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99 Cards in this Set

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What is croup?
Inflammation occurs below the glottis;
Croup generally affects peo what age?
6 months to 5 years
What viruses usually causes Croup?
Secondary to myxoviruses, parainfluenza virus types A & B; increases in fall and winter, also RSV, adenoviruses, measles, M. pneumonia.
Tx for Croup?
Treatment: supportive.
Another name for Epligottitis
supraglottitis
Croup is secondary to?
Secondary to myxoviruses, parainfluenza virus types A & B; increases in fall and winter, also RSV, adenoviruses, measles, M. pneumonia.
At what time of the yr do peop usually get croup?
its increased in the fall and winter
With croup where does the inflammation occur?
inflammation occurs below the glottis
S/S of croup?
S/Sx: fever, inspiratory stridor, barking cough, usually preceded by URI Sx, worsens at night, with hoarseness, sign s respiratory distress.
What is the tx Epligotittis?
Requires staat peds ENT referral
What is epiglottitis?
acute infection of larynx above the vocal cords;
Epiglottitis is usually caused by?
acute usually caused by H. flu, type B,
How does epiglottitis usually present?
presents with drooling, sudden onset rapid progression, severe respiratory distress, fever > 101° F, toxic appearance, severe sore throat.
Tx for epiglottitis?
Contraindicated to look at pharynx, since complete airway obstruction may occur. Requires STAT peds ENT referral.
Peritonisillar abscess usually presents?
Peritonsillar abscess: presents with asymmetric tonsillar edema, may include tonsillar fossa or overlying soft palate. Uvula shifts to opposite side with phonation. Fever Trismus Pt also C/O difficulty swallowing, a feeling of throat fullness and unilateral throat pain; on PE, tonsil affected often 4+.
With Peritonisillar abscess, how does fever present?
Fever persists 4 days after onset antibiotic treatment for strep.
Trismus?
Trismus (difficulty opening mouth)
Tx for Peritonisillar abscess?
ENT referral can give clarithromycin first
Foreign body aspiration to pharyngeal site induces?
discomfort
Foreign body aspiration to laryngeal site induces?
airway occlusion
Foreign body aspiration to traccheobronchial site induces?
cough, stridor, wheeze, cyanosis
Foreign body aspiration usually ends up in which main bronchus?
rt main bronxhus b/c its wider and straighter ...therefore the pathway of least resistance
Foreign body aspiration usually cuases what types of breath sounds and what type of chest expansion?
Diminished
reduced chest expansion
Tx for Foreign body aspiration\?
Ent/ pulm referral
Epistaxis should be referred when?
should be referred or consult if unable to control bleed via pressure for 10-15 minutes, the second episode in one week or
is a source is posterior nasopharyngeal bleed.
Tx for epistaxis?
Treatment may include cauterization; silver nitrate stick; certainly increasing humidification at home, esp at night.
The four causes of dizziness?
1 vertigo
2 presyncope
3 dysequilibrium,
4 light-headedness
Vestibular?
associated with a spinning feeling… ‘vestibular’
Presyncope?
or a ‘fainting’ feeling…’cardiovascular’
dysequilibrium?
a ‘falling’ feeling while upright…’locomotor’
lightheadnesses?
, which doesn’t fit any of the above…’idiopathic’ or perhaps psych origin.
could also be caused by hypoglycemia or hypotensive episode
Vertigo?
cause if usually vestibular
accounts for 1/2 cases of dizziness; usually peripheral or central
Peripheral causes of vertigo are?
1. benign positional vertigo
(1/2 cases)
2. Labrynthitis
3. Meniere’s disease:
episodic; spells last for
hours, recur over months
or years. Often severe,
acute attack; hallmark is
recurrence. Concurrent
vertigo, tinnitus, hearing
loss. Most common in
women over 50; starts as
vertigo, then later, tinnitus
and hearing loss develop.
Meniere's dx may have concurrent?
Often severe, acute attack; Concurrent vertigo, tinnitus, hearing loss.
What is hallmark in Meniere's dx?
hallmark is the recurrence
Meniere's dx mostly happens in what age and gender?
in women over 50
Timing and duration of Meniere's dx?
Meniere’s disease: episodic; spells last for hours, recur over months or years.
How does Meniere's dx start?
starts as vertigo, then later, tinnitus and hearing loss develop.
