Quiz 2 Flashcards
1
Q
Vestibular Neuritis affects which CN?
A
CN VIII
2
Q
Hx: Vestibular Neuritis
A
Usu preceded by URI
3
Q
SSx: Vestibular Neuritis
A
Sudden onset vertigo, constant, < movement, N/V
No hearing loss, No tinnitus
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
5
Q
Course: Vestibular Neuritis
A
Severe/persistent vertigo becomes intermittent/positional and resolves in days-wks
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
7
Q
Etiology: Labryrinthisis
A
Bacterial/viral, AI (BL), ototoxic drugs
8
Q
SSx: Viral labyrinthitis
A
Acute onset of mild-severe vertigo (assoc. w/ N/V) accompanied by concomitant ear/nose/sinus infx, tinnitus
9
Q
PE: Viral labyrinthitis
A
Spontaneous nystagmus toward UNAFFECTED side w/ diminished/absent caloric response in affect ear, +HIT
10
Q
DDx: Viral labyrinthitis vs. Vestibular neuritis
A
VL affects vestibular system + hearing
VN affects vestibular system ONLY
11
Q
Risk Factors: CNS Stroke
A
Older age, HTN, DM
12
Q
What is the Rothrock criteria used for?
A
Help determine whether pts w/ vertigo should undergo CT scan
13
Q
Rothrock Criteria
A
Pt >60 years, new onset focal neurological deficit, HA w/ vomiting, altered mental status
14
Q
Red flags: CNS Stroke
A
Hyperacute onset vertigo, occipital HA, gait ataxia
15
Q
DDx: VL, VN vs. CNS stroke
A
VN - Vestibular fxn
VL - Vestibular fxn + hearing
CNS - Vestibular fxn, focal weakness, slurred speech
16
Q
What is the MC cause of positional vertigo?
A
Benign Paroxysmal Positional Vertigo
17
Q
SSx: BPPV
A
Brief (1 min) episodes of vertigo triggered by positional changes, no hearing loss
18
Q
BPPV can be 2˚ to ___.
A
head trauma, dental surgery, ASOM
19
Q
Pathophysiology: BPPV
A
Otoliths roll across hairs when the head moves, sending signals to brain causing vertigo
20
Q
What are Ototliths?
A
Calcium carbonate precipitates in endolymph
21
Q
PE: BPPV
A
+Dix-Hallpike (upbeat nystagmus, fatigues on repeat exam), NO hearing loss/tinnitus
22
Q
If BPPV is 2˚ to trauma, ___
A
order X-ray to r/o temporal bone fracture
23
Q
What population is at risk for BPPV?
A
Children w/ migraines
24
Q
Tx: BPPV
A
Epley Maneuvers
25
DDx: BPPV vs. other conditions causing vertigo
BPPV is not simply made worse with position change, it is TRIGGERED by it
26
DDx: BPPV vs Central Positional Vertigo
BPPV - upbeat nystagmus on Dix-Hallpike
CPV - downbeat or pure tortional nystagmus on Dix-Hallpike
27
Pathophysiology: Meniere's disease
Edema within endolympatic space
28
SSx: Meniere's disease
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
29
Population: Meniere's disease
Middle-aged women MC
30
PE: Meniere's disease
+HIT, auditory brainstem response w/ acoustic masking
31
DDx: Meniere's disease vs. Transient Ischemic Attack
TIA episodes usu briefer than MD, get worse in crescendo pattern
32
Dx: Pt w/ acute audiovestibular loss who does not have typical Meniere's disease sxs
Brainstem stroke
33
Bilateral vestibular failure are MC d/t __.
Aminoglycoside toxicity (Gentamicin, Streptomycin)
34
What % of pts with acoustic neuroma have vertigo?
