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547 > Week 4 EENT Resp > Flashcards

Week 4 EENT Resp Flashcards

1
Q

Risk factors for hearing loss?

A
  • older age
  • male
  • lighter complexion

High frequency loss

  • low education
  • toxic noise exposure
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2
Q

Presbycusis

-what type of hearing loss? (sensorineural or conductive?)

A

SNHL

symmetric and insidious
high frequency tones first

“I can hear you but I can’t understand you”

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3
Q

When to screen for hearing loss in older adults?

A

-insufficient evidence to support asymptomatic screening in older adults

  • whisper test has good sensitivity and specificity in older adults
  • “do you feel you have any difficulty hearing?”
  • “has anyone told you you have difficulty hearing?”

screen especially if cognitive concerns OR depressive symptoms

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4
Q

Indications for ENT referral?

A

*sudden acute or rapidly progressive hearing loss (<72 hours) is URGENT referral

  • unilateral or pulsatile tinnitus
  • hearing loss with hx of noise exposure, fam hx, TB, syphilis, HIV, Meniere, autoimmune, ototoxic med, otosclerosis
  • acute recurrent chronic dizziness
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5
Q

conductive or sensorineural hearing loss?

  • cerumen
  • presbycusis
  • Meniere’s
  • otitis externa/media
  • diabetes
  • otosclerosis
A
  • cerumen: C
  • presbycusis: S
  • Meniere’s: S
  • otitis externa/media: C
  • diabetes: S
  • otosclerosis C
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6
Q

Common ototoxic medications

“don’t loop and snag my plate Christine Quinn”

A

“Don’t Loop and SNAG My Plate Cristine Quinn”

• Loop diuretics: furosemide 
• Salicylates: high dose ASA
• NSAIDs: Ibuprofen, Indomethacin 
• Antibiotics: tetracyclines, macrolides
• aminoglycosides 
• vancomycin
• PDE5 inhibitors: tadalafil
• chemotherapeutic agent: such as cisplatin
Quinine
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7
Q

red flags for red eye

A

-decreased VA (unless vision clears with blinking)
-pain
-photophobia
-coloured halos
-ciliary flush
-corneal opacification
corneal disruption (fluorescein uptake)
-abnormal pupils
-increased IOP
-proptosis

***same day access to ophthalmology

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8
Q

Blepharitis

  • signs and symptoms
  • management
A

red eye, no red flags
flaky deposits on eyelashes
worse in AM

Treatment:

  • warm compresses 3-5 min BID
  • eyelid scrub (2 drops baby shampoo in 2 oz water) BID if oily
  • lubricating eyedrops BID/TID
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9
Q

Dry Eye Disease aka keratoconjunctivitis sicca

what is the most important treatment?

A
  • identify exacerbating factors

- minimize contributing meds

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10
Q

Dry eye disease (sicca)

risk factors?

A

Non modifiable risk factors

  • Female sex
  • Sjogrens
  • age
Modifiable
-dry enviro
-meds
-blepharitis
-smoking
-alcohol use
contact lens use 
-LASIK
pollution, 
activities with decreased blinking
-topical ocular meds
  • poorly fitting sleep apnea masks
  • Parkinson
  • peripheral neuropathy
  • lid abnormality
  • thyroid disease
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11
Q

Treatment for dry eye disease?

A
  • hot compresses
  • artificial tears
  • nighttime lubrication ointments

**artificial tears with preservatives used >QID will worsen symptoms **

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12
Q

What are some medications that can cause dry eyes?

A 
Medications that may impair aqueous production include the following:
	• Antihistamines
	• Beta blockers
	• Phenothiazines
	• Atropine
	• Oral contraceptives
	• Anxiolytics
	• Antiparkinsonian agents
	• Diuretics
	• Anticholinergics
	• Antiarrhythmics
	• Topical preservatives in eye drops (eg, benzalkonium chloride [BAK], thimerosal)
	• Topical anesthetics
	• Isotretinoin
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13
Q

DDx for acute bilateral painless vision loss?

acute unilateral painless vision loss?

A

stroke
**needs urgent imaging

central retinal artery occlusion
stroke

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14
Q

what is the pattern of vision loss in age-related macular degeneration?

A

begins CENTRALLY, extends PERIPHERALLY

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15
Q

Risk factors for age-related macular degeneration?

A
  • age
  • european descent
  • genetics
  • female
  • SMOKING
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16
Q

what is the pathognomonic sign of macular degeneration?

A

DRUSEN (yellow deposits of macula from death of retinal cells)

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17
Q

symptoms of progression from early/intermediate AMD to late AMD?

