Quiz 2 Flashcards
Vestibular Neuritis affects which CN?
CN VIII
Hx: Vestibular Neuritis
Usu preceded by URI
SSx: Vestibular Neuritis
Sudden onset vertigo, constant, < movement, N/V
No hearing loss, No tinnitus
PE: Vestibular Neuritis
Spontaneous horizontal-torsional nystagmus AWAY from affected side, +HIT, decreased VEMPs, falling tendency toward affected side, inc. visual dependency
Course: Vestibular Neuritis
Severe/persistent vertigo becomes intermittent/positional and resolves in days-wks
In a pt w/ suspected Vestibular Neuritis, when is brain imaging indicated?
Unprecendented HA, negative head impulse test, severe unsteadiness, no recovery in 1-2 days
Etiology: Labryrinthisis
Bacterial/viral, AI (BL), ototoxic drugs
SSx: Viral labyrinthitis
Acute onset of mild-severe vertigo (assoc. w/ N/V) accompanied by concomitant ear/nose/sinus infx, tinnitus
PE: Viral labyrinthitis
Spontaneous nystagmus toward UNAFFECTED side w/ diminished/absent caloric response in affect ear, +HIT
DDx: Viral labyrinthitis vs. Vestibular neuritis
VL affects vestibular system + hearing
VN affects vestibular system ONLY
Risk Factors: CNS Stroke
Older age, HTN, DM
What is the Rothrock criteria used for?
Help determine whether pts w/ vertigo should undergo CT scan
Rothrock Criteria
Pt >60 years, new onset focal neurological deficit, HA w/ vomiting, altered mental status
Red flags: CNS Stroke
Hyperacute onset vertigo, occipital HA, gait ataxia
DDx: VL, VN vs. CNS stroke
VN - Vestibular fxn
VL - Vestibular fxn + hearing
CNS - Vestibular fxn, focal weakness, slurred speech
What is the MC cause of positional vertigo?
Benign Paroxysmal Positional Vertigo
SSx: BPPV
Brief (1 min) episodes of vertigo triggered by positional changes, no hearing loss
BPPV can be 2˚ to ___.
head trauma, dental surgery, ASOM
Pathophysiology: BPPV
Otoliths roll across hairs when the head moves, sending signals to brain causing vertigo
What are Ototliths?
Calcium carbonate precipitates in endolymph
PE: BPPV
+Dix-Hallpike (upbeat nystagmus, fatigues on repeat exam), NO hearing loss/tinnitus
If BPPV is 2˚ to trauma, ___
order X-ray to r/o temporal bone fracture
What population is at risk for BPPV?
Children w/ migraines
Tx: BPPV
Epley Maneuvers
DDx: BPPV vs. other conditions causing vertigo
BPPV is not simply made worse with position change, it is TRIGGERED by it
DDx: BPPV vs Central Positional Vertigo
BPPV - upbeat nystagmus on Dix-Hallpike
CPV - downbeat or pure tortional nystagmus on Dix-Hallpike
Pathophysiology: Meniere’s disease
Edema within endolympatic space
SSx: Meniere’s disease
Episodic severe vertigo w/ N/V and aural fullness, mb tinnitus on affected side (loud/roaring), fluctuating sensorineural hearing loss (hypersensitivity to loud noises), 90% unilateral
Population: Meniere’s disease
Middle-aged women MC
PE: Meniere’s disease
+HIT, auditory brainstem response w/ acoustic masking
DDx: Meniere’s disease vs. Transient Ischemic Attack
TIA episodes usu briefer than MD, get worse in crescendo pattern
Dx: Pt w/ acute audiovestibular loss who does not have typical Meniere’s disease sxs
Brainstem stroke
Bilateral vestibular failure are MC d/t __.
Aminoglycoside toxicity (Gentamicin, Streptomycin)
What % of pts with acoustic neuroma have vertigo?
