Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

X Clin Med Exam 1 > L12 Allergic Rhinitis, Tinnitus, Urticaria > Flashcards

L12 Allergic Rhinitis, Tinnitus, Urticaria Flashcards

1
Q

Barotrauma

A

Damage/discomfort to the ear due to pressure differences b/w middle ear and outside world

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of barotrauma

A

pressure, pain, hearing loss, or tinnitus, possible hemotympanum, middle ear effusion, TM rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment of barotrauma

A

avoidance, oral/nasal decongestants, swallowing, valsalva, chewing gum, time
if perilymphatic fistula (sensorineural hearing loss and vertigo) refer to ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acoustic neuroma

vestibular schwannoma

A

Schwann cell tumors, arise from vestibular portion of CN VIII, slow growing, could result in facial nerve palsies due to compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

clinical presentation of Acoustic neuroma

A

unilateral sensorineural hearing loss and tinnitus, may cause gait disturbance or other CN involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dx of Acoustic neuroma

A

audiometry as initial screening test

mri

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of Acoustic neuroma

A

surgery, radiation, observation due to slow growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tinnitus

A

perception of sound in one or both ears, occurs more in males, associated with depression/anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tinnitus Etiology

A

Auditory causes: ototoxic medications, presbycusis, otosclerosis, vestibular schwannoma, chiari malformations, barotrauma,
pulsatile: vascular etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ototoxic medications

A

aminoglycosides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

presbycusis

A

SN hearing loss w/ aging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

otosclerosis

A

hereditary disorder where bones fuse together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chiari malformations

A

cerebellar tinnitus are lower than usual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pulsatile tinnitus is most commonly caused by?

A

vascular etiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dx of tinnitus

A

Hx, Physical perform a complete head and neck exam, Auscultate for bruits in patients with possible vascular tinnitus, if pulsatile, refer to ENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tinnitus Tx

A

goal is to lessen awareness and impact on quality of life

behavioral therapy, benzos, white noise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Allergic rhinitis

A

PAROXYSMS OF SNEEZING, RHINORRHEA, AND NASAL OBSTRUCTION, and nasal obstruction, usually accompanied by itchy eyes, nose and palate
“hay fever” aka seasonal, vs perennial which occurs year round

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Allergic rhinitis epidemiology

A

PEAK INCIDENCE IN CHILDHOOD/ADOLESCENCE, one of the most common chronic diseases in the U.S.
Lots of money and time lost due to this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

pathophysiology of Allergic Rhinitis

A

PRODUCTION OF IGE ANTIBODIES triggering an immune response cascade
IgE binds to mast cells carrying histamine, next time exposed to allergen, histamine is released

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Clinical presentation of Allergic rhinitis

A

RHINORRHEA, SNEEZING, NASAL CONGESTION, itchy eyes/nose/palate, postnasal drip, cough, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Risk factors of allergic rhinitis

A

FH of atopy, male, atopic triad, serum IgE above 100 before age 6, first born, early use of abs, maternal smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

clinical evaluation of allergic rhinitis

A

personal or FH of allergic rhinitis, asthma, or eczema? 2nd hand smoke? potential triggers? impact on pt?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

allergic rhinitis physical exam

A

Eyes: allergic shiners and denie-morgan lines, pale palpebral conjunctiva may be pale, swollen, conjunctival injection
Nose: pale boggy “BLUISH” mucosa, clear discharge, nasal crease
Throat: post-nasal drainage in posterior pharynx, cobblestoning
Ears: serous otitis media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

“allergic shiners”

A

bluish purple rings around both eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Denie-morgan lines

A

skin folds under eyes consistent with allergic conjunctivitis

26
Q

Diagnostic evaluation of Allergic Rhinitis

A

CLINICAL, allergy testing to confirmatory, but not necessary for initial dx

27
Q

Allergy testing

A

skin testing: scratch or prick skin testing “wheal and flare” rxns normally occur 15-20 min, quick & cost effective, RISK FOR ANAPHYLACTIC RXN
Serum testing: immunoCAP, detects allergen-specific IgE antibodies, less risk but less sensitive, more expensive

