EXAM 1 26-50 Flashcards
26.Causes and S/S of presbyacusis.
Presbyacusis
Patho: -\_\_\_\_ related hearing loss -Most frequent cause of \_\_\_\_\_ hearing loss Causes: -\_\_\_\_trauma -\_\_\_\_ exposure Important role -Genetic predisposition -Prior noise exposure S/S -Loss of \_\_\_\_\_ discrimination pronounced in noisy environemnts
Epid
25% of people between 65-75; 50% of those over 75
Diagnostics
Treatment
Misc
noise sensory noise drug speech
27.Causes of rhinitis medicamentosa.
Rhinitis medicamentosa – _____ congestion
Cause: _______ used >3-5 days, so restrict use to 3 days
rebound
intranasal decongestions
28.PE in Allergic Rhinitis. Treatment of allergic rhinitis. S/S allergic rhinosinusitis
Allergic Rhinitis
Patho
- Most common type overall – ___ mediated mast cell histamine release due to allergens
S/S
- Clear ______
- _____
- Tearing
- ____ irritation
- Pruritus
- _____
- Bronchospasm
- ______ dermatitis
Epid
Diagnostics
PE:
- Mucosa of the turbinates is usually ___ or violaceous because of venous engorgement
- Mucosa is ______ in viral rhinitis
- ______ are associated with long-standing allergic rhinitis
Treatment
- __________ first line if allergic or nasal polyps
-Beclomethasone, Flunisolide, Mometasone furoate, Budesonide, Fluticasone propionate
Misc
Prevention
IgE rhinorrhea sneezing eye cough eczamatous
pale
erythema
nasal polyps
intransal corticosteroid
30.S/S and pathology of vestibular neuronitis.
Vestibular Neuronitis
Patho
-Inflammation of the vestibular portion of _____
-A paroxysmal, usually single attack of _____ without ______impairment. Persists several days to weeks before clearing
-Cause unclear – presumed ____
S/S
During acute phase:
Positive ______ (usually horizonal and rotary)
Continuous ______vertigo
Absent responses to ____ stimulation on one or both sides
Epid
Diagnostics
Treatment
_________: first line management
Supportive diazepam (5 mg) or meclizine (25 mg)
Vestibular therapy
Misc
CN VIII
vertigo
auditory
viral
nystagmus
peripheral
caloric
glucocorticoids
31.Causes of BPPV.
Benign Paroxysmal Positioning Vertigo
Patho
-Vertigo induced by changes in _____ position
-_______ vertigo most commonly due to displaced otolith particles (_____ crystals) within the semicircular canals of the inner ear
S/S
- Recurrent spells lasting a few _____ per spell
- Provoked with specific ____ movements
- May be accompanied by ____ and ____
- Occur in _____ and last for several ______
Epid
Diagnostics
______ (nylen barany) test – produces fatigable nystagmus
Treatment
___ protocols
Misc
head
peripheral
calcium
minutes
head
nausea, vomiting
clusters, days
dix hallpike
PT
- Length of vertiginous episodes in various forms of peripheral vertigo.
