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Physiology > Test 2 > Flashcards

Test 2 Flashcards

1
Q

Recurrent episodic vertigo caused by endolymphatic hydrops (edema)?

A

Meniere’s disease - potentially over diagnosed?

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2
Q

What are some symptoms of Meniere’s disease?

A
  • Episodic attacks (with dread)
  • Severe to violent vertigo with N/V
  • Aural fullness
  • Fluctuating hearing loss
  • Loud, roaring, tinnitus
  • Sensitivity to loud noises
  • Usually middle-aged women
  • Autoimmune?
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3
Q

Who does Menier’s classically affect?

A

middle aged women

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4
Q

What is an uncommon but dangerous condition that only causes vertigo in 50% of pts?

A

Acoustic neuroma

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5
Q

What are some features of acoustic neuroma?

A
  • Slowly progressive, unilateral hearing loss.
  • Tinnitus
  • Facial weakness
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6
Q

What do you do with any vague dizziness or vertigo with unilateral or asymmetric sensory hearing loss?

A

Assume it’s an acoustic neuroma until proven otherwise.

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7
Q

What are some features of vestibular neuronitis?

A
  • Common, usually follows URI.
  • Sudden, severe vertigo with N/V
  • Affects CN 8
  • No tinnitus or change in hearing
  • Unidirectional nystagmus
  • Hypoactive vestibular apparatus
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8
Q

What is the prognosis for vestibular neuronitis?

A

Resolves in days to weeks down to mild positional vertigo.

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9
Q

How is labyrinthitis different from vestibular neuronitis?

A

It involves both the cochlea and the labyrinth.

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10
Q

Where does the nystagmus go in labyrinthitis?

A

Spontaneously to the unaffected side.

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11
Q

What is the prognosis of labyrinthitis?

A

May resolve in days to weeks but unsteadiness and positional vertigo may persist for months.

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12
Q

What causes labyrinthitis?

A

Lots of things: ototoxic drugs, infection, autoimmune, treatment of TB.

Most commonly concomitant to acute infection like OM or sinusitis.

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13
Q

What is BPPV?

A

It’s a brief episode of vertigo that is ALWAYS and only positional.

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14
Q

Does BPPV have hearing loss or tinnitus?

A

No it does not.

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15
Q

What can cause BPPV?

A

Head trauma, dental surgery, middle ear infection, otoliths.

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16
Q

What endocrine/metabolic conditions should be on your DDx when treating inner ear disorders?

A
  • Hypothyroid
  • Hyperlipidemia
  • Electrolytes (specifically Na/K)
  • Diabetic and dysglycemia
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17
Q

What is the most common cause of traumatic hearing loss?

A

Rupture of the TM? It may actually be noise or head injury.

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18
Q

What type of tympanogram does ruptured TM cause?

A

Ad

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19
Q

What PE can you use to assess conductive hearing loss?

A

Rinne, it’s specific but not sensitive.

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20
Q

What is the big DDx list for types of hearing loss?

A
  • Conductive
  • Sensorineural (congenital, genetic)
  • Traumatic (noise, head injury)
  • Inflammatory (ASOM, SOM)
  • Neoplastic
  • Metabolic/vascular
  • Ototoxicity
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21
Q

What syndrome has a lock of grey hair in the front of the head?

A

Waadenberg’s - it’s a genetic cause of sensorineural hearing loss.

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22
Q

What is Schwartze’s sign?

A

A pinkish blue hue to TM associated with otosclerosis.

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23
Q

What does the weber test differentiate?

A

Conductive from sensorineural hearing loss.

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24
Q

What does the Rinne test differentiate?

A

Air conduction vs bone conduction.

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25
Q

What might you notice in office about your pt with conductive hearing loss?

A

They may be very soft spoken and hear better in a noisy environment.

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26
Q

What kind of tympanogram are you likely to see in conductive hearing loss?

A

As (stiff)

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27
Q

What does audiology test?

A

Air and bone conduction between 250-8,000Hz.

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28
Q

What is Carhart’s notch?

A

Dip in bone conductive threshold at 2000 Hz where sound is loudest for human ears

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29
Q

What does speech audiometry measure?

A

the threshold at which speech is accurately heard.

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30
Q

What does auditory brainstem response measure?

A

The time it takes for impulses to get form the cochlea to the brainstem.

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31
Q

Which minerals are helpful for presbycusis?