A
  • loss of far and near vision
  • sudden visual distortion
  • central vision loss
  • change in colour vision
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18
Q

Cataracts

signs and symptoms

A
  • decreased VA/blurred/dim vision
  • decreased color perception
  • starbursts around lights
  • sensitivity to light and glare
  • difficulty with night driving
  • difficulty with vision at night

**cataracts are only clinical relevant if they impact ADLs

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19
Q

what is the pattern of vision loss with primary open angle glaucoma?

A

begins peripherally extends centrally

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20
Q

risk factors for glaucoma?

A 
high IOP (most important risk factor)
**IOP is relative
  • age
  • sub-Saharan African ethnicity
  • family hx
  • high myopia
  • male
  • low SES (late detection)
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21
Q

Symptoms of open angle glaucoma?

A 
rare to have symptoms
bilateral
no ocular pain
loss of central vision is late sign
often unaware of peripheral vision loss
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22
Q

Symptoms of closed angle glaucoma?

A 
elevated IOP >50 mm Hg
mild to severe
unilateral
severe ocular pain
blurred/cloudy vision
halos
headache, nausea, vomiting
Signs:
ciliary flush
fixed dilated pupils
corneal edema
worse in evening

***needs same day assessment

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23
Q

what change in aging causes chronic rhinosinus drainage and postnasal drip?

what groups are at highest risk of rhinitis?

A

nasal passages narrowed, decreased collagen

Geriatric rhinitis: lengthening of the nose and drooping of the tip –> restriction of nasal airflow and narrowing of the nasal passages –> rhinitis.

high risk groups:

  • women
  • younger age
  • snoring
  • GERD
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24
Q

what are the 3 components of standard PFTs?

A
  • spirometry
  • lung volume assessment
  • diffusion capacity
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25
Q

Chronic rhinosinusitis in older adults

what is a major risk factor?
most common organism?

A

SMOKING is major risk factor

S. Aureus most common

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26
Q

4 main symptoms of sinusitis? PODS

A
  • pain and pressure (facial)
  • obstruction
  • discharge (mucopurulent)
  • smell loss (anosmia)
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27
Q

Chronic rhinosinusitis in older adults

frequent co-morbidities?

A
  • nasal polyps
  • asthma (especially severe eosinophilia asthma)
  • elevated IgE levels
  • otitis media
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28
Q

Chronic rhinosinusitis in older adults

pt counselling re: decongestants?

A

Decongestants: to correct underlying mucosal edema
*must limit use to 3 days to prevent rebound congestion and rhinitis medicamentosa
*overuse of oxymetazoline can lead to body being dependent on its vasoconstricting properties
*caution with HTN or cardiac disorder
• Oxymetazoline (Afrin) 0.05% 1-2 sprays each nare 1-2x/day
• Phenylephrine 1% spray/drops 1-2 each nare q4h

*Use with caution in older adults! Especially with HTN or enlarged prostate

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29
Q

Chronic rhinosinusitis in older adults

pt counselling re: nasal corticosteroid sprays?

A

Nasal corticosteroid sprays: to reduce nasal inflammation
*lean forward, angle spray towards cheek, minimal sniffing
*never use with head back (in sniffing position) or pointing to septum
• Fluticasone propionate (Flonase) 50 mcg/spray
• Mometasone (Nasonex) 50 mcg/spray
• Beclomethasone (Beconase) 42 mcg/spray or Qnasl) 80 mcg/spray
• Budesonide (Rhinocort) 32 mcg/spray

Safe for older adults, but can cause epistaxis

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30
Q

What is the spirometry finding that confirms diagnosis of asthma?

A

FEV1 > 12% after bronchodilator
this is demonstration of reversibility

  • need to use age-adjusted spirometry value
  • greater variability = greater confidence in asthma
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31
Q

Asthma

What are some
common triggers?

which medications?

A 
viral infections (common in older adults)
allergens
smoke
exercise
stress

Medications:
beta-blockers, ACE-I, ASA, NSAIDs, COX-2

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32
Q

4 questions to ask to determine level of asthma control

A

in the last 4 weeks

  • daytime symptoms > 2 x/week
  • any night wakening due to symptoms
  • SABA use > 2 x/week
  • any exercise limitation due to symptoms

partly controlled = 1 to 2
poor control = 3 to 4

33
Q

signs and symptoms of interstitial lung disease?

A

Dyspnea
Cough
Dry inspiratory bibasilar crackles
Clubbing (40-70%)

34
Q

risk factors for interstitial lung disease?

A

Risk factors:

  • environmental/occupational exposure: silica, asbestos, mold
  • autoimmune
  • drug-induced
  • family hx
35
Q

Findings on CXR and high res CT for interstitial lung disease?

A

CXR: reticular opacities in mid and lower lobes

CT: reticulation and honeycombing

36
Q

Risk factors for PE

A
  • cancer (strongest risk factor)
  • surgery
  • traumatic fractures
  • prolonged bed rest/sedentary factors
  • hx of DVT or PE
  • meds: tamoxifen, HRT, oral contraceptives

**many are unprovoked

37
Q

What is D-dimer?

age-related changes associated with D-dimer?

