Rhinitis, Hearing Loss, Epistaxis, Pharyngitis Flashcards
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2 types hearing loss
conductive:failure of one or more of the components of the external or middle ear
sensorineural
defect in inner ear or CN VIII; injury to the hair cells in the cochlea and/or the nerves innervating the hair cells (usually bilateral and symmetrical)
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weber rinne
Weber = Widows peak Conductive = Crap
Rinne
A>B normal
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screening for hearing loss
whisper test
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risk for hearing loss
- Noise exposure
- Frequent/recent infections
- Trauma
- Ototoxic meds (NSAIDS, aminoglycosides, furosemide, fluoroquinolones)
- Barotrauma
- Cerumen impaction
- Foreign body
- eustachian tube dysfunction with middle ear effusion
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hearing loss red flags
- sudden
- pain (not responsive to medication)
- mastoiditis/osteomyelitis
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Hearing loss Ddx
so many… broad strokes
Conductive (hearing canal/drum) trauma infection impaction congenital (cholesteatoma) otosclerosis tumor
SNHL (hairs w/ sensory receptors & nerves): metabolic (hypothryroidism) infectious toxins tumor neurodegenerative autoimmune
Common causes: presbycusis medication-induced barotrauma impaction infection
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complications of age-related hearing loss?
- depression
- dementia/MCI
- social isolation
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allergic rhinitis vs non-allergic
allergic: boggy, purplish, oedematous. turbinates
associated allergic symptoms (conjunctivitis, etc)
non-allergic: may be boggy, or may be inflamed looking (erythema, oedematous, or normal)
both: shiners transverse crease nose post-nasal drip & cough dennie-morgan skin folds under eyelids?
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classifications of non-allergic rhinitis
- Idiopathic
- Vasomotor
- Atrophic
- Geriatric
- Drug induced
- Gustatory: runny nose when eating spicy food
- Occupation
- Pregnancy
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non-pharm & pharm management rhinitis
avoid allergens, saline rinse, etc
Pharm: fluticasone nasal spray
If allergic: can try nasal antihistamine (2nd line), or oral antihistamines
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epistaxis red flags
posterior bleed (sphenopalatine artery)
systemically unwell 24-48 hours post packing posterior bleed (sepsis)
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risks for epistaxis
- Anticoagulation
- foreign body
- chronic use of nasal steroids
- systemic causes: bleeding disorders, HTN
- Trauma
- Tumors
- pregnancy
- cocaine use
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s/s epistaxis
Anterior: bleeding from one nare, may be able to visualize source at the septum
Posterior: “brisk” arterial hemorrhage, patient reports swallowing blood
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epistaxis tx
- Direct pressure
- Nasal packing
- Nasal balloons
- Cautery
- TXA soaked packing
- oxymetazoline
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GAS most common age
5-15
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risk for pharyngitis
- Cigarette smoking
- allergies
- URI
- ORal sex
- Drugs (Abx and Immunosuppressants)
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pathogens for pharyngitis
- Viral: Coxsackievirus, ECHO, Epstein-Barr
- Bacterial: Group A Beta-hemolytic Streptococcus, Neisseria gonorrhoeae, Corynebacterium diphtheriae
- Fungal: Candida albicans
- Atypical agents: Mycoplasma pneumoniae
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Oral lesions (herpangina, HSV, trench mouth, thrush, mono)
Herpangina – oral coxsackie A virus - ulcers palate & pharynx
Herpes – vesicles on buccal mucosa, tongue and pharynx
Trench mouth (gingivitis)
Oral candidiasis – first Sx of HIV?
MONOnucleosis: 50% have tonsillar exudate; 33% develop petechia at junction of the hard and soft palate.
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complications GAS
Suppurative adenitis Scarlet fever Peritonsillar abscess Glomerulonephritis Rheumatic fever
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centor score
Age Exudate Lymphadenopathy Temp Cough (absent)
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Tx GAS
PenVK 600 mg PO BID X 10 days