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Clinical Med I > HEENT - Allergic Rhinitis, Tinnitus, and Urticaria - Exam 2 > Flashcards

HEENT - Allergic Rhinitis, Tinnitus, and Urticaria - Exam 2 Flashcards

1
Q

What is barotrauma?

A

Discomfort or damage due to pressure differences between the middle ear and outside world

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2
Q

What are common causes of barotrauma?

A

Flying and driving

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3
Q

What are symptoms of barotrauma?

A
  • Pressure
  • Pain
  • Hearing loss
  • Tinnitus
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4
Q

What are typical exam findings with barotrauma?

A
  • Middle ear effusion
  • Hemotympanum
  • TM rupture
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5
Q

What is the treatment for barotrauma?

A
  • Avoidance
  • Oral or nasal decongestants
  • Swallowing, valsalvia, chewing gum (to equalize middle ear pressure)
  • Treatment of injury is usually time/patience
  • If perilymphatic fistula (vertigo and senroineural hearing loss) refer to ENT
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6
Q

What is Acoustic neuroma (Vestibular Schwannoma)?

A

Slow growing Schwann cell tumors that arise from the vestibular portion of CN VIII

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7
Q

What are risk factors for Acoustic neuroma?

A
  • Childhood exposure to radiation of the head/neck

- Neurofibromatosis Type 2

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8
Q

What is the presentation of Acoustic neuroma?

A
  • Unilateral sensorineural hearing loss and tinnitus (classic presentation)
  • +/- gait disturbance or other CN involvement
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9
Q

How is Acoustic neuroma diagnosed?

A
  • Audiometry is best initial test

- MRI (diagnostic imaging of choice)

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10
Q

What is the treatment for Acoustic neuroma?

A
  • Surgery
  • Radiation
  • Observation
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11
Q

What are symptoms associated with tinnitus?

A
  • Perception of buzzing, ringing, hissing or other noise

- Continuous or intermittent; pulsatile or non-pulsatile

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12
Q

Which type of tinnitus is most commonly vascular in etiology?

A

Pulsatile tinnitus

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13
Q

Which type of tinnitus needs an ENT referral for possible imaging?

A

Pulsatile tinnitus

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14
Q

What is the treatment for tinnitus?

A
  • Main goal: lessen impact on quality of life
  • Behavioral therapy: biofeedback, stress reduction, CBT
  • Benzodiazepines - alprazolam (Xanax)
  • Masking devices such as white noise machines
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15
Q

What is the etiology associated with tinnitus?

A
  • Ototoxic medications
  • Presbycusis (SN hearing loss with aging)
  • Otosclerosis
  • Vestibular Schwannoma
  • Chiari malformations
  • Barotrauma
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16
Q

What is the pathophysiology behind allergic rhinitis?

A
  • Response to allergen exposure by production of IgE
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17
Q

What are symptoms associated with allergic rhinitis?

A
  • Rhinorrhea
  • Sneezing
  • Nasal congestion
  • +/- Itchy eyes, itchy nose, post nasal drip, cough
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18
Q

What are risk factors for allergic rhinitis?

A
  • FHx of atopy (biggest factor)
  • Male sex
  • Birth during pollen season
  • Firstborn status
  • Early use of abx
  • Maternal smoking exposure in 1st year of life
  • Exposure to indoor allergens
  • Presence of allergen-specific IgE
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19
Q

How will the periorbital area appear on physical exam in individuals with allergic rhinitis?

A
  • “Allergic Shiners”: bluish purple rings around both eyes

- Dennie-Morgan Lines: skin folds under eyes consistent with allergic conjunctivitis

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20
Q

How will the eyes appear on physical exam in individuals with allergic rhinitis?

A
  • Diffuse redness involving the bulbar and palpebral conjunctiva
  • Tearing or clear watery discharge
  • Chemosis
  • Eyelid edema

symptoms are usually bilaterally

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21
Q

How will the nose appear on physical exam in individuals with allergic rhinitis?

A
  • Pale, boggy, “bluish” mucosa
  • Clear nasal discharge
  • Nasal crease from “allergic salute”
22
Q

How will the throat appear on physical exam in individuals with allergic rhinitis?

A
  • Post-nasal drainage in posterior pharynx

- “Cobblestoning”

23
Q

How will the ears appear on physical exam in individuals with allergic rhinitis?

A

Retracted TMs and/or serous otitis media (OME)

24
Q

While allergy testing can be confirmatory, but not necessary for the initial diagnosis of allergic rhinitis, what are its benefits?

A
  • Helps to identify and facilitate avoidance of allergens

- Identifies candidates for immunotherapy

25
Q

What are you looking for in a Scratch (Prick) Test?

What is a risk with this testing?

A

Looking for a positive “Wheal and Flare” reaction

Risk for anaphylactic reaction (should have epi available)

26
Q

What symptoms do 1st generation antihistamines help with? Which symptoms do they not help with?

What are examples of 1st generation antihistamines?

What are side effects?

