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Unit 2- Clin Med > Tinnitus/Uticartia/Etc > Flashcards

Tinnitus/Uticartia/Etc Flashcards

1
Q

Barotrauma treatment

A

avoidance, oral or nasal decongestants, swallowing, valsalva, chewing gum

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2
Q

If rupture of TM, how to tx?

A

time/patience

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3
Q

Perilymphatic fistula treatment

A

ENT

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4
Q

Acoustic neuroma

A

vestibular schwannoma

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5
Q

Schwann cell tumors arise from

A

vestibular portion of CN VIII

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6
Q

Schwann cell tumors are

A

slow growing

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7
Q

What percent of intracranial tumors are schwann cell tumors

A

8%

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8
Q

Classic presentation of acoustic neuroma

A

classic presentation is unilateral sensorineural healing loss and tinnitus

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9
Q

In acoustic neuroma, you may or may not have

A

gait disturbance or other CN involvement

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10
Q

Diagnosis of acoustic neuroma

A

hearing test, mRI or CT (if need to avoid MRI)

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11
Q

Tx of acoustic neuroma

A

surgery, radiation, observation

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12
Q

Tinnitus definition

A

perception of sound in one or both ears

can be buzzing, ringing, hissing, continuous or intermittent, pulsatile or non-pulsatile

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13
Q

How many people in the US are affected by chronic tinnitis?

A

50 million

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14
Q

Pulsatile tinnitus is most commonly _____ in etiology.

A

Vascular (aneurysm)

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15
Q

Other causes of pulsatile tinnitus:

A

auditory

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16
Q

Tinnitus dx

A

history, physical - auscultate for bruits in patients, if pulsatile - refer to ENT

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17
Q

Tx goal of tinnitus

A

make them less aware of it: biofeedback, stress reduction, CBT, benzos, masking devices - white noise

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18
Q

What is barotrauma?

A

pain/trauma to ear related to pressure differences - flying/diving

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19
Q

Tinnitus is associated with

A

depression/anxiety

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20
Q

Allergic rhinitis

A

seasonal, perennial, “hay fever”

can happen all year round if dust, etc.

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21
Q

Vasomotor

A

perennial - non-allergic

happens all year round

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22
Q

Onset of allergic rhinitis

A

onset typically before 30, peak incidence in childhood/adolescence

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23
Q

Pathophysiology of allergic rhinitis: type of antibodies

A

response to allergen exposure by production of IgE antibodies

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24
Q

In allergic rhinitis: IgE binds to

A

mast cells, basophils

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25
Q

In allergic rhinitis: Mast cells exposed to allergies again….

A

release

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26
Q

Mast cells degenerate and release inflammatory mediators

A

histamine, cytokines, leukotrienes, prostaglandins which lead to signs and symptoms of allergic rhinitis

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27
Q

Clinical presentation - symptoms

A

rhinorrhea, sneezing, nasal congestion, itchy eyes, itchy nose/palate, post nasal drip, cough, fatigue

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28
Q

Risk factors of allergic rhinits

A

FH of atopy, male sex, birth during pollen season, firstborn, early use of antiobiotics, maternal smoking exposure, exposure to indoor allergies, serum IgE > 100 before age 6, presence of allergen-specific IgE

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29
Q

Allergic rhinitis symptoms in periorbital area

A

allergic shiners

denie-morgan lines

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30
Q

What are allergic shiners

A

bluish purple rings around both eyes

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31
Q

What are Denie-Morgan lines

A

skin folds under eyes consistent with allergic conjunctivitis

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32
Q

Eye symptoms - allergic rhinitis

A

palpelbral conjunctiva may be pale, sweollen; may see conjunctival injection

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33
Q

Physical exam findings of nose in allergic rhinitis

A

pale, boggy bluish mucosa, clear discharge nasal crease, allergic salute,

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34
Q

Physical exam findings of throat in allergic rhinits

A

post-nasal drainage in posterior pharynx, cobblestoning

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35
Q

Physical exam findings of ears in allergic rhinits

A

serous otitis media

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36
Q

What kind of dx is allergic rhinitis

A

clinical diagnosis

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37
Q

Allergy testing can be

A

confirmatory

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38
Q

Allergy testing can

A

identify candidates for immunotherapy

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39
Q

Allergy testing- skin testing

A

scratch or prick skin testing
wheal-and-flar reactions occur within 15-20 minutes
quick and cost effective

