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Clinical Medicine I > Allergic rhinitis, tinnitus urticaria > Flashcards

Allergic rhinitis, tinnitus urticaria Flashcards

1
Q

What is a schwann cell tumor?

A

slow growing tumors that arise from the vestibular portion of CN VIII

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2
Q

Risk factors for acoustic neuroma

A
  1. exposure to radiation of head/neck

2. Neurofibromatosis Type 2

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3
Q

A patient presents with unilateral sensorineural hearing loss and tinitis. What should you suspect?

A

Acoustic neuroma

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4
Q

What do you order to diagnose an acoustic neuroma?

A
  1. Audiometry

2. MRI

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5
Q

Tx of acoustic neuroma.

A
  1. Surgery
  2. Radiation
  3. Observation
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6
Q

What is tinnitus an early indicator of?

A

choclear heair cell dysfunction

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7
Q

What differentiates the etiology of pulsatile tinnitus from other types of tinnitus?

A

vascular etiology.

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8
Q

What commonly causes tinnitis

A
  1. ototoxic meds
  2. presbycusis
  3. otosclerosis
  4. vestibular schwannoma
  5. chari malformations
  6. barotrauma
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9
Q

What should you do on exam to rule out vascular tinnitis

A

auscultate for bruits

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10
Q

What is the main goal of treatment with tinnitis?

A
  1. lessen awareness and impact quality of life
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11
Q

How should you treat tinnitis?

A
  1. behavioral therapies, alprazolam, masking devices
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12
Q

Hallmark sxs of allergic rhinitis?

A

paroxysms of sneezing, rhinorrhea, nasal obstruction.

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13
Q

What is the typical onset of AR?

A

< 30, peak in childhood/adolescence

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14
Q

What sort of immune response is present with AR?

A
  1. allergic IgE mediated
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15
Q

Important HPE questions when evaluating AR?

A
  1. FH of AR, asthma, eczema?
  2. second hand smoke exposure?
  3. pets, grass in/around home?
  4. how is this impacting your life?
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16
Q

What are dennie morgan lines and what condition is associated with them?

A

skin folds under eyes common w/ allergic conjunctivitis

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17
Q

A patient presents with bluish purple rings around both eyes and complains of nasal congestion and sneezing. what is this type of ecchymosis called and what is your presumptive dx?

A
  1. allergic shiners

2. allergic rhinitis

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18
Q

On exam of the eye, what should you find with AR

A
  1. bilateral redness of bulbar and palpebral conjunctiva
  2. tearing/clear discharge
  3. chemosis
  4. eyelid edema
19
Q

What do you look for on inspection of turbinates on a suspected AR pt.?

A

pale, boggy bluish mucosa

20
Q

Describe the throat in AR patients.

A
  1. post-nasal drainage evidenced by “cobblestoning”
21
Q

AR is associated w/ what dissease of the ear?

A

OME, AOM

22
Q

When doing scratch or prick skin testing, what are you looking for?

A

“Wheal and flare” reactions w/ in 15-20 mins.

23
Q

What is the ImmunoCAP test?

A

detects allergen specific IgE antibodies. Less risky, less sensitive and more expensive

24
Q

How should you treat AR?

A
  1. avoidance of allergens
  2. oral/IN antihistamines
  3. IN gulcocorticosteroids
  4. decongestants
  5. leukotriene receptor antagonists
25
Q

How long could it take to clear animal particles?

A
  1. 3-6 months
26
Q

1st generation antihistamines

A
  1. chlor-trimeton, benadryl
  2. alleviate sneezing, rhinorrhea, itching
  3. dry mouth, constipation, sedation
27
Q

2nd gen antihistamines

A
  1. claritin, allegra, zyrtec

2. less sedating

28
Q

antihistamine nasal sprays

A

H1 antagonist, rapid onset, BID

29
Q

cromolyn spray

A

mast cell stabilizer, low efficacy, frequent dosing

30
Q

Nasal steroid sprays

A
  1. more effective than oral antihistamines
  2. lower bioavailability w/ 2nd generation
  3. adverse effects: epistaxis
31
Q

Leukotriene receptor antagonist

A
  1. Singulair
  2. less effective than nasal spray
  3. LTRA + 2nd generation oralantihistamine more relief than any alone
32
Q

Tx of moderate to severe AR

A
  1. 1st line is glucocorticoid nasal sprays: nasonex and veramyst
  2. can add antihistamine spray, oral antihistamine, cromolyn spray, singulair, antihistamine/degcongestant combo
33
Q

What is a good drug for pts with AR and asthma?

A

singulair is a good additive therapy

34
Q

What can you give pregnant women w/ AR?

A
  1. claritin or zyrtec

2. rhinocort, flonase, nasonex (glucocorticoid spray)

35
Q

What can you give lactating women to treat AR?

A
  1. budesonide or cromolyn + zyrtec or claritin
36
Q

What triggers non-allergic rhinitis?

A
  1. autonomic responses
  2. stress
  3. sexual arousal
  4. perfumes
  5. cigarette smoke
  6. temperature changes
37
Q

What sxs characterize non-allergic rhinitis

A
  1. nasal congestion, rhinorrhea, postnasal drainage.

NO occular/nasal itching or sneezing

38
Q

Tx of non-allergic rhinitis

A
  1. ipratropium nasal spray

2. adjuncts: oral decongestants, 1st gen antihistamines

39
Q

Nasal polyp tx

A

nasal steroid sprays

40
Q

Nasal polyp sxs

A

nasal congestion, obstruction.

41
Q

nasal polyp findings on examination

A

pedunculated, non-tender grey soft tissue growths associate w/ rhinitis, chronic sinusitis and asthma

42
Q

what is the cause of rhinitis medicamentosa?

A

regular (3+ days) use of decongestant nasal spray

43
Q

Tx for rhinitis medicamentosa

A

discontinue afrin, start nasal steroid spray

Clinical Medicine I (25 decks)

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