A

fibrin degradation product –> small protein fragment after a blood clots is degraded by fibrinolysis

D-dimer can exclude VTE if low clinical probability of PE

D-dimer INCREASES with age so older patients have higher change of false-positives

38
Q

Components of Wells score for PE

A
  • clinical suspicion for DVT
  • tachycardia (HR >100 bpm)
  • immobilization (3+ days) or surgery in last 4 weeks
  • hx of DVT/PE
  • hemoptysis
  • cancer treatment or palliative
  • alternative diagnosis less likely
39
Q

Findings on physical exam for PE:

  • vitals
  • resp
  • CV
  • DVT
A
  • Vitals: tachycardia (often absent), tachypnea (57-90%), hypotension, hypoxemia, low grade fever (40%)
  • Resp: decreased air entry, rales, (50-58%) wheezing
  • CVS: parasternal heave, increased JVP, loud P2 (from R ventricular overload), pleural chest rub, cyanosis
  • DVT symptoms: asymmetrical swelling, tenderness, pain
40
Q

Signs and symptoms of PE

A 
PE's are frequently asymptomatic
******Dyspnea at rest or with exertion (73% of symptomatic pts)
• Palpitations
*******Pleuritic chest pain (66%)
• Hemoptysis (only in 13%)
• Anxiety/apprehension
• Syncope (not common)
Signs of DVT (asymmetric lower extremity swelling, pain, erythema)
41
Q

Imaging workup for suspected PE?

A
  • US for DVT

- CT pulmonary angiogram or V/Q scan

42
Q

risk factors for aspiration pneumonia?

A

poor oral care

-esp gram negative organisms

43
Q

What are the 5 A’s of smoking cessation?

A
  • ask
  • advise to quit
  • assess willingness to quit
  • assist in quit attempt
  • arrange follow up
44
Q

CT chest should be done for lung cancer screening in high risk patients

what are the risk factors?

A
  • age 55-74, and
  • at least 30 pack year history of tobacco, and
  • smoking within the last 15 years.
45
Q

OSA is a risk factor for what 2 conditions?

A

strokes

cardiovascular diseases

46
Q

OSA

symptoms?

A

Daytime: sleepiness, fatigue (mental and physical), falling asleep while watching TV/reading, morning headaches, dry mouth
Nighttime: restless sleep, loud snoring/gasping/snorting

47
Q

OSA

STOP-BANG

A
  • snoring
  • tired during the day
  • observed apnea
  • pressure (HTN)
  • BMI > 35
  • Age > 50
  • Neck circumference > 16 inches (40 cm)
  • Gender: male
48
Q

What is the difference between obstructive and restrictive lung disease?

A

obstructive: PROXIMAL
- difficulty exhaling air all the way out (hyperinflation)

restrictive: DISTAL lung parenchyma
- difficulty filling lungs

49
Q

3 types of respiratory infections in the elderly?

A
  1. community-acquired pneumonia
  2. acute exacerbation of chronic obstructive pulmonary disease
  3. non pneumonic respiratory tract infection.
50
Q

CURB-65 for CAP

-what does CURB stand for?

A
  • confusion
  • uremia (BUN)
  • resp rate >30
  • BP: SBP <90, DBP <60

Age: 65 and older

(can omit U for CRB-65)
**score of 0 = <2% mortality, ok to treat as outpatient, any score above 0 consider hospital assessment

51
Q

Pulmonary TB

common lymph nodes involved:

A

anterior or posterior cervical and supraclavicular nodes

Less commonly involved: submandibular, axillary, and inguinal lymph nodes.

52
Q

What is the gold standard diagnostic test for pulmonary TB?

A

Sputum culture with acid-fast smear (AFB) x 3 samples: gold standard for detection of active pulmonary TB
*ideally in the morning, can be collected same day at least 1 hour apart

53
Q

What is the diagnostic finding on spirometry for ASTHMA?

A

Spirometry showing reversible airflow

12% or greater improvement in FEV1 and >200 mL from baseline after bronchodilator

54
Q

Signs and symptoms of pulmonary fibrosis?

A

Typically age 60+ with hx of smoking
Symptoms: gradual onset of SOBOE and several months of non-productive cough
Exam: bibasilar crackles
-finger clubbing is advanced sign

55
Q

How often should hearing screening be done?

A

for all adults 60+: every 2 years
annually if hearing loss detected

*not covered by MSP

56
Q

Infective endocarditis prophylaxis

antibiotics are recommended in prior to dental cleaning and extractions in these following conditions

A
  • prosthetic cardiac valve
  • hx of IE
  • congenital heart disease
  • cardiac transplant recipients who develop cardiac valvulopathy
57
Q

Infective endocarditis prophylaxis

first line med? dose (for adults)?