- Endolymphatic Hydrops (______ Syndrome): Discrete vertigo spells lasting ___ mins to several ____
- Labyrinthitis: Acute onset of continuous, usually severe vertigo lasting several ____ to a ____
- BPPV: Occur in ____ and last for several ____
- Vestibular Neuritis: ´usually ____ attack of vertigo without auditory impairment. Persists several ____ to ____ before clearing
Meniere’s syndrome
20, hours
days, week
clusters, days
single
days, weeks
33.Treatment for Meniere’s Disease. S/S of Meniere’s disease Endolymphatic Hydrops (Meniere Syndrome)
Patho
-Cause Unknown
-Distention of the endolymphatic compartment of the inner ear due to excess fluid is a pathologic finding
Two known causes: _____ and ______
S/S
- Episodic ______ vertigo
- Discrete vertigo spells lasting __ minutes to several ___
- Fluctuating Low-frequency _____ hearing loss
- _____
- Ear fullness
- ____ nystagmus
- Symptoms wax and wane
Epid
Diagnostics
- Caloric testing
- Loss of impairment of thermally induced nystagmus on the involved side
Treatment
- Low __ diet
- _____
- ______
Misc
syphillis, head trauma
peripheral 20 mins, hours sensorineural tinnitus horizontal
salt
dieuretics
acetazolamide
34.S/S of acute rhinosinusitis .Risk factors for the development of sinusitis. Treatment of viral rhinosinusitis. Treatment of bacterial rhinosinusitis
- Symptomatic inflammation of the nasal cavity and paransal sinuses
- Acute = 1-4 weeks
Acute Bacterial Rhinosinusitis/ Acute Viral Rhinosinusitis
Patho
Bacterial: _______ (most common) ______ , Moraxella catarrhalis, & group A Streptococcus
Viral: most cases are viral in etiology – ______, ______ & parainfluenza
PPP: Risk factor: most common in the setting of a viral ___, _____ infections, _____ , allergies cy
S/S
Major symptoms include
-______ nasal drainage
-nasal _______ or congestion
-facial ____/_____ with bending down & leaning forward
-altered _____
-Cough
- _____
Viral: nasal ________, _____ sense of smell, _______, sneezing, headache, throat discomfort
Minor symptoms include headache, otalgia, halitosis, dental pain, and fatigue.
“Double Sickening”
Worsening of symptoms within __ days after initial improvement OR ______ of symptoms more than 10 days after onset.
Epid
Diagnostics
-CT scan is the imaging test of choice if needed
Treatment -Bacterial: Symptomatic management: \_\_\_\_\_\_\_\_(promote sinus drainage) -antibiotics: symptoms should be present for >10-14 days -\_\_\_\_\_\_\_\_\_\_ is antibiotic of choice -Second line- doxycycline
Viral: no specific treatment or prevention
Misc
Strep pneumoniae
Haemophilus influenzae
rhinovirus, influenza
URI, dental, smoking
purulent obstruction pain/pressure smell fever
nasal congestion, decreased, watery rhinorrhea
10
persistence
decongestants
amoxicillin-clavulanic acid
35.S/S of hypopyon from anterior uveitis vs. infected corneal ulcer.
Anterior uveitis
Hypopyon (layered collection of white cells and fibrin within the ______chamber
Cells may also be seen on the corneal endothelium
Keratic precipitates (KPs)
Infected coneal ulcer:
´It is a primary infective ____ shaped paracentral corneal ulcer characterized by severe _____ (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).
Corneal Ulcer
Pathophysiology
- Most commonly due to infection by ____, _____, fungi or amoebas
- Noninfectious causes which may be complicated by infection include:
- neurotropic ____ (from loss of sensation)
- exposure (due to inadequate eyelid closure)
- severe ____ eye
- severe _____ eye disease and inflammatory disorders
S/S
- Complain of ____, _____, tearing and reduced vision
- Eye is ___ with circumcorneal injection and _____ or watery discharge
- Corneal appearance is based on cause
- It is a primary infective disc shaped paracentral corneal ulcer characterized by severe iridocyclitis (iris inflammation) with the formation of hypopyon (sterile pus at bottom of anterior chamber).
Epidemiology
Tests
To find it:
_____ with woods lamp and/or slit lamp:
Area will glow green from dye uptake at area of injury
Prevention
Treatments
Topicals
-______ (especially in contact wearers)
Conflicting information about using corticosteroids
Must refer to ophthalmology if
- Corneal Ulcer
- contact wearers with acute eye pain, redness and decreased vision.
Misc.
anterior
disc
iridocyclitis
bacteria, viruses
keratitis
dry
allergic
pain
-photohphobia
red
purulent
Fluroscein Stain
Fluoroquinolines
37.Drug reactions commonly seen with tx of strep throat and mono coexistence.
