Disorders of the Nose and Paranasal Sinuses Flashcards Preview

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Flashcards in Disorders of the Nose and Paranasal Sinuses Deck (36)
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1
Q

What is acute viral rhinosinusitis

A

common cold

2
Q

what is acute bacterial rhinosinusitis

A

acute sinusitis

3
Q

what causes acute bacterial rhinosinusitis

A

impaired mucocilliary clearance… obstruction of osteomeatal complex AKA sinus pore… accumulation of mucous in the sinus cavity… becomes secondarily infected by bacteria

4
Q

acute bacterial rhinosinusitis bacteria

A

mostly S. pneumonia and then H influenza others: M catarrhalis Staph aureus anaerobes Streptococcus species and more

5
Q

clinical manifestations of acute bacterial rhinosinusitis

A

purulent (pus) yellow-green nasal discharge facial pain or pressure over affected sinus or sinuses nasal obstruction acute onset of symptoms lasts 1-4 weeks (so after 10 days of what you think was common cold AKA acute viral rhinosinusitis start thinking this instead) cough malaise fever headache

6
Q

treatment of acute bacterial sinusitis

A

NSAIDs: examples Ibuprofen oral (pseudoephedrine) or nasal (oxymetazoline) decongestants intranasal corticosteroids for the first 5 days after dx: (reduces swelling of mucosal surface of nose so allows other drugs to get in) systemic oral antibiotics: (majority will get better without these but immunodeficient will need) neti-pot

7
Q

Weeks to be considered acute rhinosinusitis

A

0-4 weeks

8
Q

Weeks to be considered chronic rhinosinusitis

A

12 or more weeks

9
Q

chronic rhinosinusitis etiology

A

inflammatory disorder of paranasal sinuses and nasal passage lining

10
Q

diagnosis of chronic rhinosinusitis

A

2 of 4 cardinal sign of symptoms objective evidence of sinus mucosal inflammation/disease seen on direct examination, transillumination, CT, fiberoptic

11
Q

clinical manifestation: 4 cardinal sign and symptoms of chronic rhinosinusitis

A

anterior and/or posterior nasal mucopurulent drainage nasal obstruction/nasal blockage/congestion facial pain/pressure/and/or fullness reduction or loss of smell in kids the 4th sign is cough rather than loss of smell

12
Q

treatment of chronic sinusitis

A

not curable goals of therapy are to control and improve quality of life intranasal

13
Q

treatment of chronic sinusitis

A

not curable goals of therapy are to control and improve quality of life intranasal saline topical and systemic glucocorticoids antibiotics (systemic and topical) surgery refer to otolaryngology

14
Q

order of sinuses most affected with acute or chronic sinusitis

A

maxillary>frontal>ethmoid>sphenoid pansinusitis is all infected

15
Q

etiology of allergic rhinitis

A

exposure to airborne allergen in predisposed individual immune response

16
Q

clinical manifestations of allergic rhinitis

A

clear rhinorrhea sneezing tearing eye irritation pruritus associated sx: cough bronchospasm eczematous dermatitis upon PE mucosa of turbinates is pale or violaceous

17
Q

treatment of allergic rhinitis

A

avoidance of allergen intranasal corticosteroid sprays antihistamines antileukotrienes cromolyn sodium ad nedocromil intranasal anticholinergic agents referral to allergist for immunotherapy

18
Q

define epistaxis

A

nose bleed lots of times the vascular Kiesselbach’s plexus

19
Q

causes of epistaxis

A

dryness, vigorous nose rubbing, nose blowing, nose picking, rhinitis, foreign body, facial trauma, intranasal steroids

20
Q

less common but more serious causes of epistaxis

A

bleeding disorders, anticoagulation/aspirin therapy, Osler-Weber-Rendu disease, aneurysm of the carotid artery (posterior bleed), nasal neoplasm, hypertension

21
Q

less common but more serious causes of epistaxis

A

bleeding disorders, anticoagulation/aspirin therapy, Osler-Weber-Rendu disease, aneurysm of the carotid artery (posterior bleed), nasal neoplasm, hypertension

22
Q

diagnostic testing for epistaxis

A

+/- CBC if uncertain about etiology or if bleed is massive/prolonged prothrombin time and international normalized ratio is NOT indicated as a routine test but should be done for anti-coagulated patients

23
Q

epistaxis treatment

A

type and crossmatch for massive or prolonged hemorrhage nasal packing: (nasal gauze/tampons/balloon/catheters) fibrin glue cautery: (chemical-silver nitrate or electrically) gelatin or collagen sponge topical 4% cocain

24
Q

is it better to have an anterior or posterior bleed

A

anterior b/c posterior are medical emergency

25
Q

symptoms of foreign body in nose

A

lots asymptomatic kids nasal discharge usually unilateral halitosis epistaxis septal perforation

26
Q

if foreign body in nose batteries or disc magnets

A

get out right away medical emergency

27
Q

diagnosis of foreign body in nose

A

direct visualization fiber optic examination sinus x-ray CT

28
Q

treatment of foreign body in nose

A

apply topical anesthetic/vasoconstrictor (reduce pain and swelling) to nose blow nose positive pressure alligator forceps ballon catheter derma bond on cotton applicator magnet?

29
Q

features of nasal polyps

A

pale edematous fixed glistening gray or white mucoid masses in nasal cavity mucosally covered masses seen in patients with allergic rhinitis but don’t necessarily have to have allergic rhinitis to get decreased sense of smell

30
Q

treatment of nasal polyps

A

intranasal corticosteroids 1-3 months oral corticosteroids: 6 day course surgery

31
Q

define nasal polyps

A

Nasal polyps are soft, painless, noncancerous growths on the lining of your nasal passages or sinuses. They hang down like teardrops or grapes. They result from chronic inflammation due to asthma, recurring infection, allergies, drug sensitivity or certain immune disorders

32
Q

what to do if patient comes in with nasal trauma

A

examine inside of nose for hematoma of nasal septum if hematoma refer to ENT immediately: medical emergency could have fractured nasal bone could have epistaxis creptis refer to ENT

33
Q

criteria for diagnosis of acute sinusitis

A

see picture

34
Q

Oral antibiotics for acute sinusitis

A

see picture

35
Q

disorders that may exacerbate and/or contribure to chronic rhinosinusitis

A

see picture

36
Q

classification of allergic rhinitis

A

see picture