Idiopathic Rhinitis & Hearing Loss Quiz

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Questions and Answers

Which of the following medications is indicated as a treatment for idiopathic rhinitis?

  • Montelukast
  • Antihistamines
  • Cromolyn
  • Ipratropium Bromide (correct)

What is a common complication that can arise from untreated rhinitis?

  • Increased risk of asthma exacerbations
  • Increased risk of sleep apnea
  • Increased risk of infection
  • All of the above (correct)

What is the primary mechanism of action of cromolyn in the treatment of rhinitis?

  • Inhibition of mast cell degranulation (correct)
  • Anticholinergic effects
  • Blocking leukotriene receptors
  • Direct vasoconstriction

What does a patient with idiopathic rhinitis typically NOT exhibit?

<p>Itchiness of the eyes and nose (A)</p> Signup and view all the answers

Which of the following medications is contraindicated for use in patients with narrow-angle glaucoma?

<p>Ipratropium Bromide (B)</p> Signup and view all the answers

Which of the following factors can trigger idiopathic rhinitis?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following medications can worsen idiopathic rhinitis?

<p>Beta-blockers (A)</p> Signup and view all the answers

What is the primary pathophysiological mechanism thought to be responsible for idiopathic rhinitis?

<p>Abnormal balance of sympathetic and parasympathetic control of the nasal mucosa (A)</p> Signup and view all the answers

Which of the following is the second most common cause of sensorineural hearing loss?

<p>Noise Trauma (C)</p> Signup and view all the answers

What is the most frequent cause of sensory hearing loss?

<p>Presbycusis (D)</p> Signup and view all the answers

What is a common cause of referred otalgia?

<p>TMJ dysfunction (D)</p> Signup and view all the answers

What is the main goal in treating sensorineural hearing loss?

<p>Prevent further losses and improve function (A)</p> Signup and view all the answers

Which of the following conditions can cause persistent pain and discharge from the ear, requiring referral to a specialist?

<p>Osteomyelitis of the skull base (D)</p> Signup and view all the answers

Which of the following is a common cause of earache?

<p>Acute otitis media (B)</p> Signup and view all the answers

Which nerve(s) are involved in the sensory innervation of the ear?

<p>Trigeminal, facial, glossopharyngeal, vagal, and upper cervical nerves (C)</p> Signup and view all the answers

What is the first step in differentiating acute otitis media (AOM) from otitis externa (OE)?

<p>History and physical exam (B)</p> Signup and view all the answers

What is a common cause of serious otitis media in adults?

<p>Eustachian tube obstruction due to a viral URI (D)</p> Signup and view all the answers

Which symptom is most indicative of patulous Eustachian tube?

<p>Fullness in the ear and autophony (B)</p> Signup and view all the answers

What is the primary treatment for acute otitis media?

<p>Antibiotics for bacterial infections (A)</p> Signup and view all the answers

In what circumstances should one consider nasopharyngeal carcinoma when diagnosing eustachian tube dysfunction?

<p>If the condition is persistent and unilateral (C)</p> Signup and view all the answers

What finding is commonly associated with acute otitis media during a physical exam?

<p>Erythema and decreased mobility of the tympanic membrane (A)</p> Signup and view all the answers

What is one major complication of untreated acute otitis media?

<p>Severe ear empyema (C)</p> Signup and view all the answers

Which of the following is NOT a common cause of noninfectious conjunctivitis?

<p>Bacterial conjunctivitis (C)</p> Signup and view all the answers

Which of the following is the most common cause of conjunctivitis in the pediatric population?

<p>Bacterial conjunctivitis (A)</p> Signup and view all the answers

What should patients with a patulous Eustachian tube avoid during their condition?

<p>Rapid altitude changes and underwater diving (D)</p> Signup and view all the answers

What is the most common causative organism of seasonal allergic conjunctivitis?

<p>Ragweed (A)</p> Signup and view all the answers

What characterizes the tympanic membrane during physical examination in cases of serious otitis media?

