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EENT > Test four (weeks 6 + 7) > Flashcards

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
Q

Mercurius healthy pt

A

Too pathological to truly have a healthy pt; may put on a facade of normalcy, thnk others out to get them

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26
Q

General clinical picture mercurius

A

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

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27
Q

Fears mercurius

A

Death, disease, insanity, darkness, heights, ghosts, people, agoraphobia, poverty (stingy)

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28
Q

Aggregation/aversion mercurius

A

Suppressed dc
Perspiring, night sweats
Aversion to sweets, salts, artichokes

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29
Q

Cravings mercurius

A

Bread and butter, sweets, salty

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30
Q

Mercurius clinical uses

A

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

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31
Q

Pulsatilla themes

A

Changeable (weather vane remedy), weepy, need consolation/affection, emotional, clingy, warm, thick/greenish yellow dc

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32
Q

Healthy pt pulsatilla

A

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

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33
Q

General clinical picture pulsatilla

A

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)

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34
Q

Pulsatilla aggrevations

A

Worse warm room, before menses, evening, sun ,exertion, fatty foods, lying on left or painless side

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35
Q

amelioration pulsatilla

A

Better open air, cold, pressure

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36
Q

CBC results allergic rhinitis

A

MAY show eosinophilia

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37
Q

Nasal smear results allergic rhinitis, cholinergic rhinitis, NARES

A

Allergic - eosinophils
Cholinergic - negative
NARES - eosinophils

38
Q

Scratch test results allergic rhinitis, cholinergic rhinitis, NARES

A

Allergic - wheals/flares, IgE reaction

Cholinergic - negative

NARES - negative

39
Q

Pathophys of allergic rhinitis

A

Th2 > IL-4, IL-13 > IgE > mast cells > histamine, LT, kinins, TNFa >

contraction of smooth muscle, cap dilation (inc permeability), glandular hyper-secretion

40
Q

What supplements help stabilize cell membranes?

A

Antioxidants
EFAs

41
Q

What supplement stabilizes mast cell membranes?

A

Quercetin stabilizes mast cell membranes, inhibits degranulation and reduces IgE production

42
Q

Which bioflavonoid inhibits histidine decarboxylase and is also a potent antioxidant?

A

Catechin

43
Q

Which class of EFAs do atopic patients have trouble converting?

A

Atopic pts have problems converting linoleum acid > PGE1

Linoleum acid > GLA > DgGLA > PGE1

44
Q

What foods should allergic patients avoid?

A

Dairy, citrus (cooling, mucus)
Foods that trigger arachidonic acid pathways (trans fatty acids)

45
Q

Ways to support the adrenals

A

Vit C
B vitamins
DHEA if indicated
Ginseng
Drenatrophin, antronex

46
Q

herbal Ed’s formula for hay fever

A

Hydrastis, achillea, euphrasia, armoracia

47
Q

Echinacea and Vit C effectiveness in cold prevention/tx

A

Not beneficial in prevention, helpful in treatment when sx appear

48
Q

Types of inflammatory rhinitis

A

Eosinophil-predominant
Neutrophil-predominant
Complex infiltrates

49
Q

Eosinophil predominant inflammatory rhinitis ex

A

Allergic rhinitis
NARES
Nasal polyps (Sampters triad) Fungal sinusitis (allergic and non-allergic)
Churg Strauss
Eosinophilic granuloma

50
Q

Neutrophil predominant inflammatory rhinitis ex

A

Acute bacterial rhinosinusitis
Foreign body with infection
Corrosive occupational rhinitis
Acute infection
Nasal polyps in cystic fibrosis
HIV/AID rhinosinusitis
Immunodeficiency
Hypogammglobulinemia
Kartageners

51
Q

Complex infiltrates inflammatory rhinitis ex

A

Common colds
TB
Leprosy
Syphilis
Autoimmune
Atrophic rhinitis
Basophilic/metachromatic non allergic
Granulomatous and vasculitis disease

52
Q

Ex of structural abnormalities leading to non-inflammatory rhinitis

A

Deviated septum
Hypertrophic turbinates
Strictures
Tumors
Foreign body

53
Q

Hormonal causes of non-inflammatory rhinitis

A

Pregnancy
Hypothyroid
Acromegaly
Adrenergic dysfunction

54
Q

Drugs that can contribute to non-inflammatory rhinitis

A

Anti hypertensives (beta blockers, reserpine)

Chronic topical a-adrenergic agonist abuse (Afrin)

Cocaine abuse

Eye drops/glaucoma meds

Chlorpromazine (neuroleptic)

55
Q

Neural dysfunction causes of non-inflammatory rhinitis

A

Absent sympathetic function (horners, stellate ganglion resection/block)

Hyperactive cholinergic parasympathetic function (inc mucus)

