Test three (weeks 4 + 5) Flashcards
What constituents of belladonna cause its toxicity?
Anti-cholinergics; atropine, scopolamine, hyoscyamine
Sx of belladonna toxicity
Acute delirium, hallucination, tachycardia, dry mouth, retained urine, flushed skin, vomiting, dilated pupils, blurry vision
What is the deadly nightshade?
Atropa belladonna
How do anticholinergics work?
Block ach from binding to its receptors on certain nerve cells; inhibits parasympathetic nerve impulses
Anti-cholinergics can be used to treat
Nasal and chest congestion, urinary incontinence/overactive bladder
Themes of belladonna
Intense, explosive, sudden, painful, pulsing, throbbing, hot, congestive, swelling, red, violent, delirious
Healthy belladonna patient
Intense, vital, balanced
Avoid extra stimulation because internally already intense
May avoid noisy, bright places
Don’t like to be jarred
Sensitive to touch and temperature changes
May feel very hot or chilly
Onset of belladonna symptoms
Sudden onset, intensity of physical/emotional sx
Subside just as quickly as they come on
Temperatures belladonna
Deep red, hot, dry picture
Dry but thirst less
Sweat only in covered parts
Hot face with cold hands and feet
Belladonna sx are often left or right sided or both?
Right
Are pupils dilated or constricted with belladonna?
Dilated
Aggravating times/factors belladonna
3pm
Cravings belladonna
Lemons/sour
Aversions belladonna
Vegetables, fish, fruit, fat, beans
Thirstless
Touches/loud noises
Movements belladonna
Twitching, jerking, seizures
Emotions belladonna
Explosive sudden anger, red face, “wild eyed”
Mental sx belladonna
Hallucinations, esp during fever
Violent mania or psychosis, desire to bite, hit, spit; able to restrain impulses in early stages
Not really prone to anxiety
Fears belladonna
Dogs and animals in general
Ghosts
Belladonna is clinically used for
High fevers, red in face; pt VERY hot to touch (cold feet)
Excruciating/throbbing headaches and migraines
Infections/inflammation (“itis” of any times)
Sciatica
Acute arthritis
Marked HTN
Anger, rage, mania
Delirium/hallucinations
Vertigo (feels falling to left)
Intense menopause flashes
Dysmennorhea, right sided ovarian cysts, bright red blood with clots
ENT conditions belladonna
Otitis media, right sided, intense pains, bright red TM
Iritis
Pharyngitis and tonsillitis (red, swollen tonsils, right sided, worse swallowing)
Mastitis, right sided, red, painful, worse from touch or motion
What is a complementary remedy to belladonna?
Calcarea carbonica
Belladonna is related to what remedies?
Stramonium, hyoscyamus - part of nightshade family
Antidotes to belladonna
Camphor, coffea, opium, aconite
Acute dosing belladonna
Typically low dose potency and frequently
6C, 12C, 30C QD yo QID as needed
Chronic dosing belladonna
Such as mania, chronic headache, joint pain; consider ascension because of high vitality:
6C daily x 1 week
12C daily x 1 week
30C 3x/week x 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)
What parts of aconite are poisonous?
All parts of the plant, esp roots and seeds
What’s the main constituent present in aconite?
Diterpene alkaloids: isonapelline, luciculine, napelline
Sx aconite poisoning
Heart failure/arrythmia
Respiratory paralysis
Numbing of mouth and tongue
GI disturbances (N/V, abdominal pain, diarrhea)
Muscular weakness
Incoordination
Vertigo
What preparation can reduce the toxicity of aconite? Why?
Decoration; leads to a change in alkaloid composition
Onset of aconite poisoning
Within minutes to a few hours after swallowing
Severity related to onset of arrythmia
Themes of aconite
Fearful, restless, sudden, intense, overexcited
Sx after a fright, shock, trauma, exposure
Healthy aconite patient
Vital, robust
Vital ppl, flushed faces
Sympathetic
Extroverted
Although they are robust, they are vulnerable to shock or exposure and the stressors of modern life
Onset aconite sx
Sudden onset, esp after exposure or trauma
Temperatures aconite
Intense heat and fever that alternates with chills
Heat and flushing to face/ one red cheek, one pale
Thirst for cold drinks
Cold extremities
mental sx aconite
Great fear/anxiety, esp fear of death
Numbness, “out of body” detached feeling
Excessive excitability
Aggravating factors aconite
Inflammatory conditions from sudden exposure to cold, dry winds
Worse dry, cold weather, wind
Are pupils in aconite dilated/constricted?