<p>Dull and hypomobile with possible air bubbles (D)</p> Signup and view all the answers

Which of the following is a clinical presentation of viral conjunctivitis?

<p>Watery discharge (A)</p> Signup and view all the answers

Which of the following is a characteristic of conjunctivitis from medication?

<p>Most commonly encountered with eye drops containing benzalkonium chloride (C)</p> Signup and view all the answers

Which of the following is a priority differential for a patient presenting with conjunctivitis?

<p>Herpetic eye disease (D)</p> Signup and view all the answers

What is the mechanism behind auto-inoculation in viral conjunctivitis?

<p>Viral spread via direct contact (C)</p> Signup and view all the answers

Which of the following is a recommendation for patients with conjunctivitis?

<p>Avoid rubbing the eyes and wash hands frequently (C)</p> Signup and view all the answers

What is the main cause of chronic issues associated with a squamous epithelium-lined sac?

<p>Prolonged Eustachian tube dysfunction (A)</p> Signup and view all the answers

Which diagnostic imaging is most useful in identifying mastoiditis?

<p>CT scan (A)</p> Signup and view all the answers

What common complication may arise from severe petrous apicitis?

<p>Meningitis (C)</p> Signup and view all the answers

What treatment is typically recommended for facial paralysis resulting from chronic otitis media?

<p>IV antibiotics and myringotomy (C)</p> Signup and view all the answers

Which bacterium is most commonly associated with otogenic meningitis following acute otitis media?

<p>Streptococcus pneumoniae (C)</p> Signup and view all the answers

What is a typical symptom of sigmoid sinus thrombosis?

<p>Postauricular cellulitis and fevers (A)</p> Signup and view all the answers

Which treatment approach is not typically associated with managing mastoiditis?

<p>Prolonged antibiotic therapy (A)</p> Signup and view all the answers

What is the primary therapeutic goal for cholesteatoma-related chronic facial paralysis?

<p>Surgical correction (B)</p> Signup and view all the answers

Which of the following conditions is characterized by a rapid progression and may involve the cornea?

<p>Vernal conjunctivitis (D)</p> Signup and view all the answers

What are some red flags that warrant an ophthalmologist referral for conjunctivitis?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a distinguishing characteristic of hyperacute onset conjunctivitis?

<p>Severe purulent discharge within 12-24 hours (B)</p> Signup and view all the answers

In which age group is conjunctivitis caused by Haemophilus influenzae and Streptococcus pneumonia commonly found?

<p>Children (D)</p> Signup and view all the answers

Which of the following statements accurately describes the management of atopic conjunctivitis?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following conditions is primarily associated with a history of asthma, allergic rhinitis, and atopic dermatitis?

<p>Atopic conjunctivitis (D)</p> Signup and view all the answers

What is the anatomical division used to classify periorbital infections?

<p>Location of the infection relative to the orbital septum (B)</p> Signup and view all the answers

Which of the following is true regarding the prevalence of periorbital infections?

<p>Males are more likely to be affected than females. (B)</p> Signup and view all the answers

Flashcards

Conjunctivitis

Inflammation of the bulbar or palpebral conjunctiva.

Viral conjunctivitis

An eye infection often caused by adenovirus, spread by direct contact.

Bacterial conjunctivitis

Most common in children; caused by bacterial infection of the conjunctiva.

Allergic conjunctivitis

Noninfectious inflammation triggered by environmental allergens.

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Pathophysiology of conjunctivitis

Infection spread by direct contact or proximity to an infected person.

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Suspect conjunctivitis causes

Herpetic, gonococcal, chlamydia, hemorrhage, blepharitis.

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Clinical Presentation of viral conjunctivitis

Acute red eye with watery discharge, often follows a respiratory infection.

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Examination for conjunctivitis

Palpate anterior cervical nodes; check for preauricular lymph node tenderness.

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Allegra-D

A combination antihistamine and decongestant medication used for allergy relief.

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Claritin-D

An antihistamine and decongestant combo used to relieve allergy symptoms.

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Decongestant side effects

Can cause sleeplessness, tachycardia, and tremors.

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Intranasal agents

Medications delivered via the nose for allergy relief, such as sprays.

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Idiopathic Rhinitis

Chronic and non-allergic rhinitis occurring year-round without typical allergy symptoms.

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Montelukast

A leukotriene receptor antagonist used to manage asthma and allergies.

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Nasal eosinophils

White blood cells found in nasal tissue indicative of allergies or asthma.

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Allergy diary

A record kept by patients to identify allergy triggers and improve symptoms.

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Causative agents in children

Haemophilus influenzae and Streptococcus pneumonia are common causes of conjunctivitis in children.

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Causative agent in adults

Staphylococcus aureus is a common cause of conjunctivitis in adults.

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Neisseria gonorrhoeae

Rapid onset conjunctivitis with severe purulent discharge is associated with Neisseria gonorrhoeae.

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Shield ulcer

An oval corneal epithelial defect on the superior cornea, typically seen in severe cases.

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Vernal conjunctivitis management

Mast cell stabilizers should be initiated two weeks before symptoms for vernal conjunctivitis relief.

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Atopic conjunctivitis

Occurs in adults over 50, often with a history of asthma, allergic rhinitis, or atopic dermatitis.

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Referral red flags

Signs for referral include decrease in vision or severe ocular pain, and non-ocular symptoms like nausea.

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Preseptal and Orbital Cellulitis

Infections requiring immediate evaluation for visual impairment or increased orbital swelling.

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Cholesteatoma

A squamous epithelium-lined sac that may fill with keratin and can become infected.

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Mastoiditis

Infection of the mastoid air cells characterized by postauricular pain and fever.

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Petrous Apicitis

Infection of the petrous bone causing deep ear and retro-orbital pain.

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Facial Paralysis

Loss of facial movement due to inflammation of the seventh nerve in the ear.

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Sigmoid Sinus Thrombosis

Infection in mastoid air cells causing septic thrombophlebitis near the sigmoid sinus.

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Otogenic Meningitis

The most common intracranial complication of ear infections via hematogenous spread.

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Myringotomy

Surgical procedure to drain fluid and culture in cases of severe ear infection.

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IV Antibiotics (IV abx)

Intravenous antibiotics used to treat severe ear-related infections.

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Intranasal corticosteroids

Medication used to reduce inflammation in allergic patients, e.g., Beclomethasone dipropionate.

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Patulous Eustachian Tube

An overly patent Eustachian tube leading to ear fullness and autophony; may develop during rapid weight loss or pregnancy.

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Serous Otitis Media

A condition caused by eustachian tube obstruction leading to fluid buildup in the middle ear.

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Acute Otitis Media

Bacterial infection causing pain, pus, and tympanic membrane changes in the middle ear.

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Tympanic membrane signs

In acute otitis media, it appears dull, hypomobile, and may contain air bubbles.

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Eustachian tube obstruction

Blockage in the Eustachian tube often leading to otitis media; can be caused by infections or allergies.

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Ventilating tube placement

A procedure to cure persistent otitis media when medications fail; restores hearing.

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Common pathogens in otitis media

Bacteria like S pneumoniae, H influenzae, and S pyogenes are frequent culprits in acute otitis media.

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Chronic Otitis Media (COM)

Infection originating from pathways or direct extension through the petrous pyramid affecting the ear.

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Symptoms of COM

Usually asymptomatic, but can include deep pain, headache, and low-grade fever.

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Otitis Media vs. Otitis Externa

AOM is middle ear infection; OE is outer ear infection. Differentiate using history and physical exam.

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Herpes Zoster Oticus

Pain may be disproportionate due to herpes zoster, evidenced by vesicles in ear canal.

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Referred Otalgia

Ear pain from non-ear sources like TMJ dysfunction or oropharyngeal issues.

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Sensorineural Hearing Loss

Loss from cochlea diseases affecting hearing; often irreversible, managed by aids or implants.

