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Flashcards in Nose/Sinus Deck (23)
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1
Q

URI facts. Incubation

A

most often acute illness. Preschool episodes: 5-7
Adults: 2-3. Rhinovirus
Incubation: Day 2-3, duration 7 days

2
Q

Common cold. Dx, complications, Tx

A

Nasal musocal edema, congestion, pharyngeal erythema, clear lungs, conjunctivel injection.
Dx: H&P,
complication: viral, bacterial sinusitis, COPD, acute asthma, AOM, ETD
Tx: supportive care, pt edu, Zinc, hypertonic nasal saline irrigation, nasal decongestant spray, Antitussive (codeine)
Analgesics (NSAID)

3
Q

Acute Rhinosinusitis Epi, Etiology, risk factors, PE, Red flags, Dx

A

1/8 people, more women, 45-74.
Eti: rhinovirus, influenze, parainflueza, rarely bacterial.
Risk factors: Old age, smoker, air travel, swimming, Asthma, allergies, dental disease.
PE: Nasal congestion/obstrustion, purulent nasal discharge, facial pain, teeth pressure.
Red flag: Fever, Diplopia, blindness, EOM, proptosis, opthalmoplegia, mental status, periorbital edema, cranial nerve palsies. Stiff neck.
Dx: clinical, ABRS, CT

4
Q

Acute Rhinosinusitis bacterial, Tx

A

Persistent symptoms 10+ days w/o improvement. Fever, purulent discharge, facial pain 3+ days, VURI 5+ days worsening.
Tx: Days 1-9, supportive care, Amoxicillin-clavul (augmentin) (500/125 PO BID)

5
Q

Acute Rhinosinusitis PCN allergic

A

doxy, 3rd gen cephalosporin. Dont give Macrolides, Bactrim

6
Q

Acute Rhinosinusitis that leads to hospitalization & referral.

A

Severe infection, hospital, anatomical onstruction, 1st & 2nd line drugs dont work, chronic rhinosinusitis, recurrent. allergies

7
Q

Acute Rhinosinusitis complication

A

preseptal (periorbital) or orbital cellulitis, Meningitis, Osteomyelitis, cranial abscess

8
Q

Chronic Rhinosinusitis causes.

A

Allergic rhinitis, environmental irritants, defective mucociliary clearance, recurrant VURIs.

9
Q

Chronic Rhinosinusitis PE, Tx,

A

purulent mucus in ethmoid region/middle meatus. mucopurulent, facial pain, pressure, loss smell, polyps
Tx: Nasal irrigation, intranasal glucocorticoids, antileukotrienes

10
Q

Allergic Rhinits, etiology, Epi, Risk factors, PE

A

10-30% of US, increasing prevelance. Fx, Male, 1st born, early use of antibiotics, maternal smoke, IgE over 100 IU/mL.
Etiology: B-cell, T-cell
PE: allergic shiners, allergic salute, membranes bluish color, TM retraction. pharynx cobblestoning (hyperplastic lymphatoid tissue).

11
Q

allergic rhinitis atopic triad

A

allergy rhinitis, excema, asthma

12
Q

Allergic rhinitis classification

A

intermittent <4, Persistent >4, seasonal, perennial

Persistent: Cant work, school, leisure.

13
Q

Allergic Rhinitis Tx

A

Tx: Glucocordicosteriod, antihistamines, Mast cell stabilizer, leukotriene receptor antagonist, nasal decongestant, patient ed = avoid allergies, saline irrigation.

14
Q

Nonallergic rhinitis Etiology, trigger, Dx, PE, Tx

A

Etiology: Abnormal nose innervation, nasal eosinophilia
Triggers: temp changes, eating, alcohol.
Dx: Diagnosis of exclusion
PE: nasal congestion, postnasal drainage, boggy. Tx: glucocorticoids, antihistamine

15
Q

Epistaxis types

A
Anterior = non-emergency
Posterior = emergency, internal carotid (sphenopalatine art)
16
Q

Epistaxis etiology, Hx, PE, Dx, if surgery is needed what do you need to do?

A

Trauma, dryness, neoplasm, drugs, alcohol, blood disorders, Atherosclerotic disease.
Hx: find causes, PE: vitals, airways, vasoconstrictors
Dx: PT/INR hematocrit = crossmatch.

17
Q

Epistaxis Tx, pt edu

A

Tx: Contraleral packing if severe. conservative measures, cold compression at bridge, cautery (silver nitrate), nasal packing
Pt edu: avoid vigorous exercise, spicy food, nasal trauma. toxic shock syndrome

18
Q

Nasal polyps etiology, PE, Tx

A

Etiology: unclear, allergic rhinitis, asthma, avoid aspirin. ID Samter triad (Nasal polyp + asthma = no aspirin)
PE: nasal obstruction, anosmia (loss of smell), rhinorrhea, post nasal drip. Cystic fibrosis
Tx: cortocosteroids, surgery

19
Q

Samter Triad

A

immunologic salicylate sensitivity = bronchospasm mostly kids due to Aspirin Allergy.

20
Q

Malignant neoplasms, etiology, Risk factors, PE, Dx, Tx

A

Squamous cell carcinoma & adenocarcinoma.
Risk factors: tobacco smoke, wood dust, HPV
PE: obstruction and epistaxis, face swell, seizure, nodal masses.
Tx: head/neck surgeon, neurosurgeon, radiation oncology.

21
Q

Chronic Rhinosinusitis Ddx

A

Trigeminal neuralgia, nonallergic rhinitis, headaches

22
Q

Allergic Rhinitis associations

A

allergic conjuctivitis, sinusitis, Asthma, Atopic dermatitis, ETD, Serous and acute Otitis Media

23
Q

Allergic rhinitis testing

A

Dx: clinical, Prick test - wheels, Serum IgE