28
Q

Allergic rhinitis therapy

A

avoidance of allergens, INTRANASAL GLUCOCORTICOIDS, oral or intranasal antihistamines, sympathomimetics/decongestants, leukotriene receptor antagonists, immunotherapy

29
Q

Avoidance of allergens

A

allergy is often caused more by the dander, saliva, & urine than hair

30
Q

pharmacology of Allergic rhinitis for children <2 years old

A

cromolyn sodium nasal spray

2nd generation antihistamines: Zyrtec and allegra approved for children 6mo or older

31
Q

pharmacology of allergic rhinitis for children 2 years to adults: Mild symptoms

A

EPISODIC SYMPTOMS
2nd generation oral antihistamines, antihistamine nasal sprays: azelastine > 5 yrs old, olopatadine (patinas) > 12 yrs, glucocorticoid nasal sprays, cromolyn nasal spray

32
Q

pharmacology of allergic rhinitis for children 2 years to adults: Moderate-to Severe symptoms

A

GLUCOCORTICOID nasal sprays are considered 1st line treatment. risk for epistaxis, stay away from septum

33
Q

special pharmacological considerations for Allergic Rhinitis

A

w/ asthma: montelukast (Singulair) useful additive therapy
w/ allergic conjunctivitis: glucocorticoid nasal spray and ophthalmic antihistamine drops (avoid nasal sprays in its with glaucoma or cataracts

34
Q

special pharmacological considerations for pregnant & lactating pts with allergic rhinitis

A

allergen avoidance
use 2nd gen antihistamines (claritin or zyrtec), glucocorticoid nasal spray (rhinocort, flonase, nasonex)
lactating women: budesonide or cromolyn w/ or w/o cetirizine or loratadine

35
Q

pharmacology of allergic rhinitis for children 2 years to adults: PERSISTENT moderate-to severe symptoms

A

in pts who FAIL TO RESPOND to initial glucocorticoid nasal spray…
antihistamine nasal spray, oral antihistamine, cromolyn nasal spray, montelukast (singular), oral antihistamine/decongestant combo

36
Q

classifications of rhinitis

A

allergic, vasomotor, infectious

37
Q

1st generation antihistamines

A

help alleviate sneezing, rhinorrhea, and itching
no relief of nasal congestion
chlorpheniramine 4mg q4-6 or 8-12mg BID
diphenhydramine 25mg BID-TID
side effects: dry mouth, constipation, SEDATION

38
Q

2nd generation antihistamines

A 
LESS SEDATING, same effect as gen 1, 
Loratadine 10 mg/d
Fexofedadine 60 mg BID or 180 mg QD
Cetirizine 5-10 mg/d
*nasal antihistamines have the same effectiveness
39
Q

sympathomimetics

A

decongestants, indicated for pts with marked nasal congestion despite antihistamine use
Vasoconstriction will decrease edema and secretions
pseudoephedrine 30-60mg q6-8h or 120 mg BID for sustained release
CAUTION: PTS WITH HYPERTENSION OR CARDIAC DISEASE BC OF VASOCONSTRICTION

40
Q

immunotherapy

A

allergy shots
effective treatment for allergic conjunctivitis, rhinitis, and asthma
gradual admin of increasing amounts of allergen
requires lots of visits, treatment period lasts 3-5 years

41
Q

pt education for allergic rhinitis

A

dust mine & mold avoidance
clean the house
humidifiers worsen sxs
close windows, HEPA filter

42
Q

When to refer if pt has allergic rhinitis

A

severe or refractory sxs
allergic rhinitis AND asthma: consider pulm or allergist
recurrent sinusitis or otitis media: refer to ENT