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Presbycusis

Age-related hearing loss; progressive, symmetrical, and affects mainly high frequencies.

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Noise Trauma

Hearing loss from prolonged loud noise; begins with high frequencies, then speech frequencies.

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Study Notes

Conjunctivitis

  • Conjunctivitis is inflammation of the bulbar or palpebral conjunctiva.
  • Up to 70% of infectious conjunctivitis is viral.
  • Adenovirus is the most common cause of viral conjunctivitis.
  • Bacterial conjunctivitis is most common in children.
  • Allergic conjunctivitis is the most common cause of noninfectious conjunctivitis.
  • Viral conjunctivitis is spread through direct contact with infected individuals.
  • Bacterial conjunctivitis is spread through transferring organisms from the nose and sinus to the eye.
  • Seasonal allergic conjunctivitis, commonly called hay fever, is typically secondary to environmental allergens, with ragweed being the most common (75%).

Pathophysiology

  • Viral conjunctivitis spreads through direct contact.
  • Bacterial conjunctivitis is often from transfer of organisms through contact.
  • Seasonal allergic conjunctivitis is an immunoglobulin E mast cell-mediated hypersensitivity.
  • Vernal conjunctivitis and atopic conjunctivitis are chronic, mast cell, and lymphocyte-mediated immune responses.
  • Conjunctivitis from medications is due to prolonged use of eye drops (>1 month), particularly those containing benzalkonium chloride.

Clinical Presentation

  • Viral conjunctivitis: often follows recent upper respiratory infection.
  • Early signs include redness and excessive watery discharge.
  • Classically begins in one eye, then spreads to the other.
  • Examination should include palpation of the anterior cervical lymph nodes; preauricular lymph nodes are often tender (50% of patients).
  • Herpes simplex virus (HSV): often follows antecedent respiratory infection.
  • Can involve vesicular skin lesions.
  • Adenoviral conjunctivitis: may have three forms
  • Adenoviral conjunctivitis: follicles (clear bumps ranging in size), injected conjunctival vessels.
  • Pharyngoconjunctival fever: presents with systemic disease—fever, headache, and sore throat.
  • Epidemic keratoconjunctivitis: bilateral conjunctival hyperemia, chemosis, and petechial and larger sub conjunctival hemorrhages.

Clinical Presentation Continued

  • Bacterial Conjunctivitis: Thick, purulent discharge, worse in the morning, eyes appear sticky or glued shut.
  • Symptoms can occur over several days in children.
  • Bacterial conjunctivitis in adults is often caused by S. aureus.
  • Hyperacute onset of purulent discharge (12-24 hours) suggests Neisseria gonorrhoea, potentially from maternal-neonatal transmission.
  • Chlamydial conjunctivitis: present in sexually active adults with symptoms that fluctuate, lasting weeks or longer.

Clinical Presentation Continued 2

  • Molluscum contagiosum: characterized by umbilicated nodules on eyelid margin
  • Should be considered in children and HIV infected adults.

Clinical Presentation and PE of other conjunctivitis diseases

  • Allergic Conjunctivitis: Itching, watery discharge (clear or stringy/white), and boggy appearance of conjunctiva
  • Periorbital skin can be discolored, thickened, and erythematous. Periorbital venous congestion can present as dark circles under the eyes
  • Vernal conjunctivitis: Giant papillary conjunctivitis, eversion of upper eyelid reveals cobblestone appearance
  • Shield ulcer, corneal defect in the superior cornea
  • Atopic conjunctivitis: Severe itching, burning, and tearing. White, thick, ropy discharge

Management

  • Viral conjunctivitis: self-limiting (5-14 days), supportive care with artificial tears and cool compresses.
  • Bacterial conjunctivitis: antibiotics (topical), refer to ophthalmologist if high risk patients are present.
  • Allergic conjunctivitis: avoidance of allergens, antihistamines (oral and topical), mast cell stabilizers.
  • Vernal conjunctivitis: mast cell stabilizers, topical anti-inflammatory medications.

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