Pupils constricted
Desires aconite
Aconite
Heart sx aconite
Chest sx, heart palpitations, heat in chest, excessive excitability vascular system
Clinical indications aconite
Shock or fright
Fear, panic attacks, anxiety disorders
Fever with fast onset after exposure
Intense pain
Vertigo
Angina, arrhythmia, stroke, MI
Bell’s palsy, neuralgia, facial numbness/paralysis
Early stages influenza, URI, pneumonia
Blindness, photophobia
Numbness of mouth/tongue, dry tongue
URI
Urinary retention
Insomnia
ENT indications aconite
URI, cough after an exposure
Early stages URI, pharyngitis, tonsillitis, otitis, conjunctivitis, influenza, pneumonia
Numbness of mouth and tongue, dry feeling on tongue
Bitter taste in mouth
Toothache from cold exposure
Blindness after a shock, photophobia
Complementary remedies aconite
Sulfur (chronic aconite)
Arnica
Coffea
Acute dosing aconite
Typically higher potencies with this remedy; consider 30C QD to QID as needed, or a single dose of 200C
Chronic dosing aconite
Consider higher potency, esp if old trauma is being treated; 30C, 200C, 1M
Apis mellificia comes from what
Domestic/European/western honeybee + their venom
Bee venom exposure sx
Redness, swelling, itching, anxiety, trouble breathing, chest tightness, heart palpitations, dizziness, nausea, vomiting, diarrhea, sleepiness, confusion, fainting, low blood pressure
Anaphylaxis in those allergic
What has bee venom therapy been used for historically?
Inflammatory diseases such as RA
Themes of Apis mellifica
Swollen, bursting, tight, burning, stinging, inflamed, allergic, sudden, intense, dry, red, hot, irritated
Apis healthy patient
Busy, task oriented
Vital, intense, strong
Workaholic, busy bee
Healthy mentally and emotionally
May become irritable and aggressive, esp if protecting their family/friends or if someone is not pulling their weight at work
Controlling and suspicious
Increased sexual desire but balanced sex life
Better exercise
Jealous
Practical
Better/worse apis
Better exercise, cold
Worse suppressed eruptions, hearing bad news, shock, 3pm, heat, warm room, touch, right sided
Temperatures apis
Better cold, worse heat
Fever with alternating sweats and dry heat
Redness that is dusky
Thirstless until very dehydrated then extremely thirsty
Lesions Apis
Swollen, tight, bursting lesions
Cystic
Mental sx Apis
After grief, anger, jealousy
Easily vexed
Awkward/dropping things
Clinical uses apis
Anaphylaxis
Angioedema
Heart conditions/pericarditis
Bee stings
Hives or skin conditions worse with heat
Inflamed, red joints
Edema, swelling with bursting, stinging quality
Allergy, hay fever
Asthma
Pharyngitis
Herpes zoster
Acute nephritis
Meningitis
Pleurisy or bronchitis
Cystitis, pyelonephritis
Amenorrhea
Ovarian cyst (right)
PMS
Rectal bleeding/hemorrhoids
Styes, allergic conjunctivitis
ENT indications apis
Pharyngitis with marked redness
Swelling of uvula, better cold
Tonsillitis with swollen tonsils
Styes, allergic conjunctivitis
Complementary remedies apis
Natrum muriaticum
CI apis
First trimester of pregnancy
Incompatible remedies to apis
Rhus tox
Related remedy to apis
Apium virus (bee venom)
Acute dosing apis
Low dose potency and frequently for acutes
6C, 12C, 30C QD to QID as needed
Chronic dosing apis
Ascension because of high vitality
6C daily x 1 week
12C daily x 1 week
30C 3x/week for 2-3 weeks
200C once (or ongoing once a week for a few weeks if needed)
Arsenicum album is made from which form of arsenic?
White arsenic, trioxide, by-product of copper refining
Acute arsenic poisoning sx
N/V
Abdominal pain
Severe diarrhea
Encephalopathy
Peripheral neuropathy
Large doses of arsenic can lead to
Dehydration, shock, abnormal heart rhythms, multiple organ failure, death
Themes arsenicum
Anxious, restless, burning, acrid, putrid, exhausted, dependent, compulsive, better heat
Healthy patient arsenicum
Deep remedy; most people with this remedy have some sort of pathology
Emotional sx arsenicum
Anxious, proper, tense, worried, depressed
Enjoyment restricted
Sees everything from a personal standpoint
Many fears including disease, death, poisoning, cancer, poverty, being alone, worries about family, hypochondriac
Restlessness
Perfectionist, compulsive disorders, needs control, plans everything, compulsive hand washing
Impulse to kill, but fear of killing someone
Aggravating at the sea
Arsenicum left or right sided?