43
Q

Non-allergic rhinitis etiology

A

aka VASOMOTOR RHINITIS
abnormal AUTONOMIC responsiveness,
TRIGGERED BY STRESS, SEXUAL AROUSAL, PERFUMES, CIGARETTE SMOKE, TEMPERATURE CHANGES, usually occurs later in life, >20 y/o

44
Q

Non allergic rhinitis, symptoms

A

NASAL CONGESTION, RHINORRHEA, POSTNASAL DRAINAGE, USUALLY NO OCULAR OR NASAL ITCHING, nasal mucosa may appear normal, erythematous, or boggy/edematous

45
Q

treatment of non allergic rhinitis

A

avoid triggers, nasal glucocorticoids, antihistamine nasal sprays, IPRATROPIUM NASAL SPRAY (USE IF RHINORRHEA IS THE PROMINENT SYMPTOM) can also use oral decongestants, 1st generation oral antihistamines (anticholingergics)

46
Q

Nasal polyps clinical presentation

A

pedunculate, non tender, gray soft tissue growths,

47
Q

Nasal polyp symptoms

A

nasal congestion/obstruction, seen with allergic rhinitis, vasomotor rhinitis, chronic sinusitis, and asthma

48
Q

Samter’s triad

A

Aspirin Exacerbated Respiratory Disease (AERD), aka Samter’s Triad or Aspirin Sensitive Asthma
Chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other NSAIDs.

49
Q

Treatment of nasal polyps

A

NASAL GLUCOCORTICOIDS

refer to ENT for obstructive symptoms

50
Q

Rhinitis medicamentosa

A

regular use of OTC decongestant nasal spray (afrin) causes mucous membranes to become swollen and erythematous
>3 DAYS OF USE –> REBOUND CONGESTION
pts will increase freq of use and become dependent

51
Q

Treatment of rhinitis medicamentosa

A

DISCONTINUE AFRIN, START NASAL GLUCOCORTICOID SPRAY

52
Q

Urticaria

A

“hives”, welts, wheals
CIRCUMSCRIBED, RAISED, ERYTHEMATOUS PLAQUES, WITH OR WITHOUT CENTRAL PALLOR, intensely PRURITIC, raised wheals, pale to bright erythema
individual LESIONS ARE TRANSIENT (disappearing within 24 hrs)

53
Q

acute urticaria

A

present less than 6 weeks

54
Q

chronic urticaria

A

s/s recurring most days of the week for 6 wks or greater

55
Q

pathophysiology of urticaria

A

mediated by CUTANEOUS MAST CELLS in superficial epidermis, RELEASE OF HISTAMINE, vasodilatory mediators causes itching and localized swelling, might be accompanied by angioedema

56
Q

causes of urticaria

A 
infections-viral, bacterial, parasitic
allergic rxns to meds, foods
insect stings/bites
direct mast cell activation (morphine, codeine, radio-contrast agents)
nsaids
57
Q

diagnosis of urticaria

A

clinical based on H&P
review events in the hours before the rxn
there might not be lesions by the time of the visit, use pictures to verify type of irriation

58
Q

urticaria might be confused with…

A

urticarial vasculitis, fixed (last longer than 24 hours), erythematous, painful, urticarial plaques, with blanching halos, leaves residual hyperpigmentation or purport, linked with SLE

59
Q

treatment of urticaria

A

H1 HISTAMINE BLOCKER
1st gen-diphenhydramine, chlorapheniramine, hydroxyzine
2ND GENERATION - CETRIZINE, LORATIDINE, FEXOFENADINE* preferred first line treatment b/c of less side effects
can be combined with h2 histamine blocker (ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet)), or oral glucocorticoids if angioedema or persistent symptoms

60
Q

Treatment of urticaria more specifically…

A

Cetirizine and levocetirizine may be more effective due to mast cell-stabilizing properties

61
Q

if allergic etiology of urticaria is suspected

A

refer to allergist or may need epipen

X Clin Med Exam 1 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions