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NUNP 543 > Rhinitis, Hearing Loss, Epistaxis, Pharyngitis > Flashcards

Rhinitis, Hearing Loss, Epistaxis, Pharyngitis Flashcards

1
Q

ENT

2 types hearing loss

A

conductive:failure of one or more of the components of the external or middle ear

sensorineural
defect in inner ear or CN VIII; injury to the hair cells in the cochlea and/or the nerves innervating the hair cells (usually bilateral and symmetrical)

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2
Q

ENT

weber rinne

A 
Weber = Widows peak
Conductive = Crap

Rinne
A>B normal

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3
Q

ENT

screening for hearing loss

A

whisper test

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4
Q

ENT

risk for hearing loss

A
  • Noise exposure
  • Frequent/recent infections
  • Trauma
  • Ototoxic meds (NSAIDS, aminoglycosides, furosemide, fluoroquinolones)
  • Barotrauma
  • Cerumen impaction
  • Foreign body
  • eustachian tube dysfunction with middle ear effusion
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5
Q

ENT

hearing loss red flags

A
  • sudden
  • pain (not responsive to medication)
  • mastoiditis/osteomyelitis
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6
Q

ENT

Hearing loss Ddx

A

so many… broad strokes

Conductive (hearing canal/drum)
trauma
infection 
impaction 
congenital (cholesteatoma) 
otosclerosis 
tumor 
SNHL (hairs w/ sensory receptors & nerves): 
metabolic (hypothryroidism)
infectious
toxins
tumor 
neurodegenerative 
autoimmune 
Common causes: 
presbycusis
medication-induced 
barotrauma 
impaction
infection
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7
Q

ENT

complications of age-related hearing loss?

A
  • depression
  • dementia/MCI
  • social isolation
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8
Q

ENT

allergic rhinitis vs non-allergic

A

allergic: boggy, purplish, oedematous. turbinates
associated allergic symptoms (conjunctivitis, etc)

non-allergic: may be boggy, or may be inflamed looking (erythema, oedematous, or normal)

both: 
shiners
transverse crease nose
post-nasal drip & cough 
dennie-morgan skin folds under eyelids?
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9
Q

ENT

classifications of non-allergic rhinitis

A
  1. Idiopathic
    1. Vasomotor
    2. Atrophic
    3. Geriatric
    4. Drug induced
    5. Gustatory: runny nose when eating spicy food
    6. Occupation
      1. Pregnancy
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10
Q

ENT

non-pharm & pharm management rhinitis

A

avoid allergens, saline rinse, etc

Pharm: fluticasone nasal spray

If allergic: can try nasal antihistamine (2nd line), or oral antihistamines

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11
Q

ENT

epistaxis red flags

A

posterior bleed (sphenopalatine artery)

systemically unwell 24-48 hours post packing posterior bleed (sepsis)

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12
Q

ENT

risks for epistaxis

A
  • Anticoagulation
  • foreign body
  • chronic use of nasal steroids
  • systemic causes: bleeding disorders, HTN
  • Trauma
  • Tumors
  • pregnancy
  • cocaine use
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13
Q

ENT

s/s epistaxis

A

Anterior: bleeding from one nare, may be able to visualize source at the septum
Posterior: “brisk” arterial hemorrhage, patient reports swallowing blood

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14
Q

ENT

epistaxis tx

A
  • Direct pressure
  • Nasal packing
  • Nasal balloons
  • Cautery
  • TXA soaked packing
  • oxymetazoline
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15
Q

ENT

GAS most common age

A

5-15

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16
Q

ENT

risk for pharyngitis

A
  • Cigarette smoking
  • allergies
  • URI
  • ORal sex
  • Drugs (Abx and Immunosuppressants)
17
Q

ENT

pathogens for pharyngitis

A
  • Viral: Coxsackievirus, ECHO, Epstein-Barr
  • Bacterial: Group A Beta-hemolytic Streptococcus, Neisseria gonorrhoeae, Corynebacterium diphtheriae
  • Fungal: Candida albicans
  • Atypical agents: Mycoplasma pneumoniae
18
Q

ENT

Oral lesions (herpangina, HSV, trench mouth, thrush, mono)

A

Herpangina – oral coxsackie A virus - ulcers palate & pharynx

Herpes – vesicles on buccal mucosa, tongue and pharynx

Trench mouth (gingivitis)

Oral candidiasis – first Sx of HIV?

MONOnucleosis: 50% have tonsillar exudate; 33% develop petechia at junction of the hard and soft palate.

19
Q

ENT

complications GAS

A 
Suppurative adenitis
Scarlet fever
Peritonsillar abscess
Glomerulonephritis
Rheumatic fever
20
Q

ENT

centor score

A 
Age
Exudate
Lymphadenopathy 
Temp
Cough (absent)
21
Q

ENT

Tx GAS

A

PenVK 600 mg PO BID X 10 days

NUNP 543 (22 decks)

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