50%
SSx: Acoustic neuroma
Slowly progressive unilateral sensorineural hearing loss, vertigo (50%), tinnitus
PE: Acoustic neuroma
Facial weakness (late), unilateral/asymmetric sensorineural hearing loss, auditory brainstem response
Dx: Acoustic neuroma
Refer to ENT for audiology, auditory brainstem response, MRI of interior auditory canal w/ gadolinium contrast
Vague dizziness/vertigo w/ unilateral or asymmetric sensorineural hearing loss is ___ until proven otherwise
Acoustic neuroma
DDx: Conductive Hearing Loss
Genetic Otosclerosis Trauma Inflammatory (ASOM, SOM) Cholesteatoma
What is the MC cause of conductive hearing loss in adults?
Otosclerosis
Pop: Otosclerosis
Onset - early 20s, peaks 4th-5th decades, F>M
What is the MC form of otosclerosis?
Stapes fusing to malleus
SSx: Otosclerosis
Progressive conductive hearing loss, usu w/ well-preserved speech discrimination
May have sensorineural hearing loss
Carhart’s notch
Schwartze’s sign
Carhart’s notch
dip in bone conductive threshold at 2000 Hz on audiometric testing
seen in otosclerosis
Schwartze’s sign
Pink/blue hue on promontory
Clinical pearl: otosclerosis
Pts are often soft-spoken and aware that they hear better in noisy environments
Tympanogram: otosclerosis
Type As Stiff
short peak
Dx: otosclerosis
CT of temporal bone
What is the MC traumatic cause of conductive hearing loss?
Rupture of TM
Tympanogram: conductive hearing loss d/t trauma
Type Ao Disrupted
large curves, no peak
DDx: Peripheral vertigo
Meniere's disease Acoustic neuroma Vestibular neuronitis Labyrinthitis BPPV
DDx: Sensorineural Hearing Loss
Congenital Traumatic (PF) Inflammatory (ASOM) Neoplastic Metabolic/Vascular Ototoxcity Presbycusis
What are non-genetic causes of sensorineural hearing loss at birth
Rubella, jaundice, anoxia, brain injury
What is often the initial complaint in patients with a traumatic cause of sensorineural hearing loss?
Tinnitus
When is sensorineural hearing loss d/t trauma irreversible?
When the hairs in the Organ of Corti are damaged beyond repair
In nose-induced hearing loss, there is a characteristic drop-off in (low/high) frequencies.
High
What types of ear infection could cause sensorineural hearing loss?
Strep ASOM, measles, syphilis
How do you rule out unilateral sensorineural hearing loss d/t neoplasm?
MRI
Auditory brainstem response: Acoustic neuroma
Retro-cochlear pattern (delayed V wave compared to normal ear)
In acoustic neuroma, hearing loss is localized in the (low/high) frequencies.
High
Which clinical and sub-clinical endocrine/metabolic conditions should be considered in sensorineural hearing loss?
Hyperlipidemia, Hypercholesterolemia, DM, hypothyroidism
What are risk factors for hearing loss in women?
Obesity, inactivity
What are the MC ototoxic drugs?
ASA Quinine Aminoglycosides (gentamicin, neomycin, streptomycin) High-dose erythromycin Loop diuretics Thiazide diuretics Platinum-based chemo CO Nicotine EtOH Heavy metals INF-alpha
What is the first sign of sensorineural hearing loss d/t ototoxicity?
Tinnitus
Definition: Sudden sensorineural hearing loss
Loss of >30 dB in three contiguous frequencies in a period of <3 days
SSx: Presbycusis
Gradual, bilateral, symmetrical hearing loss
Presbycusis often begins with loss of ___
high frequencies
Audiogram: Presbycusis
Drop-off at higher frequencies
Risk factors: Presbycusis
Age, M, White, FHx, service/blue collar occupation, exposure to loud noises, lower education level, smoking, hyperhomocysteinemia, low folic acid intake, HTN, diabetes
SSx: Perilymphatic fistula
Post-traumatic vertigo that does not improve over time, mixed sensorineural hearing loss
PE: Perilymphatic fistula
+Fistula test (< insufflation), < valsalva
SSx: Cholesteatoma
Progressive unilateral conductive hearing loss w/ vertigo
What is the best use of tuning fork tests?
Differentiate conductive vs. sensorineural hearing loss
Not screening tools for hearing loss
Rinne test: AC > BC =
Normal
Rinne test: BC > AC =
Conductive HL
Rinne test: AC > BC, but both diminishsed =
Sensorineural HL
A hearing threshold above ___ dB is considered profound hearing loss.
91
Normal hearing threshold is ___ dB.
0-25
Bone conduction is a measure a ___.
cochlear function
Audiology: air conduction is measured with a ___
earphones
Air conduction is a measure of ___
the entire auditory system
Bone conduction is measured with a ___
vibrating oscillator
Speech audiometry measures ___.
the threshold that speech can be accurately heard
Typanometry measures ___.
tympanic membrane mobility (impedence)
also an indirect measure of middle ear pressure
Electrocoholeography measures ___ and is particularly helpful in what disease?
electrical potentials of the cochlea
Meniere’s disease, hearing loss in infants
Auditory Brainstem Response measures ___ and is prolonged in ___.
time for impulse to travel from cochlea to brainstem
acoustic neuroma
Outpatient screening for hearing loss
Ask patient if they’ve noticed hearing loss
Whispered voice test
What minerals are useful in presbycusis?
Zinc (include Cu if long-term use)
Vit C/E, alpha lipoic acid
What nutrients are protective against aminoglycoside antibiotics?
Magnesium, Vit C/E
Glutathione (Gentamicin)
What nutrient is useful in Meniere’s?
B6
What deficiency is associated with sensorineural hearing loss?
Vitamin A
What deficiency is associated with sensorineural hearing loss, BPPV, and otosclerosis?
Vitamin D
What deficiency is associated with noise-induced hearing loss and tinnitus?
Vitamin B12
What nutrient appears to slow decline of presbycusis in pts with hyperhomocysteinemia?
Folic acid
There is a strong association between Meniere’s and what metabolic condition?
Allergy to dust, pollen, mold, and/or food allergy
Naturopathic treatments to increase blood flow to middle ear
Ginkgo biloba, Bilberry, Vinpocetine, Pycnogenol, Centella
Otologic causes of tinnitus
Hearing loss
Cholesteatoma, Meniere disease, vestibular schwannoma
Toxicologic causes of tinnitus
Medication or substance use
Somatic causes of tinnitus
TMJ dysfunction, head/neck injury
Traumatic causes of tinnitus
cerumen removal
Neurologic causes of tinnitus
MS, spontaneous intracranial hypotension, type I Chiari malformation, idiopathic intracranial HTN, vestibular migraine
Infectious causes of tinnitus
Viral, bacterial, fungal
Metabolic causes of tinnitus
Hyperlipidemia, DM, B12 deficiency
Vascular causes of tinnitus
Arterial bruit, venous hum, A/V malformation, vascular tumor, carotid atherosclerosis, Paget disease
Tx: Tinnitus
Treat underlying causes (ototoxins, CV dz, DM, AI dz, infx, anemia, hypothyroidism, hyperlipidemia)
Noise protection
Correct deficiencies (B-vitamins, Mg, CoQ10)
Homeopathy, acupuncture, qi gong
Acoustic therapy
CBT/biofeedback
Etiology: Common Cold
Rhinovirus (respiratory syncytial virus)
Adenovirus
Parainfluenza virus
SSx: Common Cold
Nasal congestion Rhinorrhea (watery/thick) Mild sore throat/cough HA, malaise Low-grade fever in children
PE: Common Cold
Erythematous, swollen nasal mucosa
Pathophysiology: Allergic rhinitis
Low-dose antigen triggers Th2 response –> IL-4 and IL-13 produced –> B cells produce IgE –> IgE bind to mast cells and activated eosinophils –> Mast cells release histamine, prostaglandins, leukotrienes, kinins, TNF-alpha –> SM contraction, capillary dilation, glandular hypersecretion
Allergic rhinitis is a risk factor for what condition in children?
Migraines
What are the two main types of allergic rhinitis?
Seasonal, Perennial
Chronic allergic rhinitis may be associated with ___(4).
Sleep d/o, sinusitis, SOM, anosmia
SSx: Allergic rhinitis
Episodic nasal obstruction, rhinorrhea, sneezing, lacrimation, pruritus (nose, eye, throat), nasal voice, sore throat, allergic salute
PE: Allergic rhinitis
Enlarged tonsils, halitosis, allergic shiners, adenoidal facies, erythematous nasal mucosa w/ d/c (clear, watery)
Nasal polyps, gingival hypertrophy
PE: Nasal mucosa (Seasonal vs. Chronic perennial allergic rhinitis)
S - red
CP - pale, bluish
Labs: Allergic rhinitis
CBC, nasal culture, scratch test, RAST/ELISA test, Total serum IgE
CBC: Allergic rhinitis
May show eosinophils
Nasal culture: Allergic rhinitis
Eosinophils
When are RAST/ELISA tests indicated?
If there is potential for anaphylaxis or bad eczema
What is NARES?
Non-allergic rhinitis with eosinophil syndrome
NARES vs. Allergic rhinitis
NARES has an absence of atopic Th2 lymphocytes and IgE-mediated mechanisms
Nasal culture: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - eosinophils
AR - eosinophils
Cholinergic rhinitis - normal
Scratch test: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - negative
AR - positive
Cholinergic rhinitis - negative
Serum IgE: NARES vs. Allergic rhinitis vs. Cholinergic rhinitis
NARES - normal
AR - mb elevated
Cholinergic rhinitis - normal
SSx: NARES
Similar to allergic rhinitis
Sneezing paroxysms
Nasal itching
Coryza (serous, seromucus)
PE: NARES
Dry/atrophic appearance, pallor
NARES is often associated with what conditions? (3)
Fibromyalgia, CFS, IBS
Pathogenesis: Cholinergic rhinitis
Imbalance between SNS and PNS
Overstimulation of PNS leads to ___.
vasodilation, nasal congestion, and increased mucous secretion
What is one theory why cholinergic rhinitis is more common in women?
Estrogens inhibit acetylcholinesterase –> increased ACh
Triggers: Cholinergic rhinitis
Emotions (crying), odors, smoke, weather changes (esp. cold air), recumbency, trauma, trigeminal neuralgia, spicy food, EtOH
SSx: Cholinergic rhinitis
Chronic nasal obstruction w/ or w/o rhinorrhea, BL or unilateral, may alternate sides
PE: Cholinergic rhinitis
Swollen inferior nasal turbinates, dark red-blue, increased mucus production
What is the MC cause of drug-induced rhinitis?
Abuse of sympathomimetic nose drops/spray
What are common drugs that induce rhinitis?
Reserpine, Methyl dopa, Beta blockers, BCP
What is the name of the condition caused by the rebound effect of long-term use of sympathomimetic nose drops/sprays?
Rhinitis Medicamentosa
Tx: Drug-induced rhinitis
Conventional: switch to steroid spray
Naturopathic: Substitute with saline spray
Sick Building Syndrome, Adenoidal Hyperplasia, Tumors, and Foreign Bodies are also causes of ___.
rhinorrhea
SSx: Tumor causing rhinorrhea
Persistent unilateral nasal d/c, esp. in adults and w/ bloody d/c
SSx: Foreign bodies causing rhinorrhea
Unilateral d/c, foul smelling, snoring
Before removing foreign body from nose, consider using ___.
0.5% phenylephrine, topical lidocaine
SSx: Cerebrospinal Fluid Rhinorrhea
Unilateral, clear, profuse nasal d/c
What increases d/c in cerebrospinal fluid rhinorrhea?
valsalva, jugular vein compression, lowering the head
PE: Cerebrospinal Fluid Rhinorrhea
Normal nasal mucosa
Work-up: Cerebrospinal Fluid Rhinorrhea
Check nasal mucosa for glucose, CT w/ CSF dye
What are possible endocrine causes of rhinorrhea?
Pregnancy, hypothyroidism
Samter’s triad
Nasal polyps, ASA sensitivity, asthma
Homeopathics for nasal polyps
Calc, Sang, Teucr, Thuj
Types of rhinosinusitis
Acute - Sxs < 4 wks
Subacute - Sxs 4-12 wks
Chronic - Sxs > 12 wks
Recurrent acute - 4 or more episodes per year
SSx: Rhinosinusitis
Sudden onset of malaise, fever, nasal congestion, post-nasal drainage, throat clearing, facial/head pain, mucopurulent rhinorrhea, low-grade fever, pain at nose root
Pain at root of nose
Sticta
PE: Rhinosinusitis
Diffuse mucosal edema, narrowing of middle meatus, inferior turbinate hypertophy, copious rhinorrhea, purulent d/c
Mb polyps, septal deviation
Which PE is more reliable than sinus palpation for diagnosing rhinosinusitis?
Ask pt to bend forward –> pain?
MC cause of rhinosinusitis?
viral infection associated with common cold
MC bacterial cause of rhinosinusitis?
Haemophilus influenza
Streptococcus pneumonia
What signs and symptoms are most helpful in predicting Acute Bacterial Rhinosinusitis (ABRS)?
Purulent nasal d/c
Maxillary/tooth/facial pain
Unilateral maxillary sinus tenderness
Worsening sxs after initial improvement
CT findings: sinusitis
Air-fluid levels, mucosal edema, air bubbles within sinus
Mucosal abnormalities on CT may be observed in as many as __% of asx pts.
42
When do you order CT in cases of sinusitis?
If patient develops decreased visual acuity, diplopia, periorbital edema, severe HA, altered mental status
Complications: Sinusitis
Orbital cellulitis, brain abscess
What type of imaging do you order for sinusitis if indicated?
Limited-Sinus CT
In what patients should you screen for primary ciliary dyskinesia?
Pts w/ daily nose blowing since birth, chronic-recurrent sinusitis, chronic secretory OM, male infertility
Kartagener Syndrome
Situs inversus, chronic sinusitis, bronchiectasis
Dx: Kartagener Syndrome
CXR, Saccharin test, PE for situs inversus
Antibiotics for rhinosinusitis?
Rarely b/c most cases are viral
Sinus development in children
Maxillary and ethmoid present at birth
Sphenoid develops from ethmoid at 9 years old
Frontal from ethmoid at 5-7 years
What is the most important risk factor for development of acute bacterial rhinosinusitis?
Viral URI
The presence of nasal polyps in children should prompt evaluation for possible ___.
cystic fibrosis
Dx: Rhinosinusitis in children
Persistent cough and nasal rhinorrhea > 10 days
PE: Rhinosinusitis in children
Irritability, vomiting, persistent cough, nasal rhinorrhea
What are the 3 potential clinical presentations in children when a viral URI is complicated by acute bacterial sinusitis?
Persistent sxs
Worsening sxs
Severe sxs
SSx: Complications from acute bacterial sinusitis in children
Eye swelling w/ persistent HA and V, altered consciousness, focal neurological deficits, signs of meningeal irritation
Complications from acute bacterial sinusitis in children
Periorbital cellulitis, Orbital cellulitis, Septic cavernous sinus thrombosus, Meningitis, Osteomyelitis, Epidural abscess, Subdural empyema, Brain abscess
SSx: Meningitis
Fever, HA, nuchal rigidity, change in mental status
When should you refer a child with bacterial sinusitis for imaging and what type of imaging?
If they are toxic, going into complications, or no improvement w/ tx
CT scan
What is the gold standard for diagnosing bacterial sinusitis in children?
Sinus tap
Three forms of chronic fungal sinusitis
Invasive sinusitis, fungus ball of the sinus, allergic
Risk factors: Invasive fungal sinusitis
Acquired immunodeficiency dz, chemotherapy
Risk factors: Allergic fungal sinusitis
History of multiple preceding sinus surgeries and nasal polyposis
What is the MC cause of fungal sinusitis?
Aspergillus
Which supplements help stabilize cell membranes?
Vitamin C, Vitamin E, Vitamin A, Selenium, NAC, Quercetin, Catechin, Pycnogenol
Which bioflavonoid inhibits degranulation of mast cells?
Quercetin
Which bioflavonoids inhibits histidine carboxylase and is also a potent antioxidant?
Catechin
Which EFA do atopic patients have trouble converting to PGE? What supplements help bypass this step?
Linoleic acid
EPO, Borage oil
What are ways to support the adrenals in patients with allergies?
Drenotrophin, Antronex, Corrhyzadyn, Isocort, B-vitamins, DHEA, B5, Ginseng
What foods should patients with allergies avoid?
Dairy, citrus, animal fat, trans-fatty acids
What is the MC type of epistaxis?
Anterior epistaxis
What is the MC location for epistaxis?
Kiesselbach’s plexus
Tx: Anterior epistaxis
1) Pressure, cold application
2) Local anesthetic + silver nitrate
3) If recurrent, Vitamin C + bioflavonoids + homeopathy
Pop: Anterior vs. Posterior epistaxis
Anterior: Children, YAs
Posterior: Older adults
Work-up: Posterior epistaxis
Assess for hemodynamic stability, look for bleeding site
Tx: Posterior epistaxis
Refer to ENT
When is epistaxis potentially dangerous?
Posterior epistaxis can indicate hemodynamic instability
Physical medicine for chronic sinusitis
Nasal specifics, craniosacral therapy, nasal lavage, humming
What are some ways you can help your patients abort a cold?
Rest, water, simple diet, hydrotherapy (constitutional, fever therapy)
Evidence for Echinacea and Vitamin C in prevention/treatment of URIs
Minimal prophylactic protection, may be effective once cold has been contracted
Hydrotherapy for chronic sinusitis
Nasal lavage, contrast hydrotherapy
Which nutrient prevents the secretion of histamine by WBCs?
Vitamin C
Naturopathic tx options for rhinosinusitis?
Vitamin A/C/E Beta-carotene Zn Thymus extract Bromelain Steam inhalation Nasal irrigation Short-wave diathermy
Which bacterial agent is mc in children than adults for acute pharyngitis?
GABHS
Sudden severe throat pain, esp. in older adults, suggests ___(2).
Aortic dissection, pneumothorax
DDx: Sore throat (systemic diseases)
JRA, Hep, Polio, HIV, TSS, Leukemia, Mycoplasma pneumonia
What % of pts with M. pneumoniae develop pneumonia?
10%
What is the diagnostic test of choice for M. pneumoniae?
Multiplex PCR
Etiology: Mononucleosis
EBV (HHV-4)
SSx: Mononucleosis
Teenage, prominent sore throat > 1 week, Post. cervical nodes (mb groin/axilla adenopathy), myalgia, tonsillar exudate, petechiae on pharynx
What two extra-oral findings might you find on PE in Mononucleosis?
Hepatomegaly (12%)
Splenomegaly (52%)
Work-up: Mononucleosis
Peripheral smear (atypical lymphocytes)
Monospot (+)
Transaminases (mildly elevated)
In a pt with suspected Mononucleosis with a negative Monospot, consider ___.
CMV
Why should you order ALT, AST, and GGT in a pt with Mononucleosis?
Assess for EBV hepatitis
DDx: Sore throat (oral lesions)
Necrotizing Gingivitis HSV Hand/foot/mouth dz Aphthous ulcers Oral candidiasis
When can aphthous ulcers cause a sore throat?
When they appear on posterior 1/3rd of tongue –> innervated by CNIX
Etiology: Hand/foot/mouth dz
Coxsackie virus
Risk factors: Necrotizing gingivitis
Smoking, poor hygiene, teenagers
DDx: Sore throat (head and neck conditions)
OM Sinusitis post-nasal drip Mumps parotiditis SCM/cx spine lesions Thyroiditis CNIX neuralgia Epiglottitis Oropharyngeal CA
Complications: Mononucleosis
Airway obstruction Fatigue Splenic rupture Hemolytic anemia Thrombocytopenia CA (Burkitt's lymphoma, nasopharyngeal carcinoma, B-cell lymphomas)
Incubation period for GABHS infection?
24-72 hrs
What population is at highest risk for GABHS infection?
Children 5-15 years old
CENTOR Criteria
Temp > 100.4 = 1 pt Absence of cough = 1 pt Cervical LA = 1 pt Tonsillar swelling/exudate = 1 pt 3-14 years old = 1 pt 15-44 years old = 0 pt 45 years or older = -1 pt
Empirical treatment for GABHS - CENTOR score
> /= 4 (51-53%)
No further testing or antibiotic - CENTOR score
1 or less (1-19%)
Culture or RADT, Antibiotics for positive culture only - CENTOR score
2-3 (11-35%)
Indications: Rapid strep
Two or more CENTOR
HIV, splenectomy, DM
Hx of rheumatic fever
Sandpaper rash on trunk < groin/axilla
Scarlet fever
When do you follow-up a negative RADT with a throat culture?
Children, adults with high CENTOR score, when sensitivity of RADT is too low
Which population is at high risk for carditis and should be treated with antibiotics for GABHS?
Hx of rheumatic fever
What is a Strep carrier?
Pt who has Strep as part of normal flora, positive culture, no antibody response, negative ASO titer
Complications: Strep carriers
No risk for rheumatic fever of sequelae
Antibiotics and GABHS
Probably do not alter course of disease (~16 hrs?)
Decrease spread of infection
Prevent suppurative complications
Do antibiotics prevent glomerular nephritis as complication of GABHS?
No
Do antibiotics prevent guttate psoriasis as complication of GABHS?
No
Do antibiotics prevent erythema nodosum as complication of GABHS?
No
Do antibiotics prevent acute rheumatic fever as complication of GABHS?
Yes
SSx: Acute rheumatic fever (major manifestations)
Carditis
Polyarthritis
Erythema marginatum
SubQ nodules
What is first-line treatment of GABHS?
Penicillin
What is the NNT for symptom relief at 72 hours in those with positive throat swabs?
4
Synergists for HEMP: Gelsemium
Trembling, nervous excitement, miosis, dull/droopy, not thirsty
Synergists for HEMP: Belladonna
Dull/expressionless red face, dilated pupils, throbbing pain
Synergists for HEMP: Bryonia
Sharp/cutting pain, < pressure, < movement, hard pulse
Synergists for HEMP: Aconite
Small/fast pulse, red/dry throat, fast onset w/ fever
Which herb is best added to HEMP tincture when patient appears toxic?
Baptisia
Phys Med/Hydro for Strep throat
Saline gargles Warming throat compress Lymphatic massage Carrot-Ginger poultices Scarves
Which herb has been shown to improve pain scores in non-strep pharyngitis vs. placebo?
Salvia
When are follow-up throat cultures indicated?
Hx of ARF
Pharyngitis during outbreaks of ARF or glomerulonephritis
Families (“ping-pong” spread)
Patients who are asx and culture positive at end of tx are likely ___
Strep carriers
Herb for Mononucleosis
Lomatium
Common misdiagnosis for mononucleosis
GABHS pharyngitis
In patients treated with antibiotics who have mono, what symptom may appear?
Generalized maculopapular or urticarial rash
