

What deficiency is associated with noise-induced hearing loss and tinnitus?

A

Vitamin B12

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94
Q

What nutrient appears to slow decline of presbycusis in pts with hyperhomocysteinemia?

A

Folic acid

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95
Q

There is a strong association between Meniere’s and what metabolic condition?

A

Allergy to dust, pollen, mold, and/or food allergy

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96
Q

Naturopathic treatments to increase blood flow to middle ear

A

Ginkgo biloba, Bilberry, Vinpocetine, Pycnogenol, Centella

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97
Q

Otologic causes of tinnitus

A

Hearing loss

Cholesteatoma, Meniere disease, vestibular schwannoma

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98
Q

Toxicologic causes of tinnitus

A

Medication or substance use

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99
Q

Somatic causes of tinnitus

A

TMJ dysfunction, head/neck injury

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100
Q

Traumatic causes of tinnitus

A

cerumen removal

101
Q

Neurologic causes of tinnitus

A

MS, spontaneous intracranial hypotension, type I Chiari malformation, idiopathic intracranial HTN, vestibular migraine

102
Q

Infectious causes of tinnitus

A

Viral, bacterial, fungal

103
Q

Metabolic causes of tinnitus

A

Hyperlipidemia, DM, B12 deficiency

104
Q

Vascular causes of tinnitus

A

Arterial bruit, venous hum, A/V malformation, vascular tumor, carotid atherosclerosis, Paget disease

105
Q

Tx: Tinnitus

A

Treat underlying causes (ototoxins, CV dz, DM, AI dz, infx, anemia, hypothyroidism, hyperlipidemia)
Noise protection
Correct deficiencies (B-vitamins, Mg, CoQ10)
Homeopathy, acupuncture, qi gong
Acoustic therapy
CBT/biofeedback

106
Q

Etiology: Common Cold

A

Rhinovirus (respiratory syncytial virus)
Adenovirus
Parainfluenza virus

107
Q

SSx: Common Cold

A 
Nasal congestion
Rhinorrhea (watery/thick)
Mild sore throat/cough
HA, malaise
Low-grade fever in children
108
Q

PE: Common Cold

A

Erythematous, swollen nasal mucosa

109
Q

Pathophysiology: Allergic rhinitis

A

Low-dose antigen triggers Th2 response –> IL-4 and IL-13 produced –> B cells produce IgE –> IgE bind to mast cells and activated eosinophils –> Mast cells release histamine, prostaglandins, leukotrienes, kinins, TNF-alpha –> SM contraction, capillary dilation, glandular hypersecretion

110
Q

Allergic rhinitis is a risk factor for what condition in children?

A

Migraines

111
Q

What are the two main types of allergic rhinitis?

A

Seasonal, Perennial

112
Q

Chronic allergic rhinitis may be associated with ___(4).

A

Sleep d/o, sinusitis, SOM, anosmia

113
Q

SSx: Allergic rhinitis

A

Episodic nasal obstruction, rhinorrhea, sneezing, lacrimation, pruritus (nose, eye, throat), nasal voice, sore throat, allergic salute

114
Q

PE: Allergic rhinitis

A

Enlarged tonsils, halitosis, allergic shiners, adenoidal facies, erythematous nasal mucosa w/ d/c (clear, watery)

Nasal polyps, gingival hypertrophy

115
Q

PE: Nasal mucosa (Seasonal vs. Chronic perennial allergic rhinitis)

A

S - red

CP - pale, bluish

116
Q

Labs: Allergic rhinitis

A

CBC, nasal culture, scratch test, RAST/ELISA test, Total serum IgE

117
Q

CBC: Allergic rhinitis

A

May show eosinophils

118
Q

Nasal culture: Allergic rhinitis

A

Eosinophils

119
Q

When are RAST/ELISA tests indicated?

A

If there is potential for anaphylaxis or bad eczema

120
Q

What is NARES?

A

Non-allergic rhinitis with eosinophil syndrome

121
Q

NARES vs. Allergic rhinitis

A

NARES has an absence of atopic Th2 lymphocytes and IgE-mediated mechanisms

122
Q

Nasal culture: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis

A

NARES - eosinophils

AR - eosinophils

Cholinergic rhinitis - normal

123
Q

Scratch test: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis

A

NARES - negative

AR - positive

Cholinergic rhinitis - negative

124
Q

Serum IgE: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis

A

NARES - normal

AR - mb elevated

Cholinergic rhinitis - normal

125
Q

SSx: NARES

A

Similar to allergic rhinitis
Sneezing paroxysms
Nasal itching
Coryza (serous, seromucus)

126
Q

PE: NARES

A

Dry/atrophic appearance, pallor

127
Q

NARES is often associated with what conditions? (3)

A

Fibromyalgia, CFS, IBS

128
Q

Pathogenesis: Cholinergic rhinitis

A

Imbalance between SNS and PNS

129
Q

Overstimulation of PNS leads to ___.

A

vasodilation, nasal congestion, and increased mucous secretion

130
Q

What is one theory why cholinergic rhinitis is more common in women?

A

Estrogens inhibit acetylcholinesterase –> increased ACh

131
Q

Triggers: Cholinergic rhinitis

A

Emotions (crying), odors, smoke, weather changes (esp. cold air), recumbency, trauma, trigeminal neuralgia, spicy food, EtOH

132
Q

SSx: Cholinergic rhinitis

A

Chronic nasal obstruction w/ or w/o rhinorrhea, BL or unilateral, may alternate sides

133
Q

PE: Cholinergic rhinitis

A

Swollen inferior nasal turbinates, dark red-blue, increased mucus production

134
Q

What is the MC cause of drug-induced rhinitis?

A

Abuse of sympathomimetic nose drops/spray

135
Q

What are common drugs that induce rhinitis?

A

Reserpine, Methyl dopa, Beta blockers, BCP

136
Q

What is the name of the condition caused by the rebound effect of long-term use of sympathomimetic nose drops/sprays?

A

Rhinitis Medicamentosa

137
Q

Tx: Drug-induced rhinitis

A

Conventional: switch to steroid spray

Naturopathic: Substitute with saline spray

138
Q

Sick Building Syndrome, Adenoidal Hyperplasia, Tumors, and Foreign Bodies are also causes of ___.

A

rhinorrhea

139
Q

SSx: Tumor causing rhinorrhea

A

Persistent unilateral nasal d/c, esp. in adults and w/ bloody d/c

140
Q

SSx: Foreign bodies causing rhinorrhea

A

Unilateral d/c, foul smelling, snoring

141
Q

Before removing foreign body from nose, consider using ___.

A

0.5% phenylephrine, topical lidocaine

142
Q

SSx: Cerebrospinal Fluid Rhinorrhea

A

Unilateral, clear, profuse nasal d/c

143
Q

What increases d/c in cerebrospinal fluid rhinorrhea?

A

valsalva, jugular vein compression, lowering the head

144
Q

PE: Cerebrospinal Fluid Rhinorrhea

A

Normal nasal mucosa

145
Q

Work-up: Cerebrospinal Fluid Rhinorrhea

A

Check nasal mucosa for glucose, CT w/ CSF dye

146
Q

What are possible endocrine causes of rhinorrhea?

A

Pregnancy, hypothyroidism

147
Q

Samter’s triad

A

Nasal polyps, ASA sensitivity, asthma

148
Q

Homeopathics for nasal polyps

A

Calc, Sang, Teucr, Thuj

149
Q

Types of rhinosinusitis

A

Acute - Sxs < 4 wks
Subacute - Sxs 4-12 wks
Chronic - Sxs > 12 wks
Recurrent acute - 4 or more episodes per year

150
Q

SSx: Rhinosinusitis

A

Sudden onset of malaise, fever, nasal congestion, post-nasal drainage, throat clearing, facial/head pain, mucopurulent rhinorrhea, low-grade fever, pain at nose root

151
Q

Pain at root of nose

A

Sticta

152
Q

PE: Rhinosinusitis

A

Diffuse mucosal edema, narrowing of middle meatus, inferior turbinate hypertophy, copious rhinorrhea, purulent d/c

Mb polyps, septal deviation

153
Q

Which PE is more reliable than sinus palpation for diagnosing rhinosinusitis?