Meniere's dx may be associated with what?
Vertigo may be severe and associated with nausea and vomiting. IV hydration may be necessary.
Vestibular neuronitis?
vertigo and tinnitus lasting several days with residual vertigo for weeks. + horizontal nystagmus. Worsens with a change in head position.
What is the rec for vestibular neuronitis?
Exercises are recommended to compensate for decreased vestibular function.
Central causes for vertigo may be?
acoustic neuroma, brain tumor, TIA, CVA, MS.
How do you evaluate for vertigo?
Hallpike maneuver
http://www.youtube.com/watch?v=vRpwf2mI3SU&feature=related
Hallpike maneuver?
pt sits on exam table, examiner to one side. Place a hand behind the neck, turn the head so pt’s face faces you and quickly recline the pt with one ear to the table surface. Help the pt sit up and repeat with the other ear facing the table. Classically, this test is done with the neck hyperextended over the edge of the table but this is difficult to do and most sensitive pts will respond without hyperextension. With each change, on both reclining and arising, watch for nystagmus and ask the pt to report symptoms.
What happens with the Hallpike maneuver with benign positional vertigo?
the pt experiences response in only one position and test is + with about 50% with pt with recent onset. The onset of dizziness and occurrence of nystagmus are delayed for a few seconds after a position change; changes stop after 5-10 seconds and can’t be reproduced with a repeat test.
Presyncope accounts for __% of cases of dizziness.
5
Cardiac causes of syncope include?
Cardiac causes include electrical, where heart rate is faster or slower than normal, or mechanical, due to an outflow obstruction murmur.
Benign vascular causes include: orthostatic hypotension, from meds or DM; vasovagal episodes, or autonomic neuropathies.
Causes of epitaxis
self induced trauma
polyps
sinus infection
benign positional vertigo?
timing/duration?
often affects who?
sensation is episodic eg only when moving head, or lying in bed
only lasts seconds
often affects the elderly, improves over months
Name the 4 types of peripheral vertigo?
benign positional vertigo
labrynthitis
Meniere's dx
vestibular neuronitis
labrynthitis vertigo's duration and timing?
vertigo is intense and constant for a few days, then resolves in 1-2 weeks; pts usually present to ER; can occur as a complication of otitis media affecting the temporal bone.
Labrynthitis usually occurs with?
Occurs with dizziness, hearing loss, nausea and vomiting and nystagmus.
Which type of peripheral vertigo accounts for 1/2 the cases?
benign positional vertigo
Central causes of periperal vertigo?
acoustic neuroma, brain tumor, TIA, CVA, MS.
Don't want to miss?
Vestibular neuronitis duration and timing?
vertigo and tinnitus lasting several days with residual vertigo for weeks.
Accompanying symptom with Vestibular neuronitis?
+ horizontal nystagmus.
Vestibular neuronitis
What can help to make it better?
What worsens it?
Exercises are recommended to compensate for decreased vestibular function. Worsens with a change in head position
Besides syncope, usually there are other evident symptoms of cardiovascular disease. Cardiac Causes include?
Electrical, where heart rate is faster or slower than normal, or mechanical, due to an outflow obstruction murmur.
Benign vascular causes include?
Benign vascular causes include: orthostatic hypotension, from meds or DM; vasovagal episodes, or autonomic neuropathies.
Dizziness of the feet instead of the head is called?
Dysequilibrium-
This is a balance problem in a mobile pt. It is dizziness of the feet instead of the head.
Dysequilibrium accounts for what % of dizziness?
also accounts for 5% of cases of dizziness.
On PE, watch the pt walk: usually you note?
unsteadiness.
Balance is multifactorial, interplay of ?
vestibular, ocular (may occur after cataract surgery), and somatosensory (e.g. peripheral nerves in the feet and proprioceptors in the joints).
Usually occurs in the?
elderly.
Ambulation disorders also in elderly indicate prior ?
CVA, peripheral neuropathy, severe hip or knee arthritis, or a gait disorder due to Parkinson’s dx.
Light-headedness accounts for?
20% cases.
The pneumonic for psych causes of light headedness are?
D…depressive disorders
A…panic disorders (both of these =/- panic, often with hyperventilation)
S…somatiform
S…substance abuse
S…stress
Idiopathic causes of light headedness are?
:about 10% of cases. Serious causes are rare.