A

Zinc and copper (if long term)

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32
Q

Which minerals are helpful for aminoglycoside and antibiotic ototoxicity?

A

Magnesium

Glutathione if gentamicin toxicity

33
Q

What are a few ototoxic substances?

A

6

 Play

 Shuffle
 Options
What are a few ototoxic substances?
 CLICK TO FLIP
-Aspirin
-Quinine
-Aminoglycosides
-Erythromycin (high dose)
-Loop and thiazide diuretics
-Platinum based chemo
-CO2
-Nicotine
-Alcohol
-Heavy metals
-Interferon a
34
Q

How can you improve circulation to the middle ear?

A

Oral: Gingko, vaccinium bilberry, vinca minor.

Local: Hypericum oil, cimicifuga

35
Q

According to the article in american family physician, what are some causes of acute tinnitus?

A 
Infection
Meds
Trauma
Loud noises
Wax
Change in BP or metabolism
36
Q

According to the article in american family physician, what are some causes of chronic tinnitus?

A

Damage to auditory cortex from aging

37
Q

According to the article in american family physician, what are some causes of objective tinnitus?

A

Vascular abnormalities

Mechanical disorders

38
Q

According to the article in american family physician, what are some treatments for tinnitus?

A

-Acoustic therapy - hearing aids, sound pillows.

  • Hearing protection
  • Manage insomnia, anxiety, depression
  • Manage metabolic disorders
39
Q

Which supplements help stabilize cell membranes?

A
  • Antioxidants - Strength cell membranes.
  • Quercetin - Stabilize mast cells
  • EFAs - Stabilize cell membranes
40
Q

Which bioflavonoid helps by inhibiting the degranulation of mast cells?

A

Quercetin!

41
Q

Which bioflavonoid inhibits histidine carboxylase and is also a potent antioxidant?

A

Catechin

42
Q

Which class of EFAs do atopic patients have trouble converting to PGE1?

A

Linoleic acid, which is an omega 6.

EPO, borage, and black currant all have GLA and avoid this step.

43
Q

Which foods should allergic patients avoid?

A

Dairy, citrus, animal fat, TFAs.

All food allergens.

44
Q

What are some ways to support the adrenals?

A
  • Standard Process: Drenotrophin, Antronex, Corrhyzadyn, Isocort, Multi B vitamins,
  • DHEA if indicated by testing.
  • Pantothenic acid (B5) precursor to coenzyme A
45
Q

When is the best time ti implement a nutritional program for prophylaxis of allergic rhinitis?

A

2 months before allergy season.

46
Q

Is urtica dioica good for everyone with hay-fever?

A

It helps about 58% of the time.

47
Q

What’s a good herbal formula for hay-fever?

A

Urtica
Butterbur
Sambucus
Euphrasia

48
Q

What are some ways you can help your patients abort a cold?

A 
Nature cure
Rest
Water
Simple diet
Hydrotherapy
49
Q

Is echinacea effective for the prevention and treatment of URIs?

A

Apparently yes. It decreases the incidence and duration of the common cold.

However, it’s usually used in conjunction with other treatments.

50
Q

What are a few ND sinusitis treatments?

A

Botanicals: achillea, euphrasia, hydrasits.

Rest, water, simple diet, garlic, etc.

Hydro: Nasal lavage, steam inhalation.

51
Q

When should you order imaging for sinusitis?

A

Never for acute sinusitis.

If you have persistent sinusitis and you suspect orbital cellulitis or brain abscess.

CT is probably the most accurate.
Fiberoptic visualization of the ostia may reveal obstruction from polyps or anomalies.

52
Q

Are ABX indicated for acute sinusitis?

A

Rarely, 1 in 8 cases will respond.

53
Q

How do you assess and treat epistaxis?

A

Assess by PE, look for bleeding site.

Frontal epistaxis is usually controlled with pressure or cold.

If uncontrolled, use topical anesthetic and silver nitrate.

54
Q

When is epistaxis potentially dangerous?

A

If it’s a posterior bleed. Refer to an ENT!

Also dangerous if bleeding doesn’t stop or if the site of bleeding can’t be found.

55
Q

What are a few of the risk factors for sinusitis?

A 
VRI
Allergies
Anatomy
MEds
Irritants
Many, many more.
56
Q

What is the pathophysiology of sinusitis?

