tennitis etc. x 2

Question 1

Barotrauma

Answer 1

discomfort or dmage due to pressure dufferrnces

- flying or diving common causes

Question 2

Barotrauma exam

Answer 2

middle ear effusion, hemotympanum, possible TM rupture

Question 3

Barotrauma tx

Answer 3

avoidance 
oral or nasal decongest
swallowing, nchewing gum
tx of injury 
if vertigo refer to ENT

Question 4

Acoustic Neruoma

Answer 4

Schwann cell tumor
arise from vestibylar portion of CN vII
very slow growing tumor
- usually in older adult s

Question 5

Acoustic neuroma risks/ present

Answer 5

radiation exposure as a kid
- present: unilaterl sensorineual hearing loss and tinnitus
+/- gait disturbance

Neurofibromotatosis type 2 also risk factor- bilateral often

Question 6

Acoustic Neuroma

Answer 6

Audiometry best initial test
MRI
- alt CT w/w/o contrast

Question 7

Aucoustic neuroma tx

Answer 7

surgery, radiation, observation

Question 8

Tinnitus presentation

Answer 8

Perception of sound in one or both ears
M>F 
- buzzing or ringing 
- can be continuous or come and go 
Often indicator of cochlear hair cell disfunction or loss

Question 9

Tinnitus Etiology

Answer 9

Autitory 
- ototoxic medication
-presbycusis (aging hearing loss)
- otosclerosis
- vestibular schwannoma
- chiari malformation 
- barrow trauma 
Pulsatile tinnitus: commonly a vascular etiology

Question 10

Tinnitus diagnosis

Answer 10

based on history

• physical - HEENT exam
• if pulsitile refer to ENT and check for bruist

Question 11

Tinnitus tx

Answer 11

main goal is to lessen awareness and impact on qulity of life 
- behvioral therapy
- biofeedback or CBT 
Bensodiazepines 
masking devices- "white nose"

Question 12

Allergic Rhinitis types

Answer 12

Alergic:
- seasonal- hay fever, ususlly only certain times of the year 
- perennial- occurs year round 
Vasomotor Rhinitis 
- perennial non-allergic

Question 13

Allergic Rhinitis present

Answer 13

sneezing , rhinorrhea, nasal obstruction

• often accompanied by itchy eyes nose and palate
• cough and fatigue
• response of IgE antibodies which sensitizes mast cells and basophills

Question 14

Allergic rhinitis physical exam eyes

Answer 14

Periorbital area
- “sllergy shiners” bluish rings arounf the eyes
- Dennie- morgan lines: skin folds associated with conjunctivitis
Eyes:
- diffuse redness, tearing, chemosis, eyelid edema

Question 15

Rhinitis exam nose, ears, throat

Answer 15

Nose: boggy, pales, bluish mucosa
Throat: post nasal drainage, “cobblestoning”
Ears: retracted TM

Question 16

Allergic rhinits dx

Answer 16

clinical diagnosis
- can do allery testing not always necessay
Skin testing: scratch or prick skin test
- “wheel and flare” reactions normally occur within 15 -20 min
serum testing: immunoCAP
- detects IGE antibodies, less risk but less sensitive

Question 17

ALlergic Rhinitis Tx

Answer 17

1. Avoidance
2. Pharm
   - oral/intanasal antihistamines
   - Intranasal glucocorticosteroids**
   - sympathomimeticss/decongestants
   - leukotriene receptor antagonists
3. Immunotherapy

Question 18

1st generation of antihistamines of allergic rhinitis

Answer 18

• will not releive the nasal congestion
  1. Chlorpheniramine
  2. Diphenhydramine
  side effects- dry mouth, constipation, sedation

Question 19

2nd gen antihistamines

Answer 19

less sedating

• loratadine (clartin)
• Fexofedadine
• Cetirizine (zyrtec)

Question 20

Antihistamine Nasal Sprays - allergic rhinitis

Answer 20

Rapid onset
bitter taste
can be used in combination

Question 21

Cromolyn Nasal spray

Answer 21

mast cell stabilzer

- lower efficay but no serious side effects

Question 22

Nsal Steroid Sprays

Answer 22

More effective than oral antihistamines
- lower bioavailability in the 2nd generation
side effect- epistaxis

Question 23

Leukortriene receptor antagonist

Answer 23

Montelukast (singular)

- LTRA +2nd gen antihistamine it provides real good releif

Question 24

Sympathomimetics (decongestants)

Answer 24

if have congestant despite antihistamine use

• will has vasocontrictions will release edma
• caution in patients with hypertension

Question 25

Immunotherapy

Answer 25

allergy dose tx: allergic asthma, conjunctiitis, rhinitis - gradual administation of increasing the amount of the allergen - typically subcutanious and sublingual Tx time 3-5 years

Question 26

Allergic rhinitis pharmacotherpay children

Answer 26

Cromolyn nasal spray 2nd gen antihistamines ex: cetirizine (zyrtec approved for chilfren >6mo

Question 27

Rhinitis tx kids and adults mild

Answer 27

Mild: 2nd gen oral antihistamines: loratadine(claratin), Cetriizine(zyrtec), Fexofenadine (allegra) Nasal spray: azelastine, olopatadine Glucocorticoid nasal spray ( strat 2-3 days before exposure)

Question 28

Mod/sever allergic rhinits Tx

Answer 28

``` Glucocoticoid nasal spray! - 2nd generation are the safest best single drug Can add in another drug if needed ex: antihistamine or cromoly nasal spray ```

Question 29

Allergic rhinitis and asthma or conjunctivitis

Answer 29

Asthma: Montelikast(singulair) Conjuct: - steroid nasal spray and opthalmic antihisamine drip

Question 30

Allergc rhinitis pregnancy

Answer 30

1. 2nd gen antihistamines 2. glucocorticoid therapy Lactating women: Budesonide or cromolyn

Question 31

Perennial non-allergic rhinitis

Answer 31

"vasomotor rhinitis" autonomic response - triggered by stress, sexual arousal, purfumes, cigarette smoke, temp change

Question 32

Non allergic rhinitis presenation

Answer 32

nasal congestion, rhinorrhea, postnasal drainage - usually no ocular/ nasal itching nasal mucosal may appear normal, erythematous, or boddy edmea

Question 33

Non allergic rhinits tx

Answer 33

avpidance of triggeres - nasal steroid spray - antihistamine nasal spray - ***ipratropium nasal spray ( anticholinergic ) if rhinorrhea is primary sx Adjunctive therapy: oral decongestants nd 1st gen antihistamines

Question 34

Nasal polyps

Answer 34

non tender, pedunculates, grey soft tissue growths Sx: nasa; congestion/ onstruction Seen with allergic rhinitis, vasomotor rhinitis, and asthma Tx: Nasal steroid spray and refer to ENt

Question 35

Rhinitis Medicamentosa

Answer 35

Result of regular use of decongestant nasa spray >3days of use leads to reboud congestion - become dependen Tx: discontinue use and start of nasal steroid spray

Question 36

Urticaria presentation

Answer 36

``` Hives, welts, wheals - well circumscribed prurutic riased wheels - pale to bright red - +/- central pallor acute- < 6wks chronic> 6wks occuring most days they are transient lesions ```

Question 37

Uticaria pathophysip

Answer 37

caused by histamine relase from mast cells | - can be accompanies by angioedema

Question 38

Uticaria Dx/Tx

Answer 38

based on hisotry and physical Tx: H1 histamine blocker - cetirizine(zyrtec) and levocetirizine (Xyzal) H2 blocker Ranitidine, Famotidine, cimetidine Oral glucocorticoids- if angioedema or sx are persisant