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Test four (weeks 6 + 7) Flashcards

1
Q

What is bilateral nasal specific technique?

A

Procedure in which a balloon is inserted into each nasal passage in 3 different positions; briefly inflated in each position, then removed

Serves to open nasal passages and allow for optimal breathing and drainage of sinuses

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2
Q

Major indications for BLNS

A

Sinusitis (chronic/recurrent, acute with no sig rhinitis)
Snoring
Headaches
Hx facial trauma w pain/dysfunction
Difficulty breathing through nose

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3
Q

Other conditions that have been treated with BLNS

A

Seizure disorders
Nasal polyps
Sphenoid malposition (pituitary hypofunction)
TMJ dysfunction

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4
Q

CI BLNS technique

A

Implanted hardware
Severe epistaxis (blood thinning meds, clotting disorders)
Recent nasal surgery
Status post surgery
Foreign body in nose
Latex allergy

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5
Q

Cautions BLNS technique

A

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

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6
Q

Nat mur themes

A

Proper, responsible, closed off, perfectionist, disciplined, dry, never better since grief/being betrayed or forsaken

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7
Q

Nat mur healthy pt

A

“Buttoned up”
Friendly but reserved
Dependable, responsible, mature, disciplined
Holds old betrayals, wont share unless directly asked
Intolerant to imperfections (small pimples)

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8
Q

General clinical picture nat mur

A

Very affected by grief, betrayal like a child “little adult”
Well put together, not overly done
Perfectionist
Fingernail biter
Insomnia thinking about past
Sleeps on left side, dreams of robbers

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9
Q

Emotional complaints nat mur

A

Betrayal
Depression, suicidal thoughts
Easily offended/humiliated
Sad but can’t cry > involuntary crying
Dwells on past

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10
Q

Aversions nat mur

A

Company, consolation
Fatty/slimy foods like egg whites, chicken, bread, salt, milk
Sensitive to noise/music

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11
Q

Fears nat mur

A

Robbers, break ins, dark, storms, insects, germs, heights, claustrophobic

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12
Q

Aggravations nat mur

A

Heat
Sun
Sea (can be better or worse)
10am

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13
Q

Cravings nat mur

A

Salt, sour, bitter, beer, chocolate, fish, burned food, bread, milk
Ice cold drinks

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14
Q

Onset nat mur

A

Periodicity, sx recur at intervals (such as fever, malaria)

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15
Q

Clinical uses nat mur

A

Recurring/periodic fevers

Vertigo worse looking in distance, with nausea and falling to the left

Migraine, hammers beating head, hx head injury/grief, numbness in face beforehand

Facial neuralgia

Egg white coryza/colds with sneezing

Herpetic eruptions

Pharyngitis with stitching pains

Sensation of lump in throat

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16
Q

Hepar sulf themes

A

Cold, hypersensitive, irritable, anxious, painful, intolerant, impatient, swollen

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17
Q

Hepar sulf pain

A

stitching, splinter like, sharp debilitating pains
Inc sensitivity to pain, complains intensely
Slow to heal
Painful swelling and induration of glands, abscesses, ulcers

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18
Q

Hepar sulf healthy pt

A

Deep remedy; sensitive to all stimuli and pain, dont like to leave home, impatient and cranky

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19
Q

General clinic picture Hepar sulf

A

Oversensitive to all external stimuli, esp pain
Irritable/angry outbursts
Mental anguish at night
Critical, impatient, hurried, anxious
Discouraged, suicidal over suffering
Violent impulses to stab/kill
Fire (dreams, impulses of pyromania)
Offensive odors, sour/old cheese, sour smelling stool
Lots of pus

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20
Q

Fears Hepar sulf

A

Hearing of violent accidents or movies, injury, dentist

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21
Q

Temps Hepar sulf

A

Chilly and aggravated from cold
One of coldest remedies
Worse uncovering hands or feet
Intolerant to drafts, esp cold dry winds
Head sensitive to uncovering (ear pain, headache, etc)

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22
Q

Desires Hepar sulf

A

Pyromania
Violent impulses to stab or kill
Fat, sour (esp vinegar/pickles), spicy, pungent

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23
Q

Hepar sulf clinically used for

A

V painful otitis media (pt shrieking, can’t be comforted)

Otorrhea

Ears v sensitive to wind

Iritis, corneal ulcers

Conjunctivitis

Eruptions on eyelids

Sinusitis with thick dc, post nasal dc

Dental abscesses, toothache, gum abscesses

Swollen tonsils

Croup

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24
Q

Mercurius themes

A

Closed, suspicious, emotionally intense, impulses, putrid, dripply, smelly, sweaty, ulcerated

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25
Mercurius healthy pt
Too pathological to truly have a healthy pt; may put on a facade of normalcy, thnk others out to get them
26
General clinical picture mercurius
Introverted, closed, emotionally intense and suspicious Hurried, irritable, anxious, restless Violent destructive impulses (stabbing, screaming, punching nose of strangers, sex, kill/get rid of enemy) Slow to answer, stammering Withdrawn, depressed, suicidal Offensive dc, stool, breath Sick often Abscesses, v painful Ulcerations Bone pain Metallic taste in mouth, drooling Imprint of teeth on tongue Wake up with weakness, SOB on exertion Pale, marble blotchy and translucent face
27
Fears mercurius
Death, disease, insanity, darkness, heights, ghosts, people, agoraphobia, poverty (stingy)
28
Aggregation/aversion mercurius
Suppressed dc Perspiring, night sweats Aversion to sweets, salts, artichokes
29
Cravings mercurius
Bread and butter, sweets, salty
30
Mercurius clinical uses
Rhinitis, chorionic, green dc Althea in mouth/tongue Ulceration in mouth/pharynx Otitis media (acute + chronic) Gingivitis, toothache Conjunctivitis, iritis Acute or chronic pharyngitis with coated tongue and salivation Tonsillitis Sinusitis, URIs
31
Pulsatilla themes
Changeable (weather vane remedy), weepy, need consolation/affection, emotional, clingy, warm, thick/greenish yellow dc
32
Healthy pt pulsatilla
Soft, sensitive, prone to shyness Attached, wants affection Clingy/anxious Changeability w softness (have a hard time explaining patterns bc of Changeability) Dogmatic about beliefs/religion but otherwise easily influenced and dependent on others
33
General clinical picture pulsatilla
Changes (no two stools the same, no two menses the same) Sensitive, attached Weeps easily Changeable moods, forsaken, desires consolation, worse stress Irritable/manipulative to get affection Sleeps with arms raised over heads Hormone problems, allergies, acute infection Congestion in circulation Sensation of cold water on back Thirstless (but mouth may be dry)
34
Pulsatilla aggrevations
Worse warm room, before menses, evening, sun ,exertion, fatty foods, lying on left or painless side
35
amelioration pulsatilla
Better open air, cold, pressure
36
CBC results allergic rhinitis
MAY show eosinophilia
37
Nasal smear results allergic rhinitis, cholinergic rhinitis, NARES
Allergic - eosinophils Cholinergic - negative NARES - eosinophils
38
Scratch test results allergic rhinitis, cholinergic rhinitis, NARES
Allergic - wheals/flares, IgE reaction Cholinergic - negative NARES - negative
39
Pathophys of allergic rhinitis
Th2 > IL-4, IL-13 > IgE > mast cells > histamine, LT, kinins, TNFa > contraction of smooth muscle, cap dilation (inc permeability), glandular hyper-secretion
40
What supplements help stabilize cell membranes?
Antioxidants EFAs
41
What supplement stabilizes mast cell membranes?
Quercetin stabilizes mast cell membranes, inhibits degranulation and reduces IgE production
42
Which bioflavonoid inhibits histidine decarboxylase and is also a potent antioxidant?
Catechin
43
Which class of EFAs do atopic patients have trouble converting?
Atopic pts have problems converting linoleum acid > PGE1 Linoleum acid > GLA > DgGLA > PGE1
44
What foods should allergic patients avoid?
Dairy, citrus (cooling, mucus) Foods that trigger arachidonic acid pathways (trans fatty acids)
45
Ways to support the adrenals
Vit C B vitamins DHEA if indicated Ginseng Drenatrophin, antronex
46
herbal Ed’s formula for hay fever
Hydrastis, achillea, euphrasia, armoracia
47
Echinacea and Vit C effectiveness in cold prevention/tx
Not beneficial in prevention, helpful in treatment when sx appear
48
Types of inflammatory rhinitis
Eosinophil-predominant Neutrophil-predominant Complex infiltrates
49
Eosinophil predominant inflammatory rhinitis ex
Allergic rhinitis NARES Nasal polyps (Sampters triad) Fungal sinusitis (allergic and non-allergic) Churg Strauss Eosinophilic granuloma
50
Neutrophil predominant inflammatory rhinitis ex
Acute bacterial rhinosinusitis Foreign body with infection Corrosive occupational rhinitis Acute infection Nasal polyps in cystic fibrosis HIV/AID rhinosinusitis Immunodeficiency Hypogammglobulinemia Kartageners
51
Complex infiltrates inflammatory rhinitis ex
Common colds TB Leprosy Syphilis Autoimmune Atrophic rhinitis Basophilic/metachromatic non allergic Granulomatous and vasculitis disease
52
Ex of structural abnormalities leading to non-inflammatory rhinitis
Deviated septum Hypertrophic turbinates Strictures Tumors Foreign body
53
Hormonal causes of non-inflammatory rhinitis
Pregnancy Hypothyroid Acromegaly Adrenergic dysfunction
54
Drugs that can contribute to non-inflammatory rhinitis
Anti hypertensives (beta blockers, reserpine) Chronic topical a-adrenergic agonist abuse (Afrin) Cocaine abuse Eye drops/glaucoma meds Chlorpromazine (neuroleptic)
55
Neural dysfunction causes of non-inflammatory rhinitis
Absent sympathetic function (horners, stellate ganglion resection/block) Hyperactive cholinergic parasympathetic function (inc mucus) Nociceptive/irritant rhinitis Cold, dry air induced Food induced
56
Supplements used for inner ear disorders
Zinc Magnesium Glutathione B6/pyridoxine Vit A, D, B12, iron if def Folic acid
56
Zinc usage in inner ear disorders
Presbycusis, other SN hearing loss
57
Magnesium use inner ear disorders
Ototoxicity from aminoglycoside antibiotics Noise and age induced SN hearing loss
58
Glutathione use inner ear disorders
Gentamicin toxicity
59
Vit A use inner ear disorders
Vit A def associated with SN hearing loss
60
Vit D inner ear disorders
Vit D def associated with SN hearing loss, BPPV, otosclerosis
61
Vit B12 inner ear disorders
Vit B12 def associated with tinnitus and noise induced hearing loss, presbycusis
62
Iron inner ear disorders
Iron def associated with SN hearing loss
63
Clinical / sub clinical endocrine disorders associated with inner ear disorders
Hypothyroid, diabetes, dysglycemia Inner ear highly vascular, organ of orti and vestibular apparatus have high metabolic rate > ATP dependent (glucose) > highly sensitive to anoxia and nutrient deprivation
64
Naturopathic recs for reactive hypoglycemia
Inc Whole Foods, water soluble fiber Avoid sugar Chromium in the form of brewers yeast GTF, glycyrrhiza, adrenal protomophogen Reg, balanced meals; lean protein esp at bfast Rule out electrolyte problems
65
Metabolic associated with menieres
Associated with allergy to dust, pollen, mold, and/or food sensitivity (gluten)
66
Hyperlipidemia association inner ear disorders
Combination of atheroslerotic diet and HTN in addition to even moderate noise is devastating to hearing High lipids have also been associated with tinnitus and vertigo
67
Ototoxins
Alcohol Caffeine MSG AA Smoking Quinine Loop and thiazide diuretics Aminoglycoside Vanco-/erythro-mycin Heavy metals Street drugs Platinum chemos
68
What is protective after platinum based chemotherapeutics?
Rosemarius inhibits apoptosis of primary organ of corti and auditory cells Curcumin, Vit E
69
What botanicals are good for increased blood flow?
Ginkgo biloba Vaccinum (bilberry) Capsicum Ginger Vinca minor Vincopocetine Pycnogenol
70
Patients most likely to benefit from ginkgo will have _____
Cerebral insufficiency
71
Ginkgo is useful in what conditions
Tinnitus, vertigo, SN hearing loss
72
Vinca minor inc cerebral blood flow and is indicated in which conditions
Tinnitus SN hearing loss of old age Secondary to arteriosclerosis and vertigo of Menieres
73
Vincopocetine action inner ear disorers
Vasodilators; improves micro circulation of stria vascularis in the inner ear Tinnitus, vertigo
74
Pycnogenol inner ear disorders
Improves tinnitus sx by improving cochlear blood flow in pts with altered perfusion
75
Antiviral botanicals for vestibular neuritis
Lomatium Ligusticum Echinacea Larix Astragalus
76
Curcumin use inner ears
Anti-inflammatory; resolve hearing loss associated with otitis media
77
Nervines role in inner ear disorders
Supports neural tissue and dec stress/insomnia associated with inner ear sx Avena saliva Scutellaria Melissa Pasiflora Hummulus
78
Acupuncture role in inner ear disorders
Tinnitus Vertigo
79
Phys med role in inner ear disorders
Cervical manipulation; hearing loss and tinnitus, aural sx of TMJ Epley for BBPV
80
What are vestibular rehab exercises and what are they used for?
Vertigo Train the brain to use alternative proprioceptive and visual cues to maintain balance; brain adjusts to new baseline of vestibular function
81
Tx otosclerosis
Vit D Calcium citrate or gluconate Osteoprime Gaby/Wright formation for osteoporosis Tea of nettles, raspberry leaf, alfalfa, avena Calc Phos
82
Meniere diet
Low sodium diet Allergy elimination diet
83
Meniere botanicals
Diuretics - taraxacum leaf
84
Meniere pts should avoid
Allergenic foods Sodium Vasoconstrictors (alcohol, caffeine, chocolate)
85
Meds/supplements/therapies meniere
Pyridoxine Migraine meds (comorbid) Diuretics Betahistine, antihistamines, steroids (weak evidence) Vestibular rehab / hearing aids Constitutional hydro
86
Tx acute vestibular syndrome (Labyrinthitis and vestibular neuronitis)
Treat underlying infection; E tube massage Anti inflammatory tx, adrenal support Steroids Acupuncture Homeopathy, anticholinergics, histamine antagonists, benzos Vestibular rehab exercises
87
Presbycusis tx
Ginkgo Antioxidants (via diet is best), NAC Low sat/trans fat Diet, exercise B12, folate, zinc, marine oils Assess thyroid and aldosterone
88
Tinnitus management
Noise protection Correct def (esp B Vit and mg) Homeopathy, acupuncture If cerebral vascular insufficiency: ginkgo, vinpocetine, centella, pychnogennol Cognitive therapy, biofeedback Insomnia Depression Hearing aids Acoustic therapy Transcranial magnetic stim
89
SSNHL tx
Start tx early Steroids Ginkgo Antioxidants: Vit E, alpha lipoic acid High dose IV Vit C Mag oral or IV meyers cocktail Oral zinc B Vit CoQ10 Fasting, inc water, Mediterranean diet Hyperbaric O2 therapy
90
BPPV management
Epley Modify diet to lower serum uric acid Sup Vit D helps prevent recurrences
91
Acoustic neuroma (Schwannoma) management
Gamma knife radiosurgery

EENT (6 decks)

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