50%
35
SSx: Acoustic neuroma
Slowly progressive unilateral sensorineural hearing loss, vertigo (50%), tinnitus
36
PE: Acoustic neuroma
Facial weakness (late), unilateral/asymmetric sensorineural hearing loss, auditory brainstem response
37
Dx: Acoustic neuroma
Refer to ENT for audiology, auditory brainstem response, MRI of interior auditory canal w/ gadolinium contrast
38
Vague dizziness/vertigo w/ unilateral or asymmetric sensorineural hearing loss is ___ until proven otherwise
Acoustic neuroma
39
DDx: Conductive Hearing Loss
```
Genetic
Otosclerosis
Trauma
Inflammatory (ASOM, SOM)
Cholesteatoma
```
40
What is the MC cause of conductive hearing loss in adults?
Otosclerosis
41
Pop: Otosclerosis
Onset - early 20s, peaks 4th-5th decades, F>M
42
What is the MC form of otosclerosis?
Stapes fusing to malleus
43
SSx: Otosclerosis
Progressive conductive hearing loss, usu w/ well-preserved speech discrimination
May have sensorineural hearing loss
Carhart's notch
Schwartze's sign
44
Carhart's notch
dip in bone conductive threshold at 2000 Hz on audiometric testing
seen in otosclerosis
45
Schwartze's sign
Pink/blue hue on promontory
46
Clinical pearl: otosclerosis
Pts are often soft-spoken and aware that they hear better in noisy environments
47
Tympanogram: otosclerosis
Type As Stiff
short peak
48
Dx: otosclerosis
CT of temporal bone
49
What is the MC traumatic cause of conductive hearing loss?
Rupture of TM
50
Tympanogram: conductive hearing loss d/t trauma
Type Ao Disrupted
large curves, no peak
51
DDx: Peripheral vertigo
```
Meniere's disease
Acoustic neuroma
Vestibular neuronitis
Labyrinthitis
BPPV
```
52
DDx: Sensorineural Hearing Loss
```
Congenital
Traumatic (PF)
Inflammatory (ASOM)
Neoplastic
Metabolic/Vascular
Ototoxcity
Presbycusis
```
53
What are non-genetic causes of sensorineural hearing loss at birth
Rubella, jaundice, anoxia, brain injury
54
What is often the initial complaint in patients with a traumatic cause of sensorineural hearing loss?
Tinnitus
55
When is sensorineural hearing loss d/t trauma irreversible?
When the hairs in the Organ of Corti are damaged beyond repair
56
In nose-induced hearing loss, there is a characteristic drop-off in (low/high) frequencies.
High
57
What types of ear infection could cause sensorineural hearing loss?
Strep ASOM, measles, syphilis
58
How do you rule out unilateral sensorineural hearing loss d/t neoplasm?
MRI
59
Auditory brainstem response: Acoustic neuroma
Retro-cochlear pattern (delayed V wave compared to normal ear)
60
In acoustic neuroma, hearing loss is localized in the (low/high) frequencies.
High
61
Which clinical and sub-clinical endocrine/metabolic conditions should be considered in sensorineural hearing loss?
Hyperlipidemia, Hypercholesterolemia, DM, hypothyroidism
62
What are risk factors for hearing loss in women?
Obesity, inactivity
63
What are the MC ototoxic drugs?
```
ASA
Quinine
Aminoglycosides (gentamicin, neomycin, streptomycin)
High-dose erythromycin
Loop diuretics
Thiazide diuretics
Platinum-based chemo
CO
Nicotine
EtOH
Heavy metals
INF-alpha
```
64
What is the first sign of sensorineural hearing loss d/t ototoxicity?
Tinnitus
65
Definition: Sudden sensorineural hearing loss
Loss of >30 dB in three contiguous frequencies in a period of <3 days
66
SSx: Presbycusis
Gradual, bilateral, symmetrical hearing loss
67
Presbycusis often begins with loss of ___
high frequencies
68
Audiogram: Presbycusis
Drop-off at higher frequencies
69
Risk factors: Presbycusis
Age, M, White, FHx, service/blue collar occupation, exposure to loud noises, lower education level, smoking, hyperhomocysteinemia, low folic acid intake, HTN, diabetes
70
SSx: Perilymphatic fistula
Post-traumatic vertigo that does not improve over time, mixed sensorineural hearing loss
71
PE: Perilymphatic fistula
+Fistula test (< insufflation), < valsalva
72
SSx: Cholesteatoma
Progressive unilateral conductive hearing loss w/ vertigo
73
What is the best use of tuning fork tests?