A

amoxicillin 2 g po single dose 30-60 min before procedure

58
Q

Acronym RULE for oral cancer lesions?

A

red or red/white lesion
ulcer
lump
especially if in combination OR indurated

**these need to be biopsied

59
Q

Risk factors to consider for oral cancer?

A
  • smoking
  • smokeless (chewing) tobacco
  • alcohol consumption
  • sores in mouth
  • hx of childhood cancer
  • feeding via G/J-tube
  • inhaled corticosteroids
60
Q

Management of dry mouth (xerostomia)?

A
  • stimulate saliva flow with sugar-free candies and lozenges or chewing gum
  • artificial saliva if insufficient benefit
61
Q

Common auto-immune cause of xerostomia?

A

Sjogren’s syndrome

62
Q

Xerostomia increases risk of ______

A

candidiasis

-• Saliva is part of the natural defense system with anti-viral, anti-fungal, antibacterial properties.
As salivary flow decreases (due to many causes), Candida count increases thus patients have a higher prevalence of Candida infections

symptoms:
burning, mouth pain, or sensitivity and may exhibit apparent resistance to treatment for symptoms of oral dryness.

63
Q

definition of sinusitis timeline

acute:
subacute:
chronic:

A
  • acute: up to 4 weeks
  • subacute: 4-12 weeks

-chronic: 12+ weeks
acute viral usually is <10 days, then usually clears or transforms into bacterial sinusitis

64
Q

Presentation of pneumonia in older adults:

A
  • low grade temp (oral >37.8)
  • fever can be absent in 30-50%!*
  • increased O2 requirements
  • CONFUSION!
  • falling
  • anorexia
65
Q

True or false: the colour of nasal discharge indicates bacterial vs viral sinusitis

first line tx for bacterial sinusitis?

A

FALSE
-colour of discharge indicates inflammation but not of bacteria

first line:
amoxil 500 mg TID x 5 days

high dose amox (1 g TID) OR amox-clav 875 mg if antibiotic use in the last month, age >65, close contact with child in daycare, immunocompromised, comorbidities (DM, heart), smoker

66
Q

risk factors for cataracts

A

diabetes
long term use of topical, systemic
intravitreal, inhaled, or oral corticosteroids
prior intraocular surgery

67
Q

cataracts

finding on eye exam

A

darkening of the red reflex

opacities within the red reflex
or 
obscuration of ocular fundus detail

when red reflex is lost –> this is a mature cataract

68
Q

nuclear cataracts

affect distance or near vision?

A

distance is affected far more

most common in old age
progresses very slowly

69
Q

which two types of cataract are more common with diabetes?

A

cortical

posterior subscapular (very quick progression, usually changes in night vision first)

70
Q

signs and symptoms of cataracts

A

Decreased visual acuity, blurred or dim vision, decrease color perception
Increasing difficulty with vision at night
Sensitivity to light and glare

71
Q

signs and symptoms of closed angle glaucoma

A 
ocular pain
redness
blurry vision
headache
nausea
visual halos

**ciliary flush

72
Q

what medications increase risk for closed angle glaucoma?

A 
Sympathomimetics&anticholinergic drops
TCA
MAOIs
antihistamine
antipsychotic
antiparkinson
antispasmodics
sulpha
73
Q

infective endocarditis prophylaxis

med?
indication?

A

amoxil 2 g po 30-60 min prior to procedure

  • prosthetic valves
  • hx infective endocarditis
  • cardiac transplants that end up with valve issues
  • congenital cardiac conditions ONLY CERTAIN
74
Q

symptoms venous insufficiency

A

pain/aching worst at end of day
edema to ankle and calf, relieved by elevation

stasis dermatitis
hemosiderin deposit and fibrosis

shallow ulcers above medial malloelus, wet, weeping, painless, irregular

75
Q

BP targets for adults 60+

A

BP AOBP <145/85

76
Q

corneal abrasion: treatment if contact wearer?

A

must cover for pseudomonas: cipro, genta or tobramycin

77
Q

what is difference between presyncope, vertigo and disequilibrium?

A

presyncope: lightheaded, feeling of falling from decreased blood flow, “almost fainting”
vertigo: room spinning (labyrinthe/vestibular)

disequilibrium: unsteadiness only when standing/walking
* disappears with sitting/lying* (MSK/cerebellar/neuropathy)

78
Q

what makes vertigo worse?

what makes disequilibrium worse?

A

vertigo: head movement
disequilibrium: walking, standing

79
Q

what is the most common cause of hearing loss in older adults?

A

presbycusis

  • symmetrical
  • SNHL
  • high frequency first

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