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HEENT > Exam II > Flashcards

Exam II Flashcards

1
Q

What is the MC cause of conductive HL?

A

Otosclerosis

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2
Q

How does otosclerosis present?

A

HX - well preserved speech; patients are often soft spoken and aware they hear better in noisy environments

PE - stapes and malleus fuse, this is confirmed with CT

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3
Q

What are the causes of sensorineural HL?

A 
Congenital (Waadenburg's Syndrome - white patch of hair)
Viral 
Traumatic (noise occupations)
Inflammatory (strep, measles, syphilis)
Neoplastic
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4
Q

How do you differentiate neoplastic SNHL?

A

U/L hearing loss
R/O w/ MRI

  • acoustic neuroma, hearing loss localized in high frequencies
  • V wave delayed in affected ear
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5
Q

What does speech audiometry measure?

A

threshold that speech can be accurately heard

- increase cochlear HL leads to decreased word recognition

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6
Q

Tympanometry measures

A

TM mobility (impedance)

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7
Q

Which conditions present with stiff tympanometry?

A

Otosclerosis (Type A)

Inflammatory Conductive HL

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8
Q

What does Electrocholeography record?

A

electrical potentials of cochlea

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9
Q

Which condition is dx’d with electrocholography?

A

Meniere’s dz
OR Idiopathic Endolymphatic hydrops

  • fluctuating HL; vertigo (episodic), tinnitus, aural fullness
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10
Q

For Acoustic Neuroma - which test is positive with a prolonged time period?

A

Auditory Brainstem Response

- nerve conduction study (from cochlea to brainstem)

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11
Q

Which minerals help with presbycussis (slow developing SNHL d/t noise)

A

ZINC
Vit C
Vit E
ALA

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12
Q

What substances are ototoxic?

A 
AMINOGLYCOSIDES (gentamicin, streptomycin, neomycin)
Phenytoin
Anti-HTN
Diuretics
NTG
Quinine
Salicylates
Sedatives
TB TX sequelae
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13
Q

How do you improve circulation of blood to middle ear?

A

Vaccinium (bilberry)
Vinpocetine
Gingko

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14
Q

How to differentiate Vestibular Neuritis from Labyrinthitis

A

BOTH - characteristic peripheral vertigo

VN - Virus PRECEDES vertigo
Labyrinthitis - CONCURRENT infxn, HL

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15
Q

PE for DX Perilymphatic Fistula?

A

When pressing on tragus or using insufflation it will MAKE SX WORSE

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16
Q

PE for DX of Benign Paroxysmal Positional Vertigo?

A

Dix Hallpike (brief upbeat, then fatigues)

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17
Q

When performing Dix Hallpike, when should you suspect central vertigo?

A

Downbeat Nystagmus that DOES NOT fatigue with Dix Hallpike

In gen:
Spontaneous nystagmus
Bidirectional
Vertical

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18
Q

Which test is SPECIFIC for conductive HL?

A

Rinne

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19
Q

What are the RED FLAGS for stroke?

A 
sudden onset
asymmetrical smile (neuro indication)
ataxia
central nystagmus (vertical)
Worst H/A ever
> 50 years
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20
Q

how is vertigo most commonly described and what is the MC cause?

A

“pt says room is spinning around them”

MC d/t Peripheral Labyrinth

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21
Q

Which condition presents with Roaring in the ears?

A

syncope

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22
Q

How do you differentiate orthostatic BP vs Autonomic Dysfunction?

A

When testing, lay to stand:
Orthostatic: SBP decreases, HR increases
Autonomic: SBP & HR decrease!!

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23
Q

What is the MC cause of disequilibrium?

A

Impaired Motor FXN control

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24
Q

Which patients are at risk for increase in falls?

A

Multiple Sensory Deficit (MSD) - geriatrics patients, gen because of decreased eyesight, poor proprioception, mm weakness

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25
Q

How do you DX lightheadedness?

A

DX of exclusion

assoc with sweating and pallor - think hypoglycemia, medications, anxiety, encephalopathy

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26
Q

What is Peripheral Vertigo?

A

Spontaneous nystagmus
Unidirectional
Horizontal

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27
Q

What is Central Vertigo

A

Spontaneous nystagmus
Bidirectional
Vertical
Neuro SX - ataxia, vision changes, altered mental status - REFER for NEURO*

28
Q

Which tests are positive for Peripheral Vertigo?

A

Vestibular Ocular Reflex (i.e. Head Impulse) - catchup saccade (req 40% diff between ears)
Suppression w/Visual Fixation
Dix-Hallpike: latency, adaptability, fatigue
Hearing Loss is COMMON
Caloric test = NO NYSTAGMUS*
Tullio’s phenomenon

29
Q

What is Tullio’s phenomenon?

A

Nystagmus and vertigo after a loud noise

30
Q

Which tests are positive for Central Vertigo?

A

Normal VOR
Smooth Pursuit - pursuit is broken
RARE auditory signs
Caloric test = Normal (creates nystagmus)

31
Q

Any vague dizziness/vertigo with U/L sensory hearing loss is a ___________

A

ACOUSTIC NEUROMA

- until proven otherwise

32
Q

What will labs show for ALLERGIC Rhinitis

A

CBC & nasal smear - eosinophilia
Scratch Test - wheal and flare
Serum IgE - may be increased

33
Q

What does a PE look like for allergic rhinitis patient?

A

perennial pale, bluish nares
d/c clear
adenoidal facies

IF perennial non-allergic - pale, atrophic appearance

34
Q

What will labs/PE show for CHOLINERGIC Rhinitis

A

CBC - nothing
NEGATIVE Nasal smear/Serum IgE

PE - swollen inferior nasal turbinates, dark red to blue
increased mucus

35
Q

What will a nasal smear show for someone with CSF inspired rhinitis

A

glucose

  • Request CT w/CSF dye
36
Q

Which supplements help stabilize cell membranes

A 
quercetin
Vit A,C,E
NAC
Se
EFAs
37
Q

How do Bioflavonoids help and what are the two used?

