Test 4 Flashcards

Question

Sudden Sensorineural Hearing Loss TX

Answer 1

Ginkgo biloba Vit E, Alpha lipoic acid High dose intravenous Vitamin C Magnesium: Oral or in IV Myers Cocktail Oral Zinc 30 MG Multiple B vitamins Coenzyme Q10 100 mg BID Caloric restriction, fasting, increase water, Mediterranean diet to decrease blood viscosity Hyperbaric Oxygen therapy Ozone therapy Acupuncture

Answer 2

- Perform Epley maneuvers for P SCC BPPV - Anterior SCC BPPV treat with Variants of the Dix-Hallpike - Horizontal SCC BPPV treat with Gufoni Maneuver. - supplemental Vit D

Answer 3

surgery radiosurgery gamma knife radiosurgery

Answer 4

A simple intranasal procedure in which a balloon is inserted into each nasal passage in three different positions. The balloon is briefly inflated in each position, then removed.

Answer 5

- chronic recurrent sinusitis - Snoring if due to nasal passage and not tongue position - Headaches - History of facial trauma leading to pain or dysfunction - Difficulty breathing through the nose - Seizure disorders - Nasal polyps - Sphenoid malposition - Pituitary hypofunction - TMJ dysfunction

Answer 6

- Implanted hardware - Severe epistaxis - Thrombocytopenia - Patient taking blood thinning medications - Recent nasal surgery - Status post cleft palate surgery or other surgeries that might leave the area fragile in light of dilation caused by the procedure - Foreign body in the nose - Latex allergy

Answer 7

- Osteoporosis - Elderly patients - Infants and children - Nervous, hesitant, or reticent patients

Answer 8

aspiration tissue damage

Answer 9

- Bulb (quick release is nice) - Medium latex finger cots - 1-layer soft pressure - 2 - 3 - 4 lot of pressure, more firm - Floss (waxed) or rubber grommets - Lubricant - Round or flat toothpicks or 2mm ear curette - Exam gloves - Facial tissues

Answer 10

- Inspect the nose and nasal cavity - Look for foreign objects - Note asymmetry and places of narrowing - Insert the deflated balloon into the first meatus - Have the patient inhale through their mouth and hold their breath - Secure and seal the balloon in the nostril - Give two pumps of air and then quickly release the pressure - Repeat for the remaining meatuses

Answer 11

very sensitive to pain and stimuli impatient and cranky violent impulses discouraged or even suicidal over their suffering dream of fires and tend towards pyromania fear violent accidents, injury very cold and intolerant to it painful swelling and ulceration offensive odors from discharges stitching, sharp, or splinter-like pains

Answer 12

closed, suspicious, emotionally intense, putrid, dribbly, smelly paranoia irritability, anxious, restless, urge to kill, or be killed suicidal frequent infections offensive greenish discharges, abscess, suppressed ones aggravates worse at night, heat, and cold tremor

Answer 13

reserved/private responsible, dependable, put together mature beyond their years holding an old betrayal close to the chest but will not openly share or complain unless directly asked affected by grief and ailments from it sad but can't cry easily offended or wounded desire to be alone periodicity to complaints

Answer 14

changeable, emotional, weepy, clingily thick/greenish yellow discharges dogmatic about their beliefs strong attachments to few individuals desires consolation, manipulative to get affection worse warm

Answer 15

- Rhinovirus (i.e., respiratory syncytial virus) - Adenovirus - Parainfluenza virus - Coronaviruses

Answer 16

- Nasal congestion - Rhinorrhea - watery thick - Mild sore throat and cough - Headache and malaise - Fever - unusual in adults; low grade in children

Answer 17

Nasal mucosa is erythematous, swollen, and congested with discharge

Answer 18

-hydrotherapy: constitutional, hot fomentation, colonics, enema, 42s, carrot/ginger therapy, fever therapy -rest -stress reduction -increase water intake -fasting not more than 48 -chicken soup or miso First sign of sx - HP: ocillococcinum - Yin chiao - echinacea - esberitox - Zinc lozenges - mycosheild Sicker patients - bioflavonids - vit C - Carrot juice

Answer 19

- sambucus - ginger - achillea - salvia - foeniculum - Eriodictyon - Stillingia - Verbascum - Glycyrrhiza - Usnea - Ligusticum

Answer 20

to be taken at the first sign of cold, especially after exposure to dry, cold wind. Sneezing, burning throat, thirst, restlessness at night, buzzing in ears. Clear, hot discharge < stuffy atmosphere. * Useful only during onset

Answer 21

sneezing, with streaming nose & eyes. Nasal discharge makes nose and upper lip sore. Hot, thirsty, headachy. < warm room. > open air. Cough hurts larynx

Answer 22

gets cold with every change of weather. Sneezing frequent and painful. Thin, watery, burning nasal discharge, irritates nostrils. Intense tickle inside nose, one spot. Tends to move to chest. < after midnight, > warm drinks, burning pains relieved by heat. Sensation of "ice cold water or boiling water coursing through veins". Thirst for small amounts.

Answer 23

sudden onset of cold, perhaps even violent. After exposure, especially chilling of head. Face flushed, skin feels hot and dry to touch. Fever may strike quickly, restlessness. Sensitivity to light. Sore throat, bright red, < right side. Very little nasal discharge. thirstless.

Answer 24

Symptoms slow in developing, onset delayed. Much sneezing, eyes red and watery. Nasal discharge watery. Lips & mouth dry, great thirst for large quantities. Tendency to spread to chest, painful cough. Severe headache. < slightest movement, warm room.

Answer 25

old follows exposure to cold, wet or chilling after being over-heated. Profuse watery discharge from nose and eyes. Nose runs more in warm room. Sneezing severe, eyes red and sore. Wants to keep nose warm, neck stiff, throat sore, pains in back and limbs. < cold room.

Answer 26

Recommended for early stages of cold with no marked indications, except fever

Answer 27

Profuse watery discharge from nose and eyes. Makes eyes, but not nose, sore. Discharge < at night when lying down. Cough < by day, > lying down.

Answer 28

Influenza type of cold. Brought on by warm, moist weather, slow onset. Sluggish feeling, chilly, dull headache with heavy feeling in eyes and limbs. Much sneezing and watery discharge. Wants to be left alone. Little thirst. Discharge makes nose sore. Tickling cough, > by fire.

Answer 29

From exposure to dry cold. Much sneezing, nose alternately blocked, running, streams in warm room and daytime. > outdoors. Extremely chilly. Shudders drinking water or least movement.

Answer 30

Begins in chest or throat. Sneezing causes pain in throat or head. Nose alternately blocked or running and red, shiny, sore. Throat sore, voice hoarse. Tight feeling in chest.

Answer 31

healthy diet good hygiene and preventing transmission lactobacillus breastfeeding low stress active lifestyle echinacea and vit C: Vit D Fish oil DHA: hydrotherapy: sauna

Answer 32

low dose antigen diffuses across mucous membranes → Th2 response → allergen specific Th2 clls produce IL-4 and IL-13 and B cells produce IgE → IgE bind to mast cell and activated eosinophils → mast cells release histamine, leukotrienes, kinins, TNFa → contraction of SM, capillary dilation which increases permeability of capillary cells, and glandular hypersecretion.

Answer 33

seasonal - associated with arrival of trees, grass, weeds perennial - dust, mold, dust mites, animal dnader - associated with sleep disorders, sinusitis, serous otitis media and anosmia - dust mite allergy appear to be mediated by IL 22

Answer 34

- Episodic nasal obstruction - Rhinorrhea - Sneezing (uncommon with URI) - Lacrimation and pruritus of nose, eye & throat - Sore throat - secondary to mouth breathing - Nasal voice - Allergic salute - itch nose → crease above the bridge - Itchy eyes→ redness, puffiness

Answer 35

- Internal nose - red; if perennial can be pale, bluish; discharge usually clear and watery - Mouth breathing may cause adenoidal facies- sunken cheeks with high palatine arch. - Airflow obstruction may be objectively quantified with peak nasal inspiratory flow (PNIF) - Allergic shiners may be present - bluish discoloration secondary to obstruction of venous drainage because of nasal and sinus congestion. - May have gingival hypertrophy. - Halitosis - often from mouth breathing - Enlarged adenoidal tonsils - Asthma, atopic dermatitis and urticaria may get worse in individuals with these conditions

Answer 36

- CBC - show eosinophilia may - Nasal cytology demonstrates eosinophils - Scratch tests - RAST/ELISA tests; in vitro serum test - Total serum Ige:

Answer 37

- elimination diet, food allergens, anti-inflammatory diet, Mediterranean diet - avoid trans fatty acid - avoid indoor air pollution and smoking Supplements - antioxidants - vitamin C - Selenium - Vitamin E - Vitamin A - N-Acetyl Cysteine - Quercetin - Catechin - Pycnogenol - Essential Fatty Acids - Vitamin D - Fish oils - Calcium and magnesium - Quail egg - Adrenal support: Consider cortisol and DHEA testing. - probiotics: fermented foods Herbs - urtica: - butterbur - scutellaria biacalensis - green tea - elder flower - astragalus - zingiber - Cromolyn sodium nasal spray: amnii visnaga potent mast cell stabilizer - Hydrastis, Achillea, Euphrasia, Armoracia. - honey biofeedback stress reduction exercise environmental - air filters - HEPA vacuum cleaners - change pillowcase daily, sheets every 2 days Hydrotherapy - sauna - nasal irrigation Homeopathy - arundo - ambrosia - sabadilla - wyethia - euphrasia Sublingual immunotherapy/allergy shots Acupuncture

Answer 38

is unclear; believed to be due to same chemical mediators as all rhinitis but activated by non-immune events. Characterized by absence of atopy, T H2 lymphocyte, immunoglobulin E (Ige)-mediated mechanisms

Answer 39

- Sneezing paroxysms - Nasal itching - Runny nose- serous or seromucous hypersecretion

Answer 40

dry atrophic appearance, pallor

Answer 41

- Positive nasal cytology for eosinophils - Negative skin scratch test and normal serum Ige

Answer 42

fibromyalgia, Chronic fatigue syndrome, IBS,

Answer 43

thought to be secondary to imbalance between the sympathetic and parasympathetic nervous systems. The parasympathetics =>increase in cholinergic (ACH) leads to vasodilation, nasal congestion and increased mucous secretion. This condition is more common in women. One theory is estrogens inhibits acetylcholinesterase → inc acetylcholine (parasympathetic neurotransmitter)

Answer 44

Obstruction with or without rhinorrhea, will complain of chronic sinus problems chronic, not seasonally or geographically associated Bilateral or unilateral May alternate sides

Answer 45

Obstruction with or without rhinorrhea, will complain of chronic sinus problems chronic, not seasonally or geographically associated Bilateral or unilateral May alternate sides

Answer 46

Swollen inferior nasal turbinates, Color - dark red to blue. Significantly increased mucus production.

Answer 47

All IgE allergy tests negative Negative nasal smear

Answer 48

nervine herbs food sensitivities massage spinal manipulation stress management 15 micrograms *capsaicin* (from capsicum) suspended in 100 microliters solution acupuncture

Answer 49

Reserpine, Methyl Dopa, Beta-blockers, BCP (birth control pills) Abuse of sympathomimetic nose drops and sprays cocaine

Answer 50

Redness, edema, friability of mucosa

Answer 51

Patient education, allopathic treatment is to switch to steroid sprays and wean off. Naturopathic: slowly wean off substituting sympathomimetics with saline spray

Answer 52

Inhalation exposures can produce asthma and rhinitis by several mechanisms. Respiratory irritants can lead to asthma and rhinitis through interaction with chemical irritant receptors in the airway

Answer 53

- Associated with allergies - Tonsils enlarge =>-nasal obstruction

Answer 54

occupational exposure to chemicals, such as nickel, wood or leather dusts, chromate, formaldehyde, and chlorophenol,

Answer 55

With persistent unilateral nasal discharge, discharge is bloody.

Answer 56

referred to an otolaryngologist

Answer 57

crayons, peas, stones, erasers, gum Causes airway obstruction and secondary bacterial infection

Answer 58

Unilateral discharge, foul smelling, snoring

Answer 59

0.5% phenylephrine (Neo-Synephrine) topical lidocaine direct visualization using forceps, curved hooks, cerumen loops, or suction catheters blowing their nose Refer EENT

Answer 60

bronchial foreign body

Answer 61

secondary to head trauma, sinus surgery, weightlifting

Answer 62

history of prominent unilateral nasal drainage clear profuse discharge

Answer 63

increased discharge with Valsalva, jugular vein compression, and lowering head negative swelling, redness, normal mucosa

Answer 64

check for glucose CT with CSF dye

Answer 65

interventional neuroradiologist

Answer 66

Chronic rhinitis predisposes due to traction effect of nose blowing and forced breathing

Answer 67

Pale grape-like swellings that project into the nasal lumen from the turbinates opalescent appearance, soft consistency, ethmoid origin, and tissue eosinophilia