•Mononucleosis
•Marked lymphadenopathy an shaggy white-purple tonsillar exudate into the nasopharynx
•1/3 patients have secondary strept; _____ should be avoided because induces a rash that may be interpreted as a PCN allergy
ampicillin
38.Types of epistaxis and anatomy involved.
Epistaxis
Patho
_____ from the unilateral anterior nasal cavity most common
Patients with epistaxis often have higher __ that returns to normal following treatment of acute bleeding
Anterior:
_______ plexus most common site
Associated with nasal ___ (picking most common in children, blowing nose forcefully, etc…), low humidity, hot environments, rhinitis, alcohol, cocaine use, antiplatelet meds, foreign body, deviated septum.
Posterior:
________ branches and woodruffs plexus most common site (may cause bleeding in both nares and posterior pharynx)
Risk factors: _______, older patients, nasal neoplasms
S/S
Epid
Diagnostics
Once acute episode has passed careful exam of the nose and paranasal sinuses to r/o ______ and hereditary hemorrhagic _______
Treatment
Anterior:
_______ is first line therapy in most cases
Pressure applied 5-15 mins with patient seated and leaning forward (to reduce vessel pressure)
PPP- Topical vasoconstrictors (sympathomimetics) may be adjunct therapy (oxymetazoline)
Short acting topical nasal decongestants act as vasoconstrictors
Phenylephrine
Posterior:
PPP- ______ most common initial management
PPP- foley catheter
PPP-Cotton packing
Misc
Bleeding
BP
Kiesselbach venous
trauma
Sphenopalatine artery
hypertension
neoplasms
telangiectasias
direct pressure
balloon catheters
39.S/S and patho of candidiasis, erythroplakia, leukoplakia and oral lichen planus. Treatment for oral candida 3, Causes of candida in buccal mucosa. S/S and causes of leukoplakia.
Oral Candidiasis (Thrush)
Patho
- Overgrowth of candida albicans.
- Causes: systemic or local _______. ____, ____ use, abx use, chemo, diabetes, patients who wear dentures, inhaled corticosteroids without a spacer
S/S
____, looks like ____ whitish curd patches overlying erythematous mucosa. Patches easily ____ off. Underlying erythema is seen after rubbing off the white patches. Can have _____
Epid
Diagnostics
Wet preparation using _______ may show spores an nonseptate mycelia
Treatment
_____ (fluconazole 100 mg PO x 7 days)
Misc
immunosuppression, HIV creamy whitish scraped angular chelitis potassium hydroxide antifungals
Nasal Foreign Body
Patho
S/S
PPP: Many are ______
-Classically presents with _____ associated with a mucopurulent discharge, ___ odor and nasal _____ (mouth bleeding)
Epid
Most commonly seen in ______
Diagnostics
- Direct visualization (head light & otoscope)
- Rigid or flexible fiberoptic endoscopy
Treatment
- Positive pressure technique: involves having the patient blow their nose while occluding the nostril ____ of the foreign body
Oral positive pressure – parent blows into mouth while occluding the ______ nostril
Misc
asymptomatic epistaxis foul obstruction children opposite unaffected
Glossitis
Patho -Inflammation of the \_\_\_\_\_\_ with loss of filiform papillae Benign- no infection or tumor likely to be appreciated Secondary to: -Nutritional deficiencies -Drug reactions -Dehydration, irritants -Food and liquids -Autoimmune reactions or psoriasis
S/S
- ____, ____-surfaced tongue
- Rarely _____
Epid
Diagnostics
Treatment
-_________ may be helpful even in cases where primary cause is unknown
Misc
tounge red smooth surface painful nutritional supplementation
42.S/S Trench mouth.
Necrotizing Ulcerative Gingivitis (Trench Mouth)
Patho
- Often caused by infection of both _______ and _____ bacilli
- Underlyng systemic disease may also predispose this order
S/S
-Painful acute _____ inflammation and _____
Epid
-Common in young adults under stress
Diagnostics
Treatment
–War half-strength ____ rinses
-Oral _____
Misc
spirochetes
fulsiform
gingival
necrosis
peroxide
penicillin