Differentiate conductive vs. sensorineural hearing loss
Not screening tools for hearing loss
74
Rinne test: AC > BC =
Normal
75
Rinne test: BC > AC =
Conductive HL
76
Rinne test: AC > BC, but both diminishsed =
Sensorineural HL
77
A hearing threshold above ___ dB is considered profound hearing loss.
91
78
Normal hearing threshold is ___ dB.
0-25
79
Bone conduction is a measure a ___.
cochlear function
80
Audiology: air conduction is measured with a ___
earphones
81
Air conduction is a measure of ___
the entire auditory system
82
Bone conduction is measured with a ___
vibrating oscillator
83
Speech audiometry measures ___.
the threshold that speech can be accurately heard
84
Typanometry measures ___.
tympanic membrane mobility (impedence)
also an indirect measure of middle ear pressure
85
Electrocoholeography measures ___ and is particularly helpful in what disease?
electrical potentials of the cochlea
Meniere's disease, hearing loss in infants
86
Auditory Brainstem Response measures ___ and is prolonged in ___.
time for impulse to travel from cochlea to brainstem
acoustic neuroma
87
Outpatient screening for hearing loss
Ask patient if they've noticed hearing loss
Whispered voice test
88
What minerals are useful in presbycusis?
Zinc (include Cu if long-term use)
Vit C/E, alpha lipoic acid
89
What nutrients are protective against aminoglycoside antibiotics?
Magnesium, Vit C/E
Glutathione (Gentamicin)
90
What nutrient is useful in Meniere's?
B6
91
What deficiency is associated with sensorineural hearing loss?
Vitamin A
92
What deficiency is associated with sensorineural hearing loss, BPPV, and otosclerosis?
Vitamin D
93
What deficiency is associated with noise-induced hearing loss and tinnitus?
Vitamin B12
94
What nutrient appears to slow decline of presbycusis in pts with hyperhomocysteinemia?
Folic acid
95
There is a strong association between Meniere's and what metabolic condition?
Allergy to dust, pollen, mold, and/or food allergy
96
Naturopathic treatments to increase blood flow to middle ear
Ginkgo biloba, Bilberry, Vinpocetine, Pycnogenol, Centella
97
Otologic causes of tinnitus
Hearing loss
| Cholesteatoma, Meniere disease, vestibular schwannoma
98
Toxicologic causes of tinnitus
Medication or substance use
99
Somatic causes of tinnitus
TMJ dysfunction, head/neck injury
100
Traumatic causes of tinnitus
cerumen removal
101
Neurologic causes of tinnitus
MS, spontaneous intracranial hypotension, type I Chiari malformation, idiopathic intracranial HTN, vestibular migraine
102
Infectious causes of tinnitus
Viral, bacterial, fungal
103
Metabolic causes of tinnitus
Hyperlipidemia, DM, B12 deficiency
104
Vascular causes of tinnitus
Arterial bruit, venous hum, A/V malformation, vascular tumor, carotid atherosclerosis, Paget disease
105
Tx: Tinnitus
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
Etiology: Common Cold
Rhinovirus (respiratory syncytial virus)
Adenovirus
Parainfluenza virus
107
SSx: Common Cold
```
Nasal congestion
Rhinorrhea (watery/thick)
Mild sore throat/cough
HA, malaise
Low-grade fever in children
```
108
PE: Common Cold
Erythematous, swollen nasal mucosa
109
Pathophysiology: Allergic rhinitis
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
Allergic rhinitis is a risk factor for what condition in children?
Migraines
111
What are the two main types of allergic rhinitis?
Seasonal, Perennial
112
Chronic allergic rhinitis may be associated with ___(4).
Sleep d/o, sinusitis, SOM, anosmia
113
SSx: Allergic rhinitis
Episodic nasal obstruction, rhinorrhea, sneezing, lacrimation, pruritus (nose, eye, throat), nasal voice, sore throat, allergic salute
114
PE: Allergic rhinitis
Enlarged tonsils, halitosis, allergic shiners, adenoidal facies, erythematous nasal mucosa w/ d/c (clear, watery)
Nasal polyps, gingival hypertrophy
115
PE: Nasal mucosa (Seasonal vs. Chronic perennial allergic rhinitis)
S - red
CP - pale, bluish
116
Labs: Allergic rhinitis
CBC, nasal culture, scratch test, RAST/ELISA test, Total serum IgE
117
CBC: Allergic rhinitis
May show eosinophils
118
Nasal culture: Allergic rhinitis
Eosinophils
119
When are RAST/ELISA tests indicated?
If there is potential for anaphylaxis or bad eczema
120
What is NARES?
Non-allergic rhinitis with eosinophil syndrome
121
NARES vs. Allergic rhinitis
NARES has an absence of atopic Th2 lymphocytes and IgE-mediated mechanisms
122
Nasal culture: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - eosinophils
AR - eosinophils
Cholinergic rhinitis - normal
123
Scratch test: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - negative
AR - positive
Cholinergic rhinitis - negative
124
Serum IgE: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - normal
AR - mb elevated
Cholinergic rhinitis - normal
125
SSx: NARES
Similar to allergic rhinitis
Sneezing paroxysms
Nasal itching
Coryza (serous, seromucus)
126
PE: NARES
Dry/atrophic appearance, pallor
127
NARES is often associated with what conditions? (3)
Fibromyalgia, CFS, IBS
128
Pathogenesis: Cholinergic rhinitis
Imbalance between SNS and PNS
129
Overstimulation of PNS leads to ___.
vasodilation, nasal congestion, and increased mucous secretion
130
What is one theory why cholinergic rhinitis is more common in women?
Estrogens inhibit acetylcholinesterase --> increased ACh
131
Triggers: Cholinergic rhinitis
Emotions (crying), odors, smoke, weather changes (esp. cold air), recumbency, trauma, trigeminal neuralgia, spicy food, EtOH
132
SSx: Cholinergic rhinitis
Chronic nasal obstruction w/ or w/o rhinorrhea, BL or unilateral, may alternate sides
133
PE: Cholinergic rhinitis
Swollen inferior nasal turbinates, dark red-blue, increased mucus production
134
What is the MC cause of drug-induced rhinitis?
Abuse of sympathomimetic nose drops/spray
135
What are common drugs that induce rhinitis?
Reserpine, Methyl dopa, Beta blockers, BCP
136
What is the name of the condition caused by the rebound effect of long-term use of sympathomimetic nose drops/sprays?
Rhinitis Medicamentosa
137
Tx: Drug-induced rhinitis
Conventional: switch to steroid spray
Naturopathic: Substitute with saline spray
138
Sick Building Syndrome, Adenoidal Hyperplasia, Tumors, and Foreign Bodies are also causes of ___.
rhinorrhea
139
SSx: Tumor causing rhinorrhea
Persistent unilateral nasal d/c, esp. in adults and w/ bloody d/c
140
SSx: Foreign bodies causing rhinorrhea
Unilateral d/c, foul smelling, snoring
141
Before removing foreign body from nose, consider using ___.
0.5% phenylephrine, topical lidocaine
142
SSx: Cerebrospinal Fluid Rhinorrhea
Unilateral, clear, profuse nasal d/c
143
What increases d/c in cerebrospinal fluid rhinorrhea?
valsalva, jugular vein compression, lowering the head
144
PE: Cerebrospinal Fluid Rhinorrhea
Normal nasal mucosa
145
Work-up: Cerebrospinal Fluid Rhinorrhea
Check nasal mucosa for glucose, CT w/ CSF dye
146
What are possible endocrine causes of rhinorrhea?
Pregnancy, hypothyroidism
147
Samter's triad
Nasal polyps, ASA sensitivity, asthma
148
Homeopathics for nasal polyps
Calc, Sang, Teucr, Thuj
149
Types of rhinosinusitis
Acute - Sxs < 4 wks
Subacute - Sxs 4-12 wks
Chronic - Sxs > 12 wks
Recurrent acute - 4 or more episodes per year
150
SSx: Rhinosinusitis
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
Pain at root of nose
Sticta
152
PE: Rhinosinusitis
Diffuse mucosal edema, narrowing of middle meatus, inferior turbinate hypertophy, copious rhinorrhea, purulent d/c
Mb polyps, septal deviation
153
Which PE is more reliable than sinus palpation for diagnosing rhinosinusitis?
Ask pt to bend forward --> pain?
154
MC cause of rhinosinusitis?
viral infection associated with common cold
155
MC bacterial cause of rhinosinusitis?
Haemophilus influenza
| Streptococcus pneumonia
156
What signs and symptoms are most helpful in predicting Acute Bacterial Rhinosinusitis (ABRS)?
Purulent nasal d/c
Maxillary/tooth/facial pain
Unilateral maxillary sinus tenderness
Worsening sxs after initial improvement
157
CT findings: sinusitis
Air-fluid levels, mucosal edema, air bubbles within sinus
158
Mucosal abnormalities on CT may be observed in as many as __% of asx pts.
42
159
When do you order CT in cases of sinusitis?
If patient develops decreased visual acuity, diplopia, periorbital edema, severe HA, altered mental status
160
Complications: Sinusitis
Orbital cellulitis, brain abscess
161
What type of imaging do you order for sinusitis if indicated?
Limited-Sinus CT
162
In what patients should you screen for primary ciliary dyskinesia?
Pts w/ daily nose blowing since birth, chronic-recurrent sinusitis, chronic secretory OM, male infertility
163
Kartagener Syndrome
Situs inversus, chronic sinusitis, bronchiectasis
164
Dx: Kartagener Syndrome
CXR, Saccharin test, PE for situs inversus
165
Antibiotics for rhinosinusitis?
Rarely b/c most cases are viral
166
Sinus development in children
Maxillary and ethmoid present at birth
Sphenoid develops from ethmoid at 9 years old
Frontal from ethmoid at 5-7 years
167
What is the most important risk factor for development of acute bacterial rhinosinusitis?
Viral URI
168
The presence of nasal polyps in children should prompt evaluation for possible ___.
cystic fibrosis
169
Dx: Rhinosinusitis in children
Persistent cough and nasal rhinorrhea > 10 days
170
PE: Rhinosinusitis in children
Irritability, vomiting, persistent cough, nasal rhinorrhea
171
What are the 3 potential clinical presentations in children when a viral URI is complicated by acute bacterial sinusitis?
Persistent sxs
Worsening sxs
Severe sxs
172
SSx: Complications from acute bacterial sinusitis in children
Eye swelling w/ persistent HA and V, altered consciousness, focal neurological deficits, signs of meningeal irritation
173
Complications from acute bacterial sinusitis in children
Periorbital cellulitis, Orbital cellulitis, Septic cavernous sinus thrombosus, Meningitis, Osteomyelitis, Epidural abscess, Subdural empyema, Brain abscess
174
SSx: Meningitis
Fever, HA, nuchal rigidity, change in mental status
175
When should you refer a child with bacterial sinusitis for imaging and what type of imaging?
If they are toxic, going into complications, or no improvement w/ tx
CT scan
176
What is the gold standard for diagnosing bacterial sinusitis in children?