A

inhibit degranulation of mast cells

  • Quercetin
  • Vit C
38
Q

This bioflavonoid is a potent antioxidant, and inhibits histidine carboxylase

A

catechin

39
Q

Which EFA does Atopic patients have trouble converting?

A

Linoleic acid to PGE1

40
Q

When is the best time to implement prophylactic treatment for allergic patients?

A

3 months before trigger season

41
Q

ND Tx of Acute Sinusitis and Chronic

A

Acute: decrease inflammation with quercetin, bromelain and EFAs; HYDRATE

Chronic: Improve digestion, constitutional hydrotherapy (contrast hydro over sinuses too), support immune system - PhysMed Sine wave w/fingers

42
Q

When should imaging be ordered for sinusitis?

A
  • decreased visual acuity
  • diplopia
  • peri-orbital edema
  • severe HA
  • altered mental status

ORDER CORONAL CT SCAN

43
Q

What is the NNT for acute sinusitis with antibiotics?

A

8, however, no longterm benefits.

  • if not better in 3-4 days, re-evaluate dx; sustain tx for 10-14 days
44
Q

What to do if epistaxis can’t be controlled w/ pressure or cold application?

A

topical anesthetic and careful application of silver nitrate

45
Q

When is epistaxis potentially dangerous?

A

POSTERIOR EPISTAXIS

46
Q

What warrants an URGENT referral for sinusitis?

A
  • high fever & severe HA
  • AbN vision
  • Mental status changes (any CN abNs)
  • Peri-orbital edema
  • acute facial pain
  • swelling
  • erythema
47
Q

What criteria is used for Strep Dx and what does it consist of?

A

Centor Criteria

  • Fever
  • NO COUGH
  • Tonsillar Swelling/Exudate
  • Age 3-14 (15-30% of kiddies)
  • Swollen Lymph - Anterior Chain
48
Q

Sudden Severe Throat Pain ESP in ELDERLY, what should you consider if normal PE?

A

Aortic Dissection

Pneumothorax

49
Q

Which oral lesions can mimic sore throat?

A

Necrotizing Gingivitis
Herpes Simplex - superficial ulcerations
Hand, Foot and Mouth DZ (coxsackie virus) - painful lesions, self-limited, CONTAGIOUS
Aphthous Ulcers - AI, small round or oval ulcers
Oral Candidiasis - MC DM, HIV and inhaled corticosteroids

50
Q

A patient presents with a sore throat for longer than 1 week, tender cervical lymph, myalgia, exudate and petechiae on back of pharynx -what do they have?

A

Mononucleosis - caused by EBV (Herpes IV)
Duration 3-4 weeks
50% experience splenomegaly

51
Q

What lab can you order if you suspect mono? What are it’s limitations?

A

Monospot
- most sensitive 2 weeks AFTER contracting

May also have mildly elevated liver enz. Assess to R/O EBV hepatitis

52
Q

What if a patient presents with symptoms of mononucleosis, but monospot is negative?

A

think CMV

53
Q

If Pt with GABHS fails to improve after therapy consider

A

co-infection with EBV

54
Q

What complications can be expected with mononucleosis?

A

Severe airway obstruction
fatigue x 6 months
Malignancy - EBV is assoc with Burkitts Lymphoma, nasopharyngeal carcinoma and B cell lymphomas

55
Q

Perform Rapid Antigen Detection Test (RADT) on patients who present with:

A

2+ on CENTOR criterion
high risk hosts (HIV, DM, Splenectomy)
Hx of rheumatic fever

Do not need to perform if close contacts have already tested + and PT has classic symptomology

56
Q

Patient presents with strep throat, and they have a hx of rheumatic fever, what should you do?

A

Treat!

High Risk for 2nd episode of carditis

57
Q

Are strep carriers at risk for rheumatic fever?

A

No.
Step is part of their normal flora
(10-30% of sore throats are asx carriers)

58
Q

AT best, antibiotics for sore throat..?

A

decrease duration by 16 hours OR PREVENT Acute Rheumatic Fever

  • helpful in peritonsillar abscess
  • not helpful in preventing glomerular nephritis or guttate psoriasis
59
Q

What does the Jones Criteria say?

A

2 major OR 1 major and 2 minor manifestations increase probability of Acute Rheumatic Fever

Major (carditis, polyarthritis, erythema marginatum, subcutaneous nodules)
Minor (arthralgia, fever, increase Acute phase reactants, increase ESR and CRP, prolong PR)

60
Q

AANP position on tx of strep throat?

A

wait x1 week, if sx have no resolved, recommend abx treatment

61
Q

Allopathic Tx

A

penicillin is 1st line therapy; 10 day course more effective than 7 day.

62
Q

Gelsemium - homeopathic for strep throat

A

trembling with nervous excitement, small pupils, dull, droopy

63
Q

Belladonna - homeopathic for strep throat

A

dull expressionless face which is red, dilated pupils

64
Q

Bryonia - homeopathic for strep throat

A

sharp cutting pain, worse pressure, worse movement, hard pulse

65
Q

aconite - homeopathic for strep throat

A

very red, dry throat, fast onset with fever

66
Q

HEMP formula is used for

A

strep throat; gargle 30 gtts in 1/4 cu water

67
Q

For mononucleosis, what is tx plan

A

avoid trauma if splenomegaly present,
LOMATIUM ISoLATE 5gtts
Sillimarin if hepatic involvement

HEENT (1 decks)

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