Right sided
What remedy is ting and saves money/is possessive with money?
Arsenicum
What remedy is stingy and saves money/is possessive with money?
Arsenicum
What remedy has an impulse to kill themseleves/others but fear of doing it?
Arsenicum
Arsenicum better/worse
Worse 12-2am, cold air and drinks
Desires heat, can hardly ever be too warm, burning pains better with heat
What remedy has acrid, excoriating discharges?
Arsenicum
What remedy has a tendency to malignancy?
Arsenicum
What remedy is thirstless, thirsty for frequent small sips?
Arsenicum
What remedy fidgets, paces, is super restless?
Arsenicum
What remedy has fever from 12-2 or 3 am or 12-2 or 3pm with delirium?
Arsenicum
Temperatures arsenicum
Chilly, aggravated by cold air and drinks
Desires heat, can hardly ever be too warm
Burning pains with amelioration by heat
Hot heat and cold body
Fevers with delirium 12-2/3
ENTClinical uses arsenicum
Iritis, severe photophobia
Conjunctivitis
Corneal ulceration
Burning eyes, acrid lacrimation
Burning lid margins
Coryza
White tongue
Pharyngitis
Ulceration of throat
Cough
Antidotes arsenicum
Nux vomica
Hepar
China
Opium
Carbo veg
Acute dosing arsenicum
Low potency, frequency for acutes
6C, 12C, 30C QD to QID as needed
Chronic dosing arsenicum
Ascension because of high sensitivity and anxiety; pt may be afraid to take the remedy and afraid of aggravation
6C daily x 1 week
12C daily x 1 week
30C 3x/week for 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)
Phosphorus poisoning sx
Severe vomiting and diarrhea (smoking and luminescence, garlic odor)
Dysrhythmias, coma, hypotension, death
Severe burns if contact with skin
Carbonated beverages with phosphoric acid have been linked with diabetes, HTN, kidney stones, CKD
Themes of phosphorus
Poor boundaries
Open
Sensitive
Excitable
Spacey
Anxious, fearful
Hard time holding in substances/thoughts
Healthy patient phosphorus
Bubbly, open, outgoing, extroverted
Sparkles with intelligence, creativity, enthusiasm
Lacks strong boundaries, ungrounded
Extremely sympathetic
Flighty, squirrel brain
Loves company
Suggestible and gullible
Intuitive, clairvoyant
Anxious
Suffers with others because they can feel it
Which remedy has a poor resistance to infection or invasion?
Phosphorus
Better/worse phosphrus
Better with sleep
Sensitive to odors
Left sided
Temperatures phosphorus
Very thirsty for very cold drinks, craves cold foods
Which remedy has large appetites, craves cold foods and salt?
Phosphorus
Phosphorus discharges
Nose runs/bleeds
Menses heavy
Diarrhea
Vomits, easily dehydrated
Easily bleeds bright red blood
What remedy is easily startled/has a sensitive nervous system?
Phosphorus
Fears phosphorus
Anxiety, fear about health and loved ones but easily reassured in moment
Doesn’t want to be alone and wants reassurance nothing bad will happen
ENT clinical uses phosphorus
Compromised mucous membranes
Detached retina, retinal hemorrhage, retinitis, optic neuritis, glaucoma
Dry lips and tongue with dehydration
Hay fever
Frequent nose bleeds, esp kids
Incompatible remedy to phosphorus
Causticum
Acute dosing phosphorus
Low potency and frequency
6C, 12C, 30 C QD to QID as needed
Chronic dosing phosphorus
30C 3x/week for 2-3 weeks
200C once (or ongoing at least once a week for a few weeks if needed)
What remedy is thirsty for lots of cold water but will throw it up once it warms in their stomach?
Phosphorus
Which remedy has burning pains but still better with heat?
Arsenicum
Presentation BPPV
Paroxysmal, brief, always positional vertigo
Comes and goes as it gradually improves, may recur
NO hearing loss
Dx BPPV
History
Pos dix-hallpike
Therapeutic response to epley maneuver
Presentation vestibular neuronitis
Sudden onset, constant and severe vertigo (becomes intermittent as it resolves)
Better movement, often follows viral infection
No hearing loss, no tinnitus
Dx vestibular neuronitis
History
Normal hearing
Spontaneous horizontal nystagmus
Resolves in hours > days
Abnormal VOR
Labyrinthitis presentation
Mild to severe vertigo accompanied by concomitant ear, sinus, or nose infection
Hearing loss with tinnitus, AOM/OME
Resolves in days to weeks with resolution of acute infection
Labyrinthitis dx
ENT exam
Abnormal VOR
Meniere disease presentation
Episodic attacks of severe vertigo with aural fullness and sensorineural, unilateral hearing loss
Meineres disease dx
History
Recurrences
ABR
Abnormal VOR
Cholesteatoma presentation
Recurrent vertigo with hx of AOM with perforation, slow progression of sx
Conductive hearing loss
Cholesteatoma dx
Usu visible on otoscopic exam
Perilymphatic fistula presentation
post-traumatic vertigo that does not improve over time
Mixed or SN hearing loss
Perilymphatic fistula dx
Pos fistula test
(Insufflation makes sx appear)
Valsalva
Acoustic neuroma presentation
Progressive unilateral SN hearing loss with vertigo, gradual development
Acoustic neuroma dx
Auditory brain stem response
MRI
Nystagmus central v peripheral vertigo
Central: bidirectional, downbeat, gaze evoked, torsional, vertical
Peripheral: unidirectional, horizontal, can be suppressed by visual fixation
Dix hallpike central v peripheral vertigo
Central - NONE
Peripheral - latency, adaptability, fatiguability
Pursuit central v peripheral vertigo
Central - pursuit broken
Peripheral - pursuit intact
VOR central v peripheral vertigo
Peripheral = + VOR, catch up saccade
Central = none
caloric and tulios central v peripheral vertigo
Central - normal
Peripheral - abnormal
Red flags with central vertigo/stroke
Hyper acute onset
Normal head impulse test
Focal Neuro deficits
Occipital headache, new onset headache with vomiting
Gait ataxia
Onset with valsalva
Slurred speech
Why do endocrine/metabolic conditions affect hearing?
The inner ear is highly vascular, and the organ of corti and vestibular apparatus have a high metabolic rate, making them ATP dependent, mainly from glucose >
inner ear is very sensitive to anoxia and nutrient deprivation.
What endocrine/metabolic conditions should be looked at with inner ear disorders?
Hypothyroid
Diabetes
Dysglycemia
Hyperlipidemia
Weber test
Testing for bone conduction with 512 hz tuning fork
Lateralize to bar ear = conductive
To good ear = SN
Rinne test
Air conduction v bone conduction with tuning fork
AC > BC - normal
BC > AC - conductive
AC > BC, both diminished - SN
Audiology testing normal levels
0-25dB
Electrocochlegraphy test
Controversial in dx of meunière/endolymphatic hydrops
Screening for hearing loss in infants
Auditory brain stem response test
Time it takes impulse to get from cochlea to brain stem
Prolonged with acoustic neuroma
Test objective hearing in young children
Types of conductive hearing loss
Otoscelerosis
Traumatic
Inflammatory
Traumatic conductive hearing loss presentation
Type Ad (disrupted) tympanogram
Inflammatory conductive hearing loss hx
AOM, OME
Otosclerosis presentation
Progressive, well preserved speech discrimination
Carharts notch (dip in bone conduction)
Schwartez sign (pink/blue promontory on otoscopic)
Hear better in noisy places
Type As(stiff) tympanogram
Dx CT of temporal bone
Types of SN/perceptive hearing loss
Congenital
Traumatic (starts w tinnitus)
Rubella, jaundice or anoxia at birth, brain injury
AOM (strep), measles, syphilis, VRI
Neoplasticism
Metabolic/vascular
Ototoxicity
SNNHL presentation
> 30 dB loss in 3 cont frequencies < 3 days
Dx of exclusion
Minerals for presbycusis
Zinc
Minerals for aminoglycoside antibiotic toxicity
Magnesium
Supplements for gentamicin toxicity
Glutathione
Ototoxic substances
Alcohol
Caffeine
MSG
ASA
Smoking
Quinine
Loop and thiazide diuretics
Vancomycin
Erythromycin
Platinum based chemo
Heavy metals
Circulatory/chi to middle ear
Ginkgo
Vaccinum, bilberry
Vinpoetine
Pycnogenol
Capsicum and ginger warming herbs
Acupuncture
Tympanometry - define admittance and impedance
Admittance / compliance - how well does energy flow through middle ear system
Impedance - how much flow is blocked by the middle ear system
Effects of admittance/impedance on audiogram
Inc stiffness > harder for low frequencies to transmit (dec low frequency admittance > inc low frequency impedance) > rising audiogram
Inc mass in system > harder to transmit higher frequencies (dec high frequency admittance, inc high frequency impedance) > sloping audiogram
Otoacoustic emission
Response from cochlea’s active mechanic; spontaneous of elicited
Tests only to level of cochlea
Auditory brain stem response testing
Automated - to screen newborns
Neuro diagnosis - potential retrocochlear pathology
Threshold - testing hearing level for pts who can’t be tested with behavioral methods