Sinus tap
177
Three forms of chronic fungal sinusitis
Invasive sinusitis, fungus ball of the sinus, allergic
178
Risk factors: Invasive fungal sinusitis
Acquired immunodeficiency dz, chemotherapy
179
Risk factors: Allergic fungal sinusitis
History of multiple preceding sinus surgeries and nasal polyposis
180
What is the MC cause of fungal sinusitis?
Aspergillus
181
Which supplements help stabilize cell membranes?
Vitamin C, Vitamin E, Vitamin A, Selenium, NAC, Quercetin, Catechin, Pycnogenol
182
Which bioflavonoid inhibits degranulation of mast cells?
Quercetin
183
Which bioflavonoids inhibits histidine carboxylase and is also a potent antioxidant?
Catechin
184
Which EFA do atopic patients have trouble converting to PGE? What supplements help bypass this step?
Linoleic acid
EPO, Borage oil
185
What are ways to support the adrenals in patients with allergies?
Drenotrophin, Antronex, Corrhyzadyn, Isocort, B-vitamins, DHEA, B5, Ginseng
186
What foods should patients with allergies avoid?
Dairy, citrus, animal fat, trans-fatty acids
187
What is the MC type of epistaxis?
Anterior epistaxis
188
What is the MC location for epistaxis?
Kiesselbach's plexus
189
Tx: Anterior epistaxis
1) Pressure, cold application
2) Local anesthetic + silver nitrate
3) If recurrent, Vitamin C + bioflavonoids + homeopathy
190
Pop: Anterior vs. Posterior epistaxis
Anterior: Children, YAs
Posterior: Older adults
191
Work-up: Posterior epistaxis
Assess for hemodynamic stability, look for bleeding site
192
Tx: Posterior epistaxis
Refer to ENT
193
When is epistaxis potentially dangerous?
Posterior epistaxis can indicate hemodynamic instability
194
Physical medicine for chronic sinusitis
Nasal specifics, craniosacral therapy, nasal lavage, humming
195
What are some ways you can help your patients abort a cold?
Rest, water, simple diet, hydrotherapy (constitutional, fever therapy)
196
Evidence for Echinacea and Vitamin C in prevention/treatment of URIs
Minimal prophylactic protection, may be effective once cold has been contracted
197
Hydrotherapy for chronic sinusitis
Nasal lavage, contrast hydrotherapy
198
Which nutrient prevents the secretion of histamine by WBCs?
Vitamin C
199
Naturopathic tx options for rhinosinusitis?
```
Vitamin A/C/E
Beta-carotene
Zn
Thymus extract
Bromelain
Steam inhalation
Nasal irrigation
Short-wave diathermy
```
200
Which bacterial agent is mc in children than adults for acute pharyngitis?
GABHS
201
Sudden severe throat pain, esp. in older adults, suggests ___(2).
Aortic dissection, pneumothorax
202
DDx: Sore throat (systemic diseases)
JRA, Hep, Polio, HIV, TSS, Leukemia, Mycoplasma pneumonia
203
What % of pts with M. pneumoniae develop pneumonia?
10%
204
What is the diagnostic test of choice for M. pneumoniae?
Multiplex PCR
205
Etiology: Mononucleosis
EBV (HHV-4)
206
SSx: Mononucleosis
Teenage, prominent sore throat > 1 week, Post. cervical nodes (mb groin/axilla adenopathy), myalgia, tonsillar exudate, petechiae on pharynx
207
What two extra-oral findings might you find on PE in Mononucleosis?
Hepatomegaly (12%)
| Splenomegaly (52%)
208
Work-up: Mononucleosis
Peripheral smear (atypical lymphocytes)
Monospot (+)
Transaminases (mildly elevated)
209
In a pt with suspected Mononucleosis with a negative Monospot, consider ___.
CMV
210
Why should you order ALT, AST, and GGT in a pt with Mononucleosis?
Assess for EBV hepatitis
211
DDx: Sore throat (oral lesions)
```
Necrotizing Gingivitis
HSV
Hand/foot/mouth dz
Aphthous ulcers
Oral candidiasis
```
212
When can aphthous ulcers cause a sore throat?
