Allergic rhinitis, tinnitus urticaria

Question 1

What is a schwann cell tumor?

Answer 1

slow growing tumors that arise from the vestibular portion of CN VIII

Question 2

Risk factors for acoustic neuroma

Answer 2

1. exposure to radiation of head/neck

2. Neurofibromatosis Type 2

Question 3

A patient presents with unilateral sensorineural hearing loss and tinitis. What should you suspect?

Answer 3

Acoustic neuroma

Question 4

What do you order to diagnose an acoustic neuroma?

Answer 4

1. Audiometry

2. MRI

Question 5

Tx of acoustic neuroma.

Answer 5

1. Surgery
2. Radiation
3. Observation

Question 6

What is tinnitus an early indicator of?

Answer 6

choclear heair cell dysfunction

Question 7

What differentiates the etiology of pulsatile tinnitus from other types of tinnitus?

Answer 7

vascular etiology.

Question 8

What commonly causes tinnitis

Answer 8

1. ototoxic meds
2. presbycusis
3. otosclerosis
4. vestibular schwannoma
5. chari malformations
6. barotrauma

Question 9

What should you do on exam to rule out vascular tinnitis

Answer 9

auscultate for bruits

Question 10

What is the main goal of treatment with tinnitis?

Answer 10

1. lessen awareness and impact quality of life

Question 11

How should you treat tinnitis?

Answer 11

1. behavioral therapies, alprazolam, masking devices

Question 12

Hallmark sxs of allergic rhinitis?

Answer 12

paroxysms of sneezing, rhinorrhea, nasal obstruction.

Question 13

What is the typical onset of AR?

Answer 13

< 30, peak in childhood/adolescence

Question 14

What sort of immune response is present with AR?

Answer 14

1. allergic IgE mediated

Question 15

Important HPE questions when evaluating AR?

Answer 15

1. FH of AR, asthma, eczema?
2. second hand smoke exposure?
3. pets, grass in/around home?
4. how is this impacting your life?

Question 16

What are dennie morgan lines and what condition is associated with them?

Answer 16

skin folds under eyes common w/ allergic conjunctivitis

Question 17

A patient presents with bluish purple rings around both eyes and complains of nasal congestion and sneezing. what is this type of ecchymosis called and what is your presumptive dx?

Answer 17

1. allergic shiners

2. allergic rhinitis

Question 18

On exam of the eye, what should you find with AR

Answer 18

1. bilateral redness of bulbar and palpebral conjunctiva
2. tearing/clear discharge
3. chemosis
4. eyelid edema

Question 19

What do you look for on inspection of turbinates on a suspected AR pt.?

Answer 19

pale, boggy bluish mucosa

Question 20

Describe the throat in AR patients.

Answer 20

1. post-nasal drainage evidenced by “cobblestoning”

Question 21

AR is associated w/ what dissease of the ear?

Answer 21

OME, AOM

Question 22

When doing scratch or prick skin testing, what are you looking for?

Answer 22

“Wheal and flare” reactions w/ in 15-20 mins.

Question 23

What is the ImmunoCAP test?

Answer 23

detects allergen specific IgE antibodies. Less risky, less sensitive and more expensive

Question 24

How should you treat AR?

Answer 24

1. avoidance of allergens
2. oral/IN antihistamines
3. IN gulcocorticosteroids
4. decongestants
5. leukotriene receptor antagonists

Question 25

How long could it take to clear animal particles?

Answer 25

1. 3-6 months

Question 26

1st generation antihistamines

Answer 26

1. chlor-trimeton, benadryl 2. alleviate sneezing, rhinorrhea, itching 3. dry mouth, constipation, sedation

Question 27

2nd gen antihistamines

Answer 27

1. claritin, allegra, zyrtec | 2. less sedating

Question 28

antihistamine nasal sprays

Answer 28

H1 antagonist, rapid onset, BID

Question 29

cromolyn spray

Answer 29

mast cell stabilizer, low efficacy, frequent dosing

Question 30

Nasal steroid sprays

Answer 30

1. more effective than oral antihistamines 2. lower bioavailability w/ 2nd generation 3. adverse effects: epistaxis

Question 31

Leukotriene receptor antagonist

Answer 31

1. Singulair 2. less effective than nasal spray 3. LTRA + 2nd generation oralantihistamine more relief than any alone

Question 32

Tx of moderate to severe AR

Answer 32

1. 1st line is glucocorticoid nasal sprays: nasonex and veramyst 2. can add antihistamine spray, oral antihistamine, cromolyn spray, singulair, antihistamine/degcongestant combo

Question 33

What is a good drug for pts with AR and asthma?

Answer 33

singulair is a good additive therapy

Question 34

What can you give pregnant women w/ AR?

Answer 34

1. claritin or zyrtec | 2. rhinocort, flonase, nasonex (glucocorticoid spray)

Question 35

What can you give lactating women to treat AR?

Answer 35

1. budesonide or cromolyn + zyrtec or claritin

Question 36

What triggers non-allergic rhinitis?

Answer 36

1. autonomic responses 2. stress 3. sexual arousal 4. perfumes 5. cigarette smoke 6. temperature changes

Question 37

What sxs characterize non-allergic rhinitis

Answer 37

1. nasal congestion, rhinorrhea, postnasal drainage. NO occular/nasal itching or sneezing

Question 38

Tx of non-allergic rhinitis

Answer 38

1. ipratropium nasal spray | 2. adjuncts: oral decongestants, 1st gen antihistamines

Question 39

Nasal polyp tx

Answer 39

nasal steroid sprays

Question 40

Nasal polyp sxs

Answer 40

nasal congestion, obstruction.

Question 41

nasal polyp findings on examination

Answer 41

pedunculated, non-tender grey soft tissue growths associate w/ rhinitis, chronic sinusitis and asthma

Question 42

what is the cause of rhinitis medicamentosa?

Answer 42

regular (3+ days) use of decongestant nasal spray

Question 43

Tx for rhinitis medicamentosa

Answer 43

discontinue afrin, start nasal steroid spray