A

Ask pt to bend forward –> pain?

154
Q

MC cause of rhinosinusitis?

A

viral infection associated with common cold

155
Q

MC bacterial cause of rhinosinusitis?

A

Haemophilus influenza

Streptococcus pneumonia

156
Q

What signs and symptoms are most helpful in predicting Acute Bacterial Rhinosinusitis (ABRS)?

A

Purulent nasal d/c
Maxillary/tooth/facial pain
Unilateral maxillary sinus tenderness
Worsening sxs after initial improvement

157
Q

CT findings: sinusitis

A

Air-fluid levels, mucosal edema, air bubbles within sinus

158
Q

Mucosal abnormalities on CT may be observed in as many as __% of asx pts.

A

42

159
Q

When do you order CT in cases of sinusitis?

A

If patient develops decreased visual acuity, diplopia, periorbital edema, severe HA, altered mental status

160
Q

Complications: Sinusitis

A

Orbital cellulitis, brain abscess

161
Q

What type of imaging do you order for sinusitis if indicated?

A

Limited-Sinus CT

162
Q

In what patients should you screen for primary ciliary dyskinesia?

A

Pts w/ daily nose blowing since birth, chronic-recurrent sinusitis, chronic secretory OM, male infertility

163
Q

Kartagener Syndrome

A

Situs inversus, chronic sinusitis, bronchiectasis

164
Q

Dx: Kartagener Syndrome

A

CXR, Saccharin test, PE for situs inversus

165
Q

Antibiotics for rhinosinusitis?

A

Rarely b/c most cases are viral

166
Q

Sinus development in children

A

Maxillary and ethmoid present at birth

Sphenoid develops from ethmoid at 9 years old

Frontal from ethmoid at 5-7 years

167
Q

What is the most important risk factor for development of acute bacterial rhinosinusitis?

A

Viral URI

168
Q

The presence of nasal polyps in children should prompt evaluation for possible ___.

A

cystic fibrosis

169
Q

Dx: Rhinosinusitis in children

A

Persistent cough and nasal rhinorrhea > 10 days

170
Q

PE: Rhinosinusitis in children

A

Irritability, vomiting, persistent cough, nasal rhinorrhea

171
Q

What are the 3 potential clinical presentations in children when a viral URI is complicated by acute bacterial sinusitis?

A

Persistent sxs
Worsening sxs
Severe sxs

172
Q

SSx: Complications from acute bacterial sinusitis in children

A

Eye swelling w/ persistent HA and V, altered consciousness, focal neurological deficits, signs of meningeal irritation

173
Q

Complications from acute bacterial sinusitis in children

A

Periorbital cellulitis, Orbital cellulitis, Septic cavernous sinus thrombosus, Meningitis, Osteomyelitis, Epidural abscess, Subdural empyema, Brain abscess

174
Q

SSx: Meningitis

A

Fever, HA, nuchal rigidity, change in mental status

175
Q

When should you refer a child with bacterial sinusitis for imaging and what type of imaging?

A

If they are toxic, going into complications, or no improvement w/ tx

CT scan

176
Q

What is the gold standard for diagnosing bacterial sinusitis in children?

A

Sinus tap

177
Q

Three forms of chronic fungal sinusitis

A

Invasive sinusitis, fungus ball of the sinus, allergic

178
Q

Risk factors: Invasive fungal sinusitis

A

Acquired immunodeficiency dz, chemotherapy

179
Q

Risk factors: Allergic fungal sinusitis

A

History of multiple preceding sinus surgeries and nasal polyposis

180
Q

What is the MC cause of fungal sinusitis?

A

Aspergillus

181
Q

Which supplements help stabilize cell membranes?

A

Vitamin C, Vitamin E, Vitamin A, Selenium, NAC, Quercetin, Catechin, Pycnogenol

182
Q

Which bioflavonoid inhibits degranulation of mast cells?

A

Quercetin

183
Q

Which bioflavonoids inhibits histidine carboxylase and is also a potent antioxidant?

A

Catechin

184
Q

Which EFA do atopic patients have trouble converting to PGE? What supplements help bypass this step?