Answer 68

small polypoid swellings along the lateral middle turbinate and ethmoid region may require rhinoscopy for identification - ***Grade 1***: smallest size polyps within the middle meatus not reaching the inferior edge of the middle turbinate). - ***Grade 2***: polyps within the middle meatus reaching the inferior border of the middle turbinate. - ***Grade 3:*** polyps extending into the nasal cavity below the edge of the middle turbinate but not below the inferior edge of the inferior turbinate - ***Grade 4:*** polyps filling up the nasal cavity

Answer 69

Surgically remove, medical polypectomy with steroids HP: Calc., Sang., Teucr., Thuj. low salicylate diet high omega-3

Answer 70

Viral rhinitis => blocked ostia => O2 absorbed => negative pressure (pain at this stage = vacuum sinusitis) => transudate => bacteria invade => inflammation => Ciliary dyskinesis=> positive pressure => pain Haemophilus *influenza* Streptococcus *pneumonia (more severe)* Anaerobes Gram-negative bacteria Staphylococcus *aureus* Moraxella *catarrhalalis* Streptococcus *species*

Answer 71

symptoms for less than four weeks

Answer 72

symptoms for four to twelve weeks

Answer 73

persists greater than twelve weeks.

Answer 74

four or more episodes of ARS per year, with interim symptom resolution.

Answer 75

Sudden onset of malaise, fever, nasal congestion, purulent rhinorrhea, post-nasal drainage with throat clearing, facial or head pain, mucopurulent discharge low-grade fever

Answer 76

diffuse mucosal edema, narrowing of the middle meatus, inferior turbinate hypertrophy, and copious rhinorrhea or purulent discharge Pain localized to the sinuses Sinus transillumination is negative

Answer 77

Purulent nasal discharge Maxillary tooth or facial pain Unilateral maxillary sinus tenderness Worsening symptoms after initial improvement

Answer 78

C-reactive protein CT only for recurrent symptoms Sinus tap: puncture into maxillary sinuses

Answer 79

1. Persistent symptoms or signs of ARS lasting 10 or more days without evidence of clinical improvement. 2. Onset of severe symptoms or signs of high fever (>39°C or 102°F) and purulent nasal discharge or facial pain for at least three to four consecutive days at the beginning of illness. 3. Onset with worsening symptoms or signs (new onset fever, headache, nasal discharge) following a typical viral upper respiratory infection that lasted five to six days and were initially improving.

Answer 80

Kartagener syndrome genetic disorder secondary: Smoking, asthma and allergic rhinitis, chronic rhinitis and sinusitis, chronic bronchitis, Sick building syndrome, air pollution, cystic fibrosis, and lung carcinoma Asthma and sinusitis

Answer 81

situs inversus, chronic sinusitis, and bronchiectasis

Answer 82

- viral URI - daycare - allergic rhinitis - dairy and food allergies - anatomic obstruction - Mucosal irritants (e.g., dry air, tobacco smoke, chlorinated water) - Sudden changes in atmospheric pressure (e.g., descent in an airplane)

Answer 83

older children will have fever, facial pain, rhinorrhea. Younger child less obvious. Increased irritability and vomiting occurring in association with gagging on mucus and/or prolonged cough

Answer 84

preseptal cellulitis orbital cellulitis septic cavernous sinus thrombosis meningitis osteomyelitis epidural abscess subdural empyema brain abscess

Answer 85

welling and erythema of the lids and periorbital area; there is no proptosis or limitation of eye

Answer 86

Pain with eye movement, conjunctival swelling (chemosis), proptosis, globe displacement, limitation of eye movements (ophthalmoplegia), double vision, vision loss.)

Answer 87

Ptosis, proptosis, ophthalmoplegia, periorbital edema, headache, alterations in mental status

Answer 88

Fever, headache, nuchal rigidity, and change in mental status, petechial rash

Answer 89

Forehead or scalp swelling, headache, photophobia, fever, vomiting, lethargy

Answer 90

Papilledema, focal neurologic signs, headache, lethargy, nausea, vomiting.

Answer 91

subdural empyema: Fever, severe headache, meningeal irritation, progressive neurologic deficits, seizures, signs of increased intracranial pressure

Answer 92

Unilateral headache, neck stiffness, changes in mental status, vomiting, focal neurologic deficits, seizures, third and sixth cranial nerve deficits, papilledema

Answer 93

- invasive sinusitis - fugus ball of the sinus - allergic

Answer 94

Invasive: HIV or chemoherapy fungus ball: Aspergillus allergic: mold, preceding sinus surgeries and nasal polyposis,

Answer 95

allergic: chronic sinus pain

Answer 96

requires histology of nasal secretions or tissues

Test 4 Flashcards

(124 cards)