Tumor: dizziness is usually not the primary presenting symptom, nor is it the only symptom. When +, consider?
acoustic neuroma or posterior cranial fossa tumors
Acoustic neuroma or posterior cranial fossa tumors are also accompanied by?
hearing loss, tinnitus, and other neurologic symptoms, often headache.
Work-up for vertigo history is usually?
diagnostic
Work-up: history for dizziness is usually diagnostic. Question whether position change affects pt. If pt has any LOC?
get cardiac work-up.
How do you confirm vestibulopathy?
. Check EOM’s for nystagmus or ask pt to shake head vigorously for 10 seconds, the look straight ahead: occurrence of nystagmus on one side confirms vestibulopathy.
ENG?
Limitation?
(electronystagmography)ENG: is the most commonly used procedure. Uncomfortable for pt. Caloric testing with cold water to induce nystagmus. Limitation: a normal result does not rule out vestibulopathy.
Rotatory chair?
Limitation?
Rotatory chair: moves pt at various speeds through different position, may be abnormal with normal ENG.
In what order do you do orthostatic BP?
Lying, sitting, standing
want to check for pooling in extremities
When do you take orthostatic BP
Dizziness
Lightheadedness
Extensive fluid loss (vommiting, diarrhea)
Dynamic posturography?
tests vestibular, visual, and somatosensory systems: relatively new and not widely available. To test visual system, some models incorporate a rotatory disk for pt to view or pt closes eyes for part of the test.
Neuro-otologic exam?
done by neuro-ophth specialist or otolaryngologist.
Audiometry detects?
detects acoutic neuroma and Meniere’s disease since picks up asymmetry between ears.
Brain stem auditory evoked response testing?
follow-up for symmetric audiometry, and check vestibular as peripheral or central.
How do you manage Benign positional vertigo
prescribe habituation exercises TID/QID. Pt sits in bed and reproduces symptoms (via Hallpike) until symptoms subside and repeat until response fatigues.
How do you manage Labrynthitis?
Labrynthitis: Meclizine 25 mg TID
How do you manage Meniere’s?
Meniere’s: perhaps Meclizine to control acute attacks, diuretics and low salt diet to help decrease chronic symptoms; surgery as a last resort.
How do you manage Presyncope?
Presyncope: D/C causative meds if possible. When associated with peripheral neuropathy and chronic orthostatics secondary to DM, elevate HOB, use graduated pressure stockings (e.g. Jobst), fludrocortisone 0.1 mg/day, increase prn. Manage arrhythmias and valvular stenosis appropriately.
How do you manage Dysequilibrium?
Dysequilibrium: correct orthopedic problems; cane, prn.
Prognosis for dizziness?
Prognosis: at least 1/3 of pts are better in 2 weeks, another 1/3 over months, condition persists in about 1/3.
Meniere's dx may induce what type of hearing loss?
unilateral hearing loss that eventually involves both ears.
Acoustic hearing loss may induce what type of hearing loss?
Acoustic neuroma affects only one side and involves a low frequency hearing loss, unlike the age-related hearing loss
Age related hearing loss is usually what frequency?
high freqency loss expected.
Age related hearing loss?
Presbycusis- high frequency loss
age related vision loss?
presbyopia
If you prescribe Meclizine, what should you do?
Chart that you've warned the pt re the drowsiness that will ensue
Acoustic neuroma?
Acoustic neuroma is a non-cancerous tumor that develops on the nerve that connects the ear to the brain. The tumor usually grows slowly. As it grows, it presses against the hearing and balance nerves. At first, you may have no symptoms or mild symptoms. They can include

Loss of hearing on one side
Ringing in ears
Dizziness and balance problems
Acoustic neuroma can be difficult to diagnose, because the symptoms are similar to those of middle ear problems. Ear exams, hearing tests and scans can show if you have it
Tx for acoustic neuroma?
radiation or surgery
Most common cause of progressive hearing loss in a young adult?
otosclerosis
otosclerosis
Otosclerosis is an abnormal bone growth in the middle ear that causes hearing loss.
Slow hearing loss that continues to get worse
(Hearing may be better in noisy environments than quiet areas), tinging in the ears (tinnitus)
Tx for collapsed eustachian tube to equlibrate/ equalization of pressure in the tube?
Afrin
or plug nose and blow through it
Earplugs
No flying or diving when?
URI