A

Linoleic acid

EPO, Borage oil

185
Q

What are ways to support the adrenals in patients with allergies?

A

Drenotrophin, Antronex, Corrhyzadyn, Isocort, B-vitamins, DHEA, B5, Ginseng

186
Q

What foods should patients with allergies avoid?

A

Dairy, citrus, animal fat, trans-fatty acids

187
Q

What is the MC type of epistaxis?

A

Anterior epistaxis

188
Q

What is the MC location for epistaxis?

A

Kiesselbach’s plexus

189
Q

Tx: Anterior epistaxis

A

1) Pressure, cold application
2) Local anesthetic + silver nitrate
3) If recurrent, Vitamin C + bioflavonoids + homeopathy

190
Q

Pop: Anterior vs. Posterior epistaxis

A

Anterior: Children, YAs
Posterior: Older adults

191
Q

Work-up: Posterior epistaxis

A

Assess for hemodynamic stability, look for bleeding site

192
Q

Tx: Posterior epistaxis

A

Refer to ENT

193
Q

When is epistaxis potentially dangerous?

A

Posterior epistaxis can indicate hemodynamic instability

194
Q

Physical medicine for chronic sinusitis

A

Nasal specifics, craniosacral therapy, nasal lavage, humming

195
Q

What are some ways you can help your patients abort a cold?

A

Rest, water, simple diet, hydrotherapy (constitutional, fever therapy)

196
Q

Evidence for Echinacea and Vitamin C in prevention/treatment of URIs

A

Minimal prophylactic protection, may be effective once cold has been contracted

197
Q

Hydrotherapy for chronic sinusitis

A

Nasal lavage, contrast hydrotherapy

198
Q

Which nutrient prevents the secretion of histamine by WBCs?

A

Vitamin C

199
Q

Naturopathic tx options for rhinosinusitis?

A 
Vitamin A/C/E
Beta-carotene
Zn
Thymus extract
Bromelain
Steam inhalation
Nasal irrigation
Short-wave diathermy
200
Q

Which bacterial agent is mc in children than adults for acute pharyngitis?

A

GABHS

201
Q

Sudden severe throat pain, esp. in older adults, suggests ___(2).

A

Aortic dissection, pneumothorax

202
Q

DDx: Sore throat (systemic diseases)

A

JRA, Hep, Polio, HIV, TSS, Leukemia, Mycoplasma pneumonia

203
Q

What % of pts with M. pneumoniae develop pneumonia?

A

10%

204
Q

What is the diagnostic test of choice for M. pneumoniae?

A

Multiplex PCR

205
Q

Etiology: Mononucleosis

A

EBV (HHV-4)

206
Q

SSx: Mononucleosis

A

Teenage, prominent sore throat > 1 week, Post. cervical nodes (mb groin/axilla adenopathy), myalgia, tonsillar exudate, petechiae on pharynx

207
Q

What two extra-oral findings might you find on PE in Mononucleosis?

A

Hepatomegaly (12%)

Splenomegaly (52%)

208
Q

Work-up: Mononucleosis

A

Peripheral smear (atypical lymphocytes)
Monospot (+)
Transaminases (mildly elevated)

209
Q

In a pt with suspected Mononucleosis with a negative Monospot, consider ___.

A

CMV

210
Q

Why should you order ALT, AST, and GGT in a pt with Mononucleosis?

A

Assess for EBV hepatitis

211
Q

DDx: Sore throat (oral lesions)

A 
Necrotizing Gingivitis
HSV
Hand/foot/mouth dz
Aphthous ulcers
Oral candidiasis
212
Q

When can aphthous ulcers cause a sore throat?

A

When they appear on posterior 1/3rd of tongue –> innervated by CNIX

213
Q

Etiology: Hand/foot/mouth dz

A

Coxsackie virus

214
Q

Risk factors: Necrotizing gingivitis

A

Smoking, poor hygiene, teenagers

215
Q

DDx: Sore throat (head and neck conditions)

A 
OM
Sinusitis post-nasal drip
Mumps parotiditis
SCM/cx spine lesions
Thyroiditis
CNIX neuralgia
Epiglottitis
Oropharyngeal CA
216
Q

Complications: Mononucleosis

A 
Airway obstruction
Fatigue
Splenic rupture
Hemolytic anemia
Thrombocytopenia
CA (Burkitt's lymphoma, nasopharyngeal carcinoma, B-cell lymphomas)
217
Q

Incubation period for GABHS infection?

