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HEENT > Exam II > Flashcards

Exam II Flashcards

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1
Q

What is the MC cause of conductive HL?

A

Otosclerosis

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2
Q

How does otosclerosis present?

A

HX - well preserved speech; patients are often soft spoken and aware they hear better in noisy environments

PE - stapes and malleus fuse, this is confirmed with CT

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3
Q

What are the causes of sensorineural HL?

A 
Congenital (Waadenburg's Syndrome - white patch of hair)
Viral 
Traumatic (noise occupations)
Inflammatory (strep, measles, syphilis)
Neoplastic
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4
Q

How do you differentiate neoplastic SNHL?

A

U/L hearing loss
R/O w/ MRI

  • acoustic neuroma, hearing loss localized in high frequencies
  • V wave delayed in affected ear
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5
Q

What does speech audiometry measure?

A

threshold that speech can be accurately heard

- increase cochlear HL leads to decreased word recognition

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6
Q

Tympanometry measures

A

TM mobility (impedance)

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7
Q

Which conditions present with stiff tympanometry?

A

Otosclerosis (Type A)

Inflammatory Conductive HL

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8
Q

What does Electrocholeography record?

A

electrical potentials of cochlea

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9
Q

Which condition is dx’d with electrocholography?

A

Meniere’s dz
OR Idiopathic Endolymphatic hydrops

  • fluctuating HL; vertigo (episodic), tinnitus, aural fullness
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10
Q

For Acoustic Neuroma - which test is positive with a prolonged time period?

A

Auditory Brainstem Response

- nerve conduction study (from cochlea to brainstem)

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11
Q

Which minerals help with presbycussis (slow developing SNHL d/t noise)

A

ZINC
Vit C
Vit E
ALA

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12
Q

What substances are ototoxic?

A 
AMINOGLYCOSIDES (gentamicin, streptomycin, neomycin)
Phenytoin
Anti-HTN
Diuretics
NTG
Quinine
Salicylates
Sedatives
TB TX sequelae
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13
Q

How do you improve circulation of blood to middle ear?

A

Vaccinium (bilberry)
Vinpocetine
Gingko

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14
Q

How to differentiate Vestibular Neuritis from Labyrinthitis

A

BOTH - characteristic peripheral vertigo

VN - Virus PRECEDES vertigo
Labyrinthitis - CONCURRENT infxn, HL

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15
Q

PE for DX Perilymphatic Fistula?

A

When pressing on tragus or using insufflation it will MAKE SX WORSE

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16
Q

PE for DX of Benign Paroxysmal Positional Vertigo?

A

Dix Hallpike (brief upbeat, then fatigues)

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17
Q

When performing Dix Hallpike, when should you suspect central vertigo?

A

Downbeat Nystagmus that DOES NOT fatigue with Dix Hallpike

In gen:
Spontaneous nystagmus
Bidirectional
Vertical

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18
Q

Which test is SPECIFIC for conductive HL?

A

Rinne

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19
Q

What are the RED FLAGS for stroke?

A 
sudden onset
asymmetrical smile (neuro indication)
ataxia
central nystagmus (vertical)
Worst H/A ever
> 50 years
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20
Q

how is vertigo most commonly described and what is the MC cause?

A

“pt says room is spinning around them”

MC d/t Peripheral Labyrinth

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21
Q

Which condition presents with Roaring in the ears?

A

syncope

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22
Q

How do you differentiate orthostatic BP vs Autonomic Dysfunction?

A

When testing, lay to stand:
Orthostatic: SBP decreases, HR increases
Autonomic: SBP & HR decrease!!

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23
Q

What is the MC cause of disequilibrium?

A

Impaired Motor FXN control

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24
Q

Which patients are at risk for increase in falls?

A

Multiple Sensory Deficit (MSD) - geriatrics patients, gen because of decreased eyesight, poor proprioception, mm weakness