When they appear on posterior 1/3rd of tongue --> innervated by CNIX
213
Etiology: Hand/foot/mouth dz
Coxsackie virus
214
Risk factors: Necrotizing gingivitis
Smoking, poor hygiene, teenagers
215
DDx: Sore throat (head and neck conditions)
```
OM
Sinusitis post-nasal drip
Mumps parotiditis
SCM/cx spine lesions
Thyroiditis
CNIX neuralgia
Epiglottitis
Oropharyngeal CA
```
216
Complications: Mononucleosis
```
Airway obstruction
Fatigue
Splenic rupture
Hemolytic anemia
Thrombocytopenia
CA (Burkitt's lymphoma, nasopharyngeal carcinoma, B-cell lymphomas)
```
217
Incubation period for GABHS infection?
24-72 hrs
218
What population is at highest risk for GABHS infection?
Children 5-15 years old
219
CENTOR Criteria
```
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
Empirical treatment for GABHS - CENTOR score
>/= 4 (51-53%)
221
No further testing or antibiotic - CENTOR score
1 or less (1-19%)
222
Culture or RADT, Antibiotics for positive culture only - CENTOR score
2-3 (11-35%)
223
Indications: Rapid strep
Two or more CENTOR
HIV, splenectomy, DM
Hx of rheumatic fever
224
Sandpaper rash on trunk < groin/axilla
Scarlet fever
225
When do you follow-up a negative RADT with a throat culture?
Children, adults with high CENTOR score, when sensitivity of RADT is too low
226
Which population is at high risk for carditis and should be treated with antibiotics for GABHS?
Hx of rheumatic fever
227
What is a Strep carrier?
Pt who has Strep as part of normal flora, positive culture, no antibody response, negative ASO titer
228
Complications: Strep carriers
No risk for rheumatic fever of sequelae
229
Antibiotics and GABHS
Probably do not alter course of disease (~16 hrs?)
Decrease spread of infection
Prevent suppurative complications
230
Do antibiotics prevent glomerular nephritis as complication of GABHS?
No
231
Do antibiotics prevent guttate psoriasis as complication of GABHS?
No
232
Do antibiotics prevent erythema nodosum as complication of GABHS?
No
233
Do antibiotics prevent acute rheumatic fever as complication of GABHS?
Yes
234
SSx: Acute rheumatic fever (major manifestations)
Carditis
Polyarthritis
Erythema marginatum
SubQ nodules
235
What is first-line treatment of GABHS?
Penicillin
236
What is the NNT for symptom relief at 72 hours in those with positive throat swabs?
4
237
Synergists for HEMP: Gelsemium
Trembling, nervous excitement, miosis, dull/droopy, not thirsty
238
Synergists for HEMP: Belladonna
Dull/expressionless red face, dilated pupils, throbbing pain
239
Synergists for HEMP: Bryonia
Sharp/cutting pain, < pressure, < movement, hard pulse
240
Synergists for HEMP: Aconite
Small/fast pulse, red/dry throat, fast onset w/ fever
241
Which herb is best added to HEMP tincture when patient appears toxic?
Baptisia
242
Phys Med/Hydro for Strep throat
```
Saline gargles
Warming throat compress
Lymphatic massage
Carrot-Ginger poultices
Scarves
```
243
Which herb has been shown to improve pain scores in non-strep pharyngitis vs. placebo?
Salvia
244
When are follow-up throat cultures indicated?
Hx of ARF
Pharyngitis during outbreaks of ARF or glomerulonephritis
Families ("ping-pong" spread)
245
Patients who are asx and culture positive at end of tx are likely ___
Strep carriers
246
Herb for Mononucleosis
Lomatium
247
Common misdiagnosis for mononucleosis
GABHS pharyngitis
248
In patients treated with antibiotics who have mono, what symptom may appear?
Generalized maculopapular or urticarial rash