A

24-72 hrs

218
Q

What population is at highest risk for GABHS infection?

A

Children 5-15 years old

219
Q

CENTOR Criteria

A 
Temp > 100.4 = 1 pt
Absence of cough = 1 pt
Cervical LA = 1 pt
Tonsillar swelling/exudate = 1 pt
3-14 years old = 1 pt
15-44 years old = 0 pt
45 years or older = -1 pt
220
Q

Empirical treatment for GABHS - CENTOR score

A

> /= 4 (51-53%)

221
Q

No further testing or antibiotic - CENTOR score

A

1 or less (1-19%)

222
Q

Culture or RADT, Antibiotics for positive culture only - CENTOR score

A

2-3 (11-35%)

223
Q

Indications: Rapid strep

A

Two or more CENTOR
HIV, splenectomy, DM
Hx of rheumatic fever

224
Q

Sandpaper rash on trunk < groin/axilla

A

Scarlet fever

225
Q

When do you follow-up a negative RADT with a throat culture?

A

Children, adults with high CENTOR score, when sensitivity of RADT is too low

226
Q

Which population is at high risk for carditis and should be treated with antibiotics for GABHS?

A

Hx of rheumatic fever

227
Q

What is a Strep carrier?

A

Pt who has Strep as part of normal flora, positive culture, no antibody response, negative ASO titer

228
Q

Complications: Strep carriers

A

No risk for rheumatic fever of sequelae

229
Q

Antibiotics and GABHS

A

Probably do not alter course of disease (~16 hrs?)
Decrease spread of infection
Prevent suppurative complications

230
Q

Do antibiotics prevent glomerular nephritis as complication of GABHS?

A

No

231
Q

Do antibiotics prevent guttate psoriasis as complication of GABHS?

A

No

232
Q

Do antibiotics prevent erythema nodosum as complication of GABHS?

A

No

233
Q

Do antibiotics prevent acute rheumatic fever as complication of GABHS?

A

Yes

234
Q

SSx: Acute rheumatic fever (major manifestations)

A

Carditis
Polyarthritis
Erythema marginatum
SubQ nodules

235
Q

What is first-line treatment of GABHS?

A

Penicillin

236
Q

What is the NNT for symptom relief at 72 hours in those with positive throat swabs?

A

4

237
Q

Synergists for HEMP: Gelsemium

A

Trembling, nervous excitement, miosis, dull/droopy, not thirsty

238
Q

Synergists for HEMP: Belladonna

A

Dull/expressionless red face, dilated pupils, throbbing pain

239
Q

Synergists for HEMP: Bryonia

A

Sharp/cutting pain, < pressure, < movement, hard pulse

240
Q

Synergists for HEMP: Aconite

A

Small/fast pulse, red/dry throat, fast onset w/ fever

241
Q

Which herb is best added to HEMP tincture when patient appears toxic?

A

Baptisia

242
Q

Phys Med/Hydro for Strep throat

A 
Saline gargles
Warming throat compress
Lymphatic massage
Carrot-Ginger poultices
Scarves
243
Q

Which herb has been shown to improve pain scores in non-strep pharyngitis vs. placebo?

A

Salvia

244
Q

When are follow-up throat cultures indicated?

A

Hx of ARF
Pharyngitis during outbreaks of ARF or glomerulonephritis
Families (“ping-pong” spread)

245
Q

Patients who are asx and culture positive at end of tx are likely ___

A

Strep carriers

246
Q

Herb for Mononucleosis

A

Lomatium

247
Q

Common misdiagnosis for mononucleosis

A

GABHS pharyngitis

248
Q

In patients treated with antibiotics who have mono, what symptom may appear?

A

Generalized maculopapular or urticarial rash

EENT (3 decks)

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