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25
How do you DX lightheadedness?
DX of exclusion | assoc with sweating and pallor - think hypoglycemia, medications, anxiety, encephalopathy
26
What is Peripheral Vertigo?
Spontaneous nystagmus Unidirectional Horizontal
27
What is Central Vertigo
Spontaneous nystagmus Bidirectional Vertical Neuro SX - ataxia, vision changes, altered mental status - REFER for NEURO*
28
Which tests are positive for Peripheral Vertigo?
Vestibular Ocular Reflex (i.e. Head Impulse) - catchup saccade (req 40% diff between ears) Suppression w/Visual Fixation Dix-Hallpike: latency, adaptability, fatigue Hearing Loss is COMMON Caloric test = NO NYSTAGMUS* Tullio's phenomenon
29
What is Tullio's phenomenon?
Nystagmus and vertigo after a loud noise
30
Which tests are positive for Central Vertigo?
Normal VOR Smooth Pursuit - pursuit is broken RARE auditory signs Caloric test = Normal (creates nystagmus)
31
Any vague dizziness/vertigo with U/L sensory hearing loss is a ___________
ACOUSTIC NEUROMA | - until proven otherwise
32
What will labs show for ALLERGIC Rhinitis
CBC & nasal smear - eosinophilia Scratch Test - wheal and flare Serum IgE - may be increased
33
What does a PE look like for allergic rhinitis patient?
perennial pale, bluish nares d/c clear adenoidal facies IF perennial non-allergic - pale, atrophic appearance
34
What will labs/PE show for CHOLINERGIC Rhinitis
CBC - nothing NEGATIVE Nasal smear/Serum IgE PE - swollen inferior nasal turbinates, dark red to blue increased mucus
35
What will a nasal smear show for someone with CSF inspired rhinitis
glucose - Request CT w/CSF dye
36
Which supplements help stabilize cell membranes
``` quercetin Vit A,C,E NAC Se EFAs ```
37
How do Bioflavonoids help and what are the two used?
inhibit degranulation of mast cells - Quercetin - Vit C
38
This bioflavonoid is a potent antioxidant, and inhibits histidine carboxylase
catechin
39
Which EFA does Atopic patients have trouble converting?
Linoleic acid to PGE1
40
When is the best time to implement prophylactic treatment for allergic patients?
3 months before trigger season
41
ND Tx of Acute Sinusitis and Chronic
Acute: decrease inflammation with quercetin, bromelain and EFAs; HYDRATE Chronic: Improve digestion, constitutional hydrotherapy (contrast hydro over sinuses too), support immune system - PhysMed Sine wave w/fingers
42
When should imaging be ordered for sinusitis?
- decreased visual acuity - diplopia - peri-orbital edema - severe HA - altered mental status ORDER CORONAL CT SCAN
43
What is the NNT for acute sinusitis with antibiotics?
8, however, no longterm benefits. - if not better in 3-4 days, re-evaluate dx; sustain tx for 10-14 days
44
What to do if epistaxis can't be controlled w/ pressure or cold application?
topical anesthetic and careful application of silver nitrate
45
When is epistaxis potentially dangerous?
POSTERIOR EPISTAXIS
46
What warrants an URGENT referral for sinusitis?
- high fever & severe HA - AbN vision - Mental status changes (any CN abNs) - Peri-orbital edema - acute facial pain - swelling - erythema
47
What criteria is used for Strep Dx and what does it consist of?
Centor Criteria - Fever - NO COUGH - Tonsillar Swelling/Exudate - Age 3-14 (15-30% of kiddies) - Swollen Lymph - Anterior Chain
48
Sudden Severe Throat Pain ESP in ELDERLY, what should you consider if normal PE?
Aortic Dissection | Pneumothorax
49
Which oral lesions can mimic sore throat?
Necrotizing Gingivitis Herpes Simplex - superficial ulcerations Hand, Foot and Mouth DZ (coxsackie virus) - painful lesions, self-limited, CONTAGIOUS Aphthous Ulcers - AI, small round or oval ulcers Oral Candidiasis - MC DM, HIV and inhaled corticosteroids
50
A patient presents with a sore throat for longer than 1 week, tender cervical lymph, myalgia, exudate and petechiae on back of pharynx -what do they have?
Mononucleosis - caused by EBV (Herpes IV) Duration 3-4 weeks 50% experience splenomegaly
51
What lab can you order if you suspect mono? What are it's limitations?
Monospot - most sensitive 2 weeks AFTER contracting May also have mildly elevated liver enz. Assess to R/O EBV hepatitis
52
What if a patient presents with symptoms of mononucleosis, but monospot is negative?
think CMV
53
If Pt with GABHS fails to improve after therapy consider
co-infection with EBV
54
What complications can be expected with mononucleosis?
Severe airway obstruction fatigue x 6 months Malignancy - EBV is assoc with Burkitts Lymphoma, nasopharyngeal carcinoma and B cell lymphomas
55
Perform Rapid Antigen Detection Test (RADT) on patients who present with:
2+ on CENTOR criterion high risk hosts (HIV, DM, Splenectomy) Hx of rheumatic fever Do not need to perform if close contacts have already tested + and PT has classic symptomology
56
Patient presents with strep throat, and they have a hx of rheumatic fever, what should you do?
Treat! | High Risk for 2nd episode of carditis
57
Are strep carriers at risk for rheumatic fever?
No. Step is part of their normal flora (10-30% of sore throats are asx carriers)
58
AT best, antibiotics for sore throat..?
decrease duration by 16 hours OR PREVENT Acute Rheumatic Fever - helpful in peritonsillar abscess - not helpful in preventing glomerular nephritis or guttate psoriasis
59
What does the Jones Criteria say?
2 major OR 1 major and 2 minor manifestations increase probability of Acute Rheumatic Fever Major (carditis, polyarthritis, erythema marginatum, subcutaneous nodules) Minor (arthralgia, fever, increase Acute phase reactants, increase ESR and CRP, prolong PR)
60
AANP position on tx of strep throat?
wait x1 week, if sx have no resolved, recommend abx treatment
61
Allopathic Tx
penicillin is 1st line therapy; 10 day course more effective than 7 day.
62
Gelsemium - homeopathic for strep throat
trembling with nervous excitement, small pupils, dull, droopy
63
Belladonna - homeopathic for strep throat
dull expressionless face which is red, dilated pupils
64
Bryonia - homeopathic for strep throat
sharp cutting pain, worse pressure, worse movement, hard pulse
65
aconite - homeopathic for strep throat
very red, dry throat, fast onset with fever
66
HEMP formula is used for
strep throat; gargle 30 gtts in 1/4 cu water
67
For mononucleosis, what is tx plan
avoid trauma if splenomegaly present, LOMATIUM ISoLATE 5gtts Sillimarin if hepatic involvement

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