A

Helps to alleviate sneezing, rhinorrhea, and itching; no relief of nasal congestion

  • Chlorpheniramine (Chlor-trimeton)
  • Diphenhydramine (Benadryl)

Side effects: dry mouth, constipation, sedation

27
Q

When would you recommend 2nd generation antihistamines instead of 1st generation?

What are examples of 2nd generation antihistamines?

A

You would recommend 2nd generation for patients that do not want sedating/drowsy side-effect of a 1st generation antihistamine

  • Loratadine (Claritin) QD
  • Fexofedadine (Allegra) QD or BID
  • Cetirizine (Zyrtec) QD
28
Q

What do antihistamine nasal sprays target?

How are they dosed?

Are they used alone or in combination with other therapies?

A

Target H1 antagonist

Dosed BID

May be used alone or in combination with steroid nasal spray

29
Q

Are nasal steroid sprays more or less effective than oral antihistamines?

What are its side effects?

A

More effective

Side effects: Epistaxis

30
Q

What is an example of a leukotriene receptor antagonist?

What can these be used in conjunction with to provide more relief of symptoms?

A

Montelukast (Singulair)

Used with 2nd generation oral antihistamine provides more relief then either agent alone

31
Q

When should sympathomimetics (decongestants) be used?

What is its mechanism?

What is an example?

A

Use if marked congestion despite antihistamine use

Causes vasocontriction that will decrease edema and secretions.

Pseudoephredrine (Sudafed)

32
Q

What populations should sympathomimetics (decongestants) be used with caution?

A

Patients with hypertension or cardiac disease

33
Q

What is immunotherapy (allergy shots) an effective treatment for?

A

Allergic conjunctivitis, rhinitis, and asthma

34
Q

What is the pharmacotherapy for allergic rhinitis in children less than 2 years old?

A
  • Cromolyn sodium nasal spray

- 2nd generation antihistamines [Cetirizine (Zyrtec)]

35
Q

What is the pharmacotherapy for adults and children > 2 years old with mild symptoms of allergic rhinitis or episodic symptoms?

A
  • 2nd generation oral antihistamines (loratadine/Claritin, cetirizine/Zyrtec, fexofenadine/Allergra)
  • Antihistamine nasal sprays (Azelastine/Astepro, Olopatadine/Patanase)
  • Glucocorticoid nasal sprays
  • Cromolyn nasal spray
36
Q

What is the pharmacotherapy for adults and children > 2 years old with moderate to severe symptoms of allergic rhinitis?

A

Glucocorticoid nasal sprays (1st line)

  • Mometasone (Nasonex) and Fluticasone furoate (Veramyst) - children 2 or older
  • Fluticasone proprionate - children 4 and older
37
Q

What should you prescribe for allergic rhinitis with concomitant asthma?

A

Montelukast (Singulair)

38
Q

What should you prescribe for allergic rhinitis with allergic conjunctivitis?

A
  • Steroid nasal spray and ophthalmic antihistamine drops

- AVOID nasal steroid spays in patients with glaucoma or cataracts

39
Q

What are triggers for non-allergic rhinitis (AKA “Vasomotor Rhinitis”?

A
  • Stress
  • Sexual arousal
  • Perfumes
  • Cigarettes smoke
  • Temperature changes
40
Q

What are typical characteristics of non-allergic rhinitis?

A
  • Nasal congestion
  • Rhinorrhea
  • Postnasal drainage
  • No ocular/nasal itching or sneezing
41
Q

What is the typical treatment for Vasomotor Rhinitis?

A
  • Avoidance of triggers
  • Nasal steroid sprays
  • Antihistamine nasal sprays
  • Ipratropium nasal spray (anticholinergic) if prominent symptom is rhinorrhea
42
Q

What are nasal polyps?

What are symptoms associated with them?

A

Non-tender, grey soft tissue nasal growths

Symptoms: nasal congestion/obstruction

43
Q

What is treatment for nasal polyps?

A
  • Nasal steroid spray

- Refer to ENT

44
Q

What is Rhinitis Medicamentosa?

How many days does it take to lead to rebound congestion?

A

The result of regular use of a decongestant spray such as Afrin.

> 3 days leads to rebound

45
Q

What is treatment for Rhinitis Medicamentosa?

A
  • Discontinue decongestant spray

- Start nasal steroid spray

46
Q

Describe urticaria.

A
  • Hives/wheals
  • Pruritic
  • Pale to bright erythema
  • Lesions are transient
47
Q

What is the pathophysiology behind urticaria?

A

Release of histamine from mast cells of the superficial epidermis

48
Q

How can you differentiate urticarial vasculitis from urticaria?

A

Urticarial vasculitis:

  • Lasts longer than 24 hours
  • Erythematous, painful plaques with blanching halos
  • Leaves hyperpigmentation
  • Link with SLE
49
Q

What is the preferred 1st line treatment for urticaria?

A

2nd generation H1 histamine blocker:

  • Cetirizine (Zyrtec)
  • Levocetirizine (Xyzal)
50
Q

What should be given for urticaria with persistent symptoms or associated angioedema?

A

Oral glucocorticoids

Clinical Med I (24 decks)

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