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EENT > EENT 2 > Flashcards

EENT 2 Flashcards

1
Q

What condition is due to recurrent episodic vertigo caused by endolymphatic hydrops (edema)?

A

Meniere’s disease

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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 Meniere’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

Labyrinthitis involves both the cochlea and the labyrinth.

Labyrinthitis (inflammation of the labyrinth) occurs when an infection affects both branches of the vestibulo-cochlear nerve, resulting in hearing changes as well as dizziness or vertigo.

Neuronitis (inflammation of the nerve) affects the branch associated with balance, resulting in dizziness or vertigo but no change in hearing.

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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

None

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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 TM is the most common cause, but head injury or noise are also big causes.

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18
Q

What type of tympanogram does ruptured TM cause?

A

type AD (disrupted) tympanogram

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19
Q

What PE can you use to assess conductive hearing loss?

A

Rinne, it’s specific but not sensitive.

Normal: AC>BC
Conductive hearing loss: BC>AC

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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

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

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22
Q

What is Schwartze sign?

A

Otoscopic examination reveals 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.

Lateralize to bad ear = conductive hearing loss
Lateralize to good ear = sensorineural hearing loss

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24
Q

What does the Rinne test differentiate?

A

Air conduction vs bone conduction.

AC>BC = normal
BC>AC = Conductive hearing loss
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25
Q

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

A

Patients often soft spoken and aware they seem to hear better in noisy environments

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26
Q

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

A

Tympanogram will indicate lower impedance (Type 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

A dip in bone conductive threshold at 2000 Hz. (where sound is loudest for human ears) on audiometric testing

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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 (aka age-related hearing loss)?

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
  • 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
Ear 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 - Strengthen cell membranes.
  • Quercetin - Stabilize mast cells
  • EFAs - Stabilize cell membranes
40
Q

Which bioflavonoid helps by inhibiting the degranulation of mast cells?

A

Quercetin!

food sources: onions, fruit, capers

41
Q

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

A

Catechin

food sources: tea, cocoa

42
Q

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

A

Linoleum 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, Trans FAs.

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 to implement a nutritional program for prophylaxis of allergic rhinitis?

A

2 months before allergy season

46
Q

Is Urtica Dioica (Stinging Nettle) 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 dioica (stingning nettle)
Butterbur
Sambucus (Elderberry)
Euphrasia (Eyebright)

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 Antibiotics 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/Rx
Irritants
Etc.
56
Q

What is the pathophysiology of sinusitis?

A

Viran 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 physical medicine and hydrotherapy 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 syndrome, 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 negative
  • Scratch negative
  • Nasal smear (eos) +
65
Q

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

A
  • CBC negative
  • Scratch negative
  • Nasal smear (eos) negative
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 dioica to every patient with hayfever?

A

No, it’s contraindicated 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, pneumothorax)
Systemic diseases (RA, Hepatitis, Polio, HIV, TSS, Leukemia, Mycoplasma pneumonia)
Other head and neck disorders (Otitis media, sinusitis post nasal drip, mumps, SCM and cervical spine lesions, thyroiditis, glossopharyngeal neuralgia, epiglottis, oropharyngeal CA)

Emergent: Sudden severe throat pain especially in older patients should suggest aortic dissection or pneumothorax.

72
Q

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

A

Yes

73
Q

What are some oral lesions that can cause sore throat?

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

What are the signs and symptoms of mono?

A
  • Posterior cervical and auricular LA
  • Exhaustion and myalgia
  • Tonsillar exudates
  • Petechiae 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

-Temperature over 100.4 F (1 point)
-No cough (1 point)
-Swollen tender anterior cervical LA (1 point)
-Tonsillar swelling or exudate (1 point)
Age 3-14 (1 point)

2 or more points = permission to do RAD test

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 Antibiotics
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.

EENT (1 decks)

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