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FNP2- test 1 > Sinuses > Flashcards

Sinuses Flashcards

1
Q

actions of the sinuses

A

Warm, moisturize, and filter air
Olfaction
Continuous mucosal lining lined with cilia

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2
Q

Unilateral purulent drainage

Foul odor, epistaxis

A

Nasal Foreign Body

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3
Q

where do 95% of epistaxis occur?

A

Kiesselbach’s plexus

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4
Q

Epistaxis Management

A
  • Direct pressure
  • Cautery
  • Nasal packing
  • Treat the underlying cause: prevention!

NS nasal sprays and humidifiers to add moisture
Cautery with silver nitrate- keep from re-bleeding

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5
Q

when do you need a referral with nasal trauma

A

if orbital involvement is suspected, airway compromise, evidence of intracranial injury, leaking CSF or c-spine injury

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6
Q 
collection of blood in the septum, or space between the two nostrils
Don’t miss-may cause chronic deformity
Often bilateral
Cover with antibiotics
Refer for drainage
immediate ENT referral
A

septal hematoma

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7
Q

Assc. w/ Unilateral nasal obstruction, pain, recurrent nosebleeds, headache, visual or smell changes are all red flag symptoms

A

nasal tumors

Carcinomas (squamous), lymphomas, sarcomas, and melanomas

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8
Q

Represent an inflammatory disorder
May cause chronic symptoms with a diminished sense of smell
Associated with chronic rhinosinusitis and cystic fibrosis

may initiate nasal corticosteroids topically and refer to ENT if no improvement after an initial period of treatment

A

nasal polyps

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9
Q
  • common across all age groups
  • May be benign—look for red flag symptoms
  • Identify the underlying etiology
  • Patient centered management plan
  • Refer when appropriate
A

Nasal Congestion

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10
Q

an immunoglobulin E (IgE) mediated inflammatory response of the nasal mucous membranes after exposure to inhaled allergens
Common symptoms: nasal congestion, post-nasal drip, nasal itching, sneezing, ocular symptoms
Seasonal vs. perennial vs. episodic

A

Allergic Rhinitis

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11
Q

Physical Exam for AP diagnosis

A
  • Allergic shiners
  • Injected conjunctivae
  • Allergic salute
  • Stigmata of atopic disease
  • “Boggy, pale” turbinate
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12
Q

AR Classification?
Present <4 days/week
OR
<4 weeks/year

A

Intermittent

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13
Q

AR Classification?
Present >4 days/week
OR
>4 weeks/year

A

Persistent

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14
Q

AR Classification?

Isolated exposure to an allergen such as pet dander that is not part of the individual’s environment

A

Episodic

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15
Q

Best way to manage AR

A

environmental control

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16
Q

3 A’s of AR H&P

A

family hx of asthma, allergies, atopy

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17
Q

most common physical sign of AR

A

boggy pale nasal turbinates

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18
Q

Factors that may lead to a severe classification of AR

A

exacerbation of co-morbid asthma, sleep disturbance, impairment of daily activities or participation in sports, impairment of schoolwork due to missed school days

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19
Q

There should be no clinical evidence of ____ for AR dx

A

endonasal infection or structural abnormality

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20
Q

Benefits of intranasal corticosteroids (INCS)

A

Recognized as most effective treatment for AR by all practice guidelines

  • Low systemic bioavailability (second-generation agents)
  • May also benefit ocular symptoms
  • Available OTC
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21
Q

Disadvantages of intranasal corticosteroids

A
  • Side effects (nasal irritation, dryness, epistaxis. Taste and smell disturbances, HA, cataract and glaucoma)
  • Improper administration or use
  • Concern in pediatric population regarding growth suppression
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22
Q

Benefits of Nasal Antihistamines

A
  • Quick action
  • More effective for nasal congestion than oral antihistamines
  • More tolerable side effect profile
  • Recognized as effective in conjunction with INCS for patients without benefit of INCS alone
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23
Q

Disadvantages of Nasal Antihistamines

A
  • More expensive

* Less effective than INCS

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24
Q

Benefits of Oral Antihistamines

A
  • Low cost/available OTC
  • Second generation advised (less sedating)
  • Addresses multiple allergy symptoms
  • Generally well tolerated
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25
Q

Disadvantages of Oral Antihistamines

A
  • Drowsiness
  • Not as effective as INCS
  • Clinical trials show no added benefit as add on to INCS
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26
Q

Good for pts that have hx of asthma of allergy to aspirin

May have limited role for those patients with comorbid asthma/allergy
•Very costly
•No added benefit seen as an add onto INCS

A

Leukotriene Antagonist (LTRA)

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27
Q

widely used- effective against histamine mediated allergic rhinitis symptoms, (rhinorrhea, sneezing, itching, and also ocular symptoms)

A

Oral Antihistamines

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28
Q

The chronic presence of one or more symptoms of rhinitis (nasal obstruction, rhinorrhea, sneezing, and/or itchy nose.) , diagnosis of exclusion, syndrome not a disease

  • No clinical signs of infection
  • No signs of allergic inflammation
A

Nonallergic, Noninfectious Rhinitis (NAR)

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29
Q

drug-induced rhinitis- can happen with the overuse or extended use of some over-the-counter nasal sprays, vasoconstrictor agents like metazoline.