A

Viral infection leads to blockage of the ostia. Oxygen is absorbed from the enclosed space leading to negative pressure (pain from vacuum). Then transudate and bacteria invade the space leading to inflammation, ciliary dyskinesis, and positive pressure. This causes a second stage of pain.

57
Q

What’s the prognosis for sinusitis?

A
  • May take 3-4 days for relief.
  • Continue Tx for 10-14 days to avoid relapse.
  • Refer: persistent HA, high fever, lethargy, orbital swelling.
58
Q

What are some good phys med and hydro options for sinusitis?

A

Nasal specific
Craniosacral
Nasal lavage
Steam inhalation

59
Q

What’s the DDx for inflammatory rhinosinusitis with mostly eosinophils?

A
  • Allergic
  • Non-allergic
  • Asthma
  • Fungal
60
Q

What’s the DDx for inflammatory rhinosinusitis with mostly neutrophils?

A
  • Acute bacterial
  • Foreign body
  • Nasal polyps
  • Primary ciliary dyskinesia
61
Q

What do you think about inflammatory rhinosinusitis with complex infiltrates?

A

Sounds like a common cold.

62
Q

What’s the general DDx for non-inflammatory rhinosinusitis?

A
  • Structural
  • Hormonal
  • Drug induced
  • Neural dysfunction
  • Other (sick building, alzheimer’s)
63
Q

What would you expect on CBC, scratch, nasal smear (eos) for allergic rhinitis?

A
  • CBC +
  • Scratch +
  • Nasal smear (eos) +
64
Q

What would you expect on CBC, scratch, nasal smear (eos) for NARES?

A
  • CBC Neg
  • Scratch Neg
  • Nasal smear (eos) +
65
Q

What would you expect on CBC, scratch, nasal smear (eos) for vasomotor rhinitis?

A
  • CBC Neg
  • Scratch Neg
  • Nasal smear (eos) Neg
66
Q

What’s the immune pathophysiology of allergic rhinitis?

A

Some Ag diffuses across the mucus membrane ->Th2 response ->IL-4, IL-13 stimulate B cells to make IgE.

Mast cells -> Histamine, PGL D2, Leukotrienes, Kinins, TNFa.

67
Q

What does degranulation of mast cells eventually lead to in allergic rhinitis?

A

Contraction of smooth muscle.

Capillary dilation, increased permeability of capillary walls.

Glandular hyper-secretion.

68
Q

Should you give urtica to every patient with hayfever?

A

No, it’s CI for diabetic pts (increases blood glucose) and people with fluid retention secondary to cardiac or kidney disease.

69
Q

What’s Herbal Ed’s formula for hayfever?

A

Hydrastis
Achillea
Euphrasia
Cochlearia

70
Q

What can you give for recurrent epistaxis?

A

Vitamin C
Bioflavinoids
Homeopathy

71
Q

What are three conditions (besides pharyngitis) that can cause sore throat?

A

Cardiovascular disease (aortic dissection)

Systemic disease

Other head and neck disorder.

72
Q

Should you always do a quick ENT exam on all patient with a sore throat?

A

Yep

73
Q

What are some oral lesions that can cause sore throat?

A
  • Necrotizing gingivitis
  • Herpes simplex
  • Hand, foot, mouth
  • Apthous ulcers
  • Oral candida
  • Mononucleosis
74
Q

What are the signs and symptoms of mono?

A
  • Posterior cervical and auricular LA
  • Exhaustion and myalgia
  • Tonsillar exudates
  • Petechia on back of pharynx
  • Hepatosplenomegaly (maybe)
75
Q

How do you confirm mono with labs?

A
  • Peripheral smear shows 80-100 atypical lymphocytes.
  • Positive monospot.
  • Elevated liver transaminases.
76
Q

What is the CENTOR criteria for strep culture?

A
  • Temp over 100
  • No cough
  • Swollen tender anterior cervical LA
  • Tonsillar swelling or exudate
77
Q

What are some cases in which you can safely decline to do a strep culture?

A
  • Close contacts are positive.
  • Scarlet fever is evident.
  • In strep epidemics.
  • Prior ABX
78
Q

What is a strep carrier? Are they at risk for non-suppurative complications of strep throat?

A

Pts who are GABHS + but ASO titer negative.

They’re not at risk, they don’t mount an Ab response.

Physiology (1 decks)

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