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Clin Med I > tennitis etc. x 2 > Flashcards

tennitis etc. x 2 Flashcards

1
Q

Barotrauma

A

discomfort or dmage due to pressure dufferrnces

- flying or diving common causes

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2
Q

Barotrauma exam

A

middle ear effusion, hemotympanum, possible TM rupture

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3
Q

Barotrauma tx

A 
avoidance 
oral or nasal decongest
swallowing, nchewing gum
tx of injury 
if vertigo refer to ENT
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4
Q

Acoustic Neruoma

A

Schwann cell tumor
arise from vestibylar portion of CN vII
very slow growing tumor
- usually in older adult s

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5
Q

Acoustic neuroma risks/ present

A

radiation exposure as a kid
- present: unilaterl sensorineual hearing loss and tinnitus
+/- gait disturbance

Neurofibromotatosis type 2 also risk factor- bilateral often

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6
Q

Acoustic Neuroma

A

Audiometry best initial test
MRI
- alt CT w/w/o contrast

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7
Q

Aucoustic neuroma tx

A

surgery, radiation, observation

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8
Q

Tinnitus presentation

A 
Perception of sound in one or both ears
M>F 
- buzzing or ringing 
- can be continuous or come and go 
Often indicator of cochlear hair cell disfunction or loss
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9
Q

Tinnitus Etiology

A 
Autitory 
- ototoxic medication
-presbycusis (aging hearing loss)
- otosclerosis
- vestibular schwannoma
- chiari malformation 
- barrow trauma 
Pulsatile tinnitus: commonly a vascular etiology
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10
Q

Tinnitus diagnosis

A

based on history

  • physical - HEENT exam
  • if pulsitile refer to ENT and check for bruist
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11
Q

Tinnitus tx

A 
main goal is to lessen awareness and impact on qulity of life 
- behvioral therapy
- biofeedback or CBT 
Bensodiazepines 
masking devices- "white nose"
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12
Q

Allergic Rhinitis types

A 
Alergic:
- seasonal- hay fever, ususlly only certain times of the year 
- perennial- occurs year round 
Vasomotor Rhinitis 
- perennial non-allergic
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13
Q

Allergic Rhinitis present

A

sneezing , rhinorrhea, nasal obstruction

  • often accompanied by itchy eyes nose and palate
  • cough and fatigue
  • response of IgE antibodies which sensitizes mast cells and basophills
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14
Q

Allergic rhinitis physical exam eyes

A

Periorbital area
- “sllergy shiners” bluish rings arounf the eyes
- Dennie- morgan lines: skin folds associated with conjunctivitis
Eyes:
- diffuse redness, tearing, chemosis, eyelid edema

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15
Q

Rhinitis exam nose, ears, throat

A

Nose: boggy, pales, bluish mucosa
Throat: post nasal drainage, “cobblestoning”
Ears: retracted TM

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16
Q

Allergic rhinits dx

A

clinical diagnosis
- can do allery testing not always necessay
Skin testing: scratch or prick skin test
- “wheel and flare” reactions normally occur within 15 -20 min
serum testing: immunoCAP
- detects IGE antibodies, less risk but less sensitive

17
Q

ALlergic Rhinitis Tx

A
  1. Avoidance
  2. Pharm
    - oral/intanasal antihistamines
    - Intranasal glucocorticosteroids**
    - sympathomimeticss/decongestants
    - leukotriene receptor antagonists
  3. Immunotherapy
18
Q

1st generation of antihistamines of allergic rhinitis

A
  • will not releive the nasal congestion
    1. Chlorpheniramine
    2. Diphenhydramine
    side effects- dry mouth, constipation, sedation
19
Q

2nd gen antihistamines

A

less sedating

  • loratadine (clartin)
  • Fexofedadine
  • Cetirizine (zyrtec)
20
Q

Antihistamine Nasal Sprays - allergic rhinitis

A

Rapid onset
bitter taste
can be used in combination

21
Q

Cromolyn Nasal spray

A

mast cell stabilzer

- lower efficay but no serious side effects

22
Q

Nsal Steroid Sprays

A

More effective than oral antihistamines
- lower bioavailability in the 2nd generation
side effect- epistaxis

23
Q

Leukortriene receptor antagonist

A

Montelukast (singular)

- LTRA +2nd gen antihistamine it provides real good releif

24
Q

Sympathomimetics (decongestants)

A

if have congestant despite antihistamine use

  • will has vasocontrictions will release edma
  • caution in patients with hypertension
25
Q

Immunotherapy

A

allergy dose
tx: allergic asthma, conjunctiitis, rhinitis
- gradual administation of increasing the amount of the allergen
- typically subcutanious and sublingual
Tx time 3-5 years

26
Q

Allergic rhinitis pharmacotherpay children

A

Cromolyn nasal spray
2nd gen antihistamines
ex: cetirizine (zyrtec approved for chilfren >6mo

27
Q

Rhinitis tx kids and adults mild

A

Mild:
2nd gen oral antihistamines: loratadine(claratin), Cetriizine(zyrtec), Fexofenadine (allegra)
Nasal spray: azelastine, olopatadine
Glucocorticoid nasal spray ( strat 2-3 days before exposure)

28
Q

Mod/sever allergic rhinits Tx

A 
Glucocoticoid nasal spray! 
- 2nd generation are the safest
best single drug
Can add in another drug if needed 
ex: antihistamine or cromoly nasal spray
29
Q

Allergic rhinitis and asthma or conjunctivitis

A

Asthma: Montelikast(singulair)

Conjuct:
- steroid nasal spray and opthalmic antihisamine drip

30
Q

Allergc rhinitis pregnancy

A
  1. 2nd gen antihistamines
  2. glucocorticoid therapy
    Lactating women:
    Budesonide or cromolyn
31
Q

Perennial non-allergic rhinitis

A

“vasomotor rhinitis”
autonomic response
- triggered by stress, sexual arousal, purfumes, cigarette smoke, temp change

32
Q

Non allergic rhinitis presenation

A

nasal congestion, rhinorrhea, postnasal drainage
- usually no ocular/ nasal itching
nasal mucosal may appear normal, erythematous, or boddy edmea

33
Q

Non allergic rhinits tx

A

avpidance of triggeres
- nasal steroid spray
- antihistamine nasal spray
- ***ipratropium nasal spray ( anticholinergic ) if rhinorrhea is primary sx
Adjunctive therapy: oral decongestants nd 1st gen antihistamines

34
Q

Nasal polyps

A

non tender, pedunculates, grey soft tissue growths
Sx: nasa; congestion/ onstruction

Seen with allergic rhinitis, vasomotor rhinitis, and asthma
Tx: Nasal steroid spray and refer to ENt

35
Q

Rhinitis Medicamentosa

A

Result of regular use of decongestant nasa spray
>3days of use leads to reboud congestion
- become dependen
Tx: discontinue use and start of nasal steroid spray

36
Q

Urticaria presentation

A 
Hives, welts, wheals 
- well circumscribed prurutic riased wheels 
- pale to bright red 
- +/- central pallor 
acute- < 6wks
chronic> 6wks occuring most days 
they are transient lesions
37
Q

Uticaria pathophysip

A

caused by histamine relase from mast cells

- can be accompanies by angioedema

38
Q

Uticaria Dx/Tx

A

based on hisotry and physical
Tx: H1 histamine blocker
- cetirizine(zyrtec) and levocetirizine (Xyzal)
H2 blocker Ranitidine, Famotidine, cimetidine
Oral glucocorticoids- if angioedema or sx are persisant

Clin Med I (14 decks)

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