Nociceptive/irritant rhinitis

Cold, dry air induced

Food induced

56
Q

Supplements used for inner ear disorders

A

Zinc
Magnesium
Glutathione
B6/pyridoxine
Vit A, D, B12, iron if def
Folic acid

56
Q

Zinc usage in inner ear disorders

A

Presbycusis, other SN hearing loss

57
Q

Magnesium use inner ear disorders

A

Ototoxicity from aminoglycoside antibiotics

Noise and age induced SN hearing loss

58
Q

Glutathione use inner ear disorders

A

Gentamicin toxicity

59
Q

Vit A use inner ear disorders

A

Vit A def associated with SN hearing loss

60
Q

Vit D inner ear disorders

A

Vit D def associated with SN hearing loss, BPPV, otosclerosis

61
Q

Vit B12 inner ear disorders

A

Vit B12 def associated with tinnitus and noise induced hearing loss, presbycusis

62
Q

Iron inner ear disorders

A

Iron def associated with SN hearing loss

63
Q

Clinical / sub clinical endocrine disorders associated with inner ear disorders

A

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
Q

Naturopathic recs for reactive hypoglycemia

A

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
Q

Metabolic associated with menieres

A

Associated with allergy to dust, pollen, mold, and/or food sensitivity (gluten)

66
Q

Hyperlipidemia association inner ear disorders

A

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
Q

Ototoxins

A

Alcohol
Caffeine
MSG
AA
Smoking
Quinine
Loop and thiazide diuretics
Aminoglycoside
Vanco-/erythro-mycin
Heavy metals
Street drugs
Platinum chemos

68
Q

What is protective after platinum based chemotherapeutics?

A

Rosemarius inhibits apoptosis of primary organ of corti and auditory cells

Curcumin, Vit E

69
Q

What botanicals are good for increased blood flow?

A

Ginkgo biloba
Vaccinum (bilberry)
Capsicum
Ginger
Vinca minor
Vincopocetine
Pycnogenol

70
Q

Patients most likely to benefit from ginkgo will have _____

A

Cerebral insufficiency

71
Q

Ginkgo is useful in what conditions

A

Tinnitus, vertigo, SN hearing loss

72
Q

Vinca minor inc cerebral blood flow and is indicated in which conditions

A

Tinnitus
SN hearing loss of old age
Secondary to arteriosclerosis and vertigo of Menieres

73
Q

Vincopocetine action inner ear disorers

A

Vasodilators; improves micro circulation of stria vascularis in the inner ear

Tinnitus, vertigo

74
Q

Pycnogenol inner ear disorders

A

Improves tinnitus sx by improving cochlear blood flow in pts with altered perfusion

75
Q

Antiviral botanicals for vestibular neuritis

A

Lomatium
Ligusticum
Echinacea
Larix
Astragalus

76
Q

Curcumin use inner ears

A

Anti-inflammatory; resolve hearing loss associated with otitis media

77
Q

Nervines role in inner ear disorders

A

Supports neural tissue and dec stress/insomnia associated with inner ear sx

Avena saliva
Scutellaria
Melissa
Pasiflora
Hummulus

78
Q

Acupuncture role in inner ear disorders

A

Tinnitus
Vertigo

79
Q

Phys med role in inner ear disorders

A

Cervical manipulation; hearing loss and tinnitus, aural sx of TMJ

Epley for BBPV

80
Q

What are vestibular rehab exercises and what are they used for?

A

Vertigo

Train the brain to use alternative proprioceptive and visual cues to maintain balance; brain adjusts to new baseline of vestibular function

81
Q

Tx otosclerosis

A

Vit D
Calcium citrate or gluconate
Osteoprime Gaby/Wright formation for osteoporosis
Tea of nettles, raspberry leaf, alfalfa, avena
Calc Phos

82
Q

Meniere diet

A

Low sodium diet
Allergy elimination diet

83
Q

Meniere botanicals

A

Diuretics - taraxacum leaf

84
Q

Meniere pts should avoid

A

Allergenic foods
Sodium
Vasoconstrictors (alcohol, caffeine, chocolate)

85
Q

Meds/supplements/therapies meniere

A

Pyridoxine
Migraine meds (comorbid)
Diuretics
Betahistine, antihistamines, steroids (weak evidence)
Vestibular rehab / hearing aids
Constitutional hydro

86
Q

Tx acute vestibular syndrome (Labyrinthitis and vestibular neuronitis)

A

Treat underlying infection; E tube massage

Anti inflammatory tx, adrenal support

Steroids

Acupuncture

Homeopathy, anticholinergics, histamine antagonists, benzos

Vestibular rehab exercises

87
Q

Presbycusis tx

A

Ginkgo
Antioxidants (via diet is best), NAC
Low sat/trans fat
Diet, exercise
B12, folate, zinc, marine oils
Assess thyroid and aldosterone

88
Q

Tinnitus management

A

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
Q

SSNHL tx

A

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
Q

BPPV management

A

Epley
Modify diet to lower serum uric acid
Sup Vit D helps prevent recurrences

91
Q

Acoustic neuroma (Schwannoma) management

A

Gamma knife radiosurgery

EENT (6 decks)

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