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40
Q

Serum testing for allergies

A

detects IgE antibodies, less risk but less sensitve, more expensive

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41
Q

RIsk associated with skin testing for allergic rhinitis

A

anaphylaxis

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42
Q

When wheal and flare reaction occurs, how large is wheal size

A

greater than or equal to 3 mm

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43
Q

Components of therapy for allergic rhinitis: pharmacotherapy

A

intranasal glucocorticosteroids, oral or intranasal antihistamines, sympathomimetics, decongestants, leukotriene receptor antagonists

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44
Q

3 types of treatment for allergic rhinitis

A

avoidance of allergens, pharmacotherapy, immunotherapy

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45
Q

Allergy is often caused by _____, _____ and _____ rather than hair.

A

dander, saliva, urine

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46
Q

If you have an allergy against animals, what should you do?

A

remove them

47
Q

How long after removing the animal will it take to clear animal particles?

A

3-6 months

48
Q

Pharmacotherapy for allergic rhinitis for children under 2 years old

A

cromolyn sodium nasal spray, 2nd generation antihistamines - zyrtec and allegra approved for kids over 6 months old

49
Q

Mild treatments (or episodic, predictable exposure) in children over 2 and adults for allergic rhinitis

A

Loratadine, cetririzine, fezofenadine,

antihistamine nasal sprays: azelastine (Astelin) for over 5 years old, olopatadine (Patanase) for over 12 years old;

glucocorticoid nasal sprays (start 2-3 days prior to exposure),

cromolyn nasal spray

50
Q

Persistent or Moderate to Severe symptom tx

A

glucocorticoid nasal sprays are considered first line treatment - most effective single agent and fewest side effects

51
Q

Names of glucocorticoid nasal sprays

A

flonase, nasocort, rhinocort, nasoline (these four have highest risk of side effects)

flonase, nasonex, omnaris (less risk of side effects)

52
Q

Allergic rhinitis with asthma

A

montelukast (singular) - useful additive therapty

53
Q

AR with allergic conjunctivitis

A

glucocorticoid nasal spray and ophthalmic antihistamine drops

54
Q

Avoid nasal sprays if:

A

glaucoma and cataracts

55
Q

Pregnant woman with AR - moderate to severe

A

Avoid allergen is possible. If that is not enough - Zyrtec, Claritin, Rhinocort, Flonase, Nasonex

56
Q

Lactating mothers, moderate to severe AR

A

Rhinocort, Cromolyn, zyrtec of claritin

57
Q

In patients who FAIL TO RESPOND to initial glucocorticoid nasal spray, a second agent can be added:

A

antihistamine nasal spray, oral antihistamine, cromolyn, singulair, oral antihistamines/decongestant combo

58
Q

1st generation of antihistamines do what

A

alleviate sneezing, rhinorrhea, and itching - will not relieve nasal congestion

59
Q

1st generation of antihistamines will not offer relief of what

A

nasal congestion

60
Q

Side effects of 1st generation antihistamines

A

dry mouth, sedation, constipation

61
Q

1st generation antihistamines + dosage

A

benadryl - 25-50mg BID/TID

Chlor-trimeton - 4 mg q4-6 hours of 8-12 hours BID for sustained release

62
Q

2nd generation antihistamines benefits

A

less sedating

63
Q

Examples of 2nd generation

A

Claritin - 10mg/day, Allegra - 60 mg BID or 180 QD, Zyrtec - 5-10 mg/day

64
Q

Nasal antihistamines sprays and montelukast (Singulair) have

A

similar effectiveness as oral antihistamines

65
Q

Decongestants

A

sympathomimetics

66
Q

Decongestants indicated for patients with marked:

A

nasal congestion despite antihistamine use

67
Q

Decongestants are

A

vasoconstrictors

68
Q

Vasoconstriction will decrease

A

edema and secretions

69
Q

What are examples of decongestants?

A

pseudoephredrine (Sudafed) - 30-60mg q6-8 hours, or 120 mg BID for sustained release

70
Q

Use caution with _____ when a patient has hypertension or cardiac disease

A

decongestants

71
Q

Immunotherapy is effective for

A

allergic conjunctivitis, rhinitis, asthma

72
Q

____ administration of increasing amounts of allergen

A

gradual

73
Q

Immunotherapy requires:

A

multiple, regularly scheduled visits

74
Q

How long is tx with immunotherapy for allergic rhinitis

A

3-5 years

75
Q

Patient education for dust mite and mold avoidance

A

clean house, humidifiers can worsen symptoms, cover mattress and pillows with plastic, no feather pillows, wash bedding weekly

76
Q

Patient education for pollens

A

close windows, HEPA filters

77
Q

When to refer with allergic rhinitis

A

severe or refractory symptoms, AR and asthma, recurrent sinusitis or otitis media

78
Q

Non allergic rhinitis aka

A

vasomotor rhinitis

79
Q

What is non-allergic rhinitis

A

abnormal autonomic responsiveness

80
Q

What triggers non-allergic rhinitis

A

stress, sexual arousal, perfumes, cigarette smoke, temperature changes

81
Q

When does non-allergic rhinitis occur

A

later in life - greater than 20 years old

82
Q

Non-allergic rhinitis is characterized by

A

nasal congestion, rhinorrhear, postnasal drip

83
Q

Non-allergic rhinitis does not usually have

A

ocular or nasal itching, sneezing

84
Q

How does nasal mucosa occur in non-allergic rhinitis

A

nasal mucosa may appear normal, erythematous, or boggy and edematous

85
Q

Vasomotor rhinits tx

A

avoidance of triggers, nasal glucocorticoids, antihistamine nasal spray, ipratropium nasal spray - use if rhinorrhea is prominent symptoms

86
Q

Adjunctive therapy with vasomotor rhinitis

A

oral decongestants, 1st generation oral antihistamines

87
Q

Nasal polyps description

A

pedunculated, non-tender, grey soft tissue growths

88
Q

Symptoms of nasal polpys

A

nasal congestion,

89
Q

What are nasal symptoms often seen with

A

allergic rhinitis, chronic sinusitis, asthma

90
Q

Tx of nasal polyps

A

nasal glucocorticoids

91
Q

Rhinits Medicamentosa results from

A

regular use of OTC decongestant nasal spray

92
Q

What happens with rhinitis medicamentosa?

A

mucous membranes swollen and erythematous

93
Q

Rebound congestion with rhinitis medicamentosa

A

3 days of use leads to rebound congestion, leads to dependency

94
Q

Tx of rhinitis medicamentosa

A

discontinue afrin, start nasal glucocorticoid spray

95
Q

Uticaria

A

hives welts, wheals

96
Q

Describe uticaria

A

well circumscribed, intensely pruritic, rasied wheals, pale to bright erythema

97
Q

Acute uticaria

A

present less than 6 weeks

98
Q

Chronis uritcaria

A

symptoms recurring most days of the week for greater than 6 weeks

99
Q

Individual lesions are:

A

transient

100
Q

Uticaria vary in:

A

shape and diameter

101
Q

Uticaria is mediated by:

A

mediated by cutaneous mast cells in superficial epidermis

102
Q

Uticaria releases

A

histamine and vasodilatory mediators causes ithcing and localized swelling

103
Q

Uticaria may be accompanied by

A

angioedema (swelling of deeper skin, affecting face, lips, extremities, and/or genitals)

104
Q

Common causes of uticaria

A

infections, allergic reaction to meds, foods, insect stings, direct mast cell activation by morphine, codeine, radioconstrast agents, NSAIDs

105
Q

Uticaria may be confused with

A

uticarial vasculitis

106
Q

Uticarial vasculitis description

A

fixed (lasts longer than 24 hours), painful, red, uticarial plaques with blanching halos, leaves residual hyperpigmentation, link with lupus

107
Q

Tx of uticaria

A

H1 histamine blocker - 1st or 2nd generation

H2 histamine blocker in combo with H1

108
Q

Examples of H1 histmaine blockers

A

hydroxyzine, diphenhydramine, chlorpheniramine, cetrizine, loratadine, fexofenadine

109
Q

Examples of H2 histamine blockers

A

zantac, pepcid, tagamet

110
Q

If angioedema or persistent symptoms, tx uticaria with

A

oral glucocorticoids

111
Q

2nd generation H1 histamine blockers are preferred first line therapy for

A

uticaria

112
Q

Zyrtec and Xyzal may be may effective why?

A

mast cell-stabilizing properties

113
Q

If allergic etiology of uticaria is suspected

A

refer to allergist - may need EPIpen

Unit 2- Clin Med (6 decks)

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