A

rhinitis medicamentosa

30
Q 
•Acute and self-limited
•Spread by hand contact to secretions or aerosol
•Multi-symptom
•Most common culprit is rhinovirus
Nasal congestion with rhinorrhea
A

Upper Respiratory Infection (URI)

31
Q

Best evidence for the

prevention of the common cold

A 
physical interventions
(e.g., handwashing) and possibly the use of zinc supplements.
32
Q

best evidence for traditional

treatments for URI support

A

acetaminophen and nonsteroidal anti-inflammatory drugs (for pain and fever) and possibly antihistamine—decongestant combinations and intranasal
ipratropium. Ibuprofen appears to be superior to acetaminophen for
the treatment of fever in children

33
Q

best evidence for
nontraditional treatments of
the common cold

A

use of oral zinc
supplements in adults and
honey at bedtime for cough
in children over one year

Children under six years of age should not receive cough medication

34
Q

Inflammation of maxillary and ethmoid sinuses a/w URI (chronic if persistent 12 wks).

Typically viral, rarely bacterial complication can occur

Facial pain/pressure along with sx of URI

A

Rhinosinusitis

35
Q

Most cases are viral and resolve spontaneously
• Uncomplicated cases can be managed with intranasal corticosteroids and nasal saline irrigation

  • Can be acute or chronic
  • Acute refers to symptoms lasting
A

Rhinosinusitis

ARS can be further classified into viral and acute bacterial rhinosinusitis (ABRS)

36
Q

Three cardinal features of ABRS

A

purulent rhinorrhea
facial pain/pressure/fullness
nasal obstruction

37
Q

One of the two criteria below: of ABRS

A
  1. Onset and duration of ABRS symptoms persisting for ≥10 days (without evidence of improvement)
  2. Onset with worsening symptoms that were initially improving in first five days “double-sickening”
38
Q

First-line (Daily Dose) for

A

Acute rhinosinusitis 1qa

39
Q

Pregnant patients with a PCN allergy will need a _____ as first line treatment for acute rhinosinusitis

A

macrolide

40
Q
  • Previously thought to be entirely infectious in nature, now recognized as inflammatory
  • Medical treatments reduce mucosal inflammation, remove mucus, and modulate environmental triggers
  • May involve co-management with ENT
A

Chronic Rhinosinusitis

41
Q

Diagnostic Criteria for CRS (Chronic Rhinosinusitis)

A

12-week duration of more than two of the following:
• Nasal discharge (anterior, posterior, or both)
•Nasal obstruction and congestion
•Facial pain, pressure, or fullness
•Reduction/loss of smell

42
Q
  • Associated with high tissue eosinophilia, tissue edema

* May have a higher prevalence of anosmia

A

CRS with nasal polyps

43
Q

CRSsNP- Fibrosis, less eosinophilic infiltration

A

CRS without nasal polyps

44
Q

Treatment for Chronic Rhinosinusitis

A
  • Nasal steroid for 4–6 weeks
  • Oral antimicrobials in case of acute exacerbation
  • Treat comorbid allergy
  • Avoid smoking and irritants
  • Consider high volume nasal irrigation
45
Q

Treatment for Uncontrolled CRS

A
  • Continue treatment
  • Add oral steroid
  • Consider long term macrolides/ doxycycline
  • Reconsider diagnosis
  • Consider surgical options
46
Q

How to confirm inflammation for Chronic Rhinosinusitis?

A

Endoscopy: purulent mucus, mucosal edema,

CT Imaging demonstrating inflammation of paranasal sinuses

47
Q

What is mainstay of treatment for chronic rhinosinusitis?

What if it is uncontrolled?

A

Glucocorticoids

may need to add oral steroid if it is uncontrolled (but comes with lots of complications)

48
Q

Often confused with URI, inflammation of nasal mucosa (<4wks)
Clinical Findings:
Nasal congestion & purulent discharge, HA -> more intense when bends over, Fever, fatigue, SINUS PAIN
Abrupt onset
suspect BACTERIAL if pt presents w. Worsening sx after 10 days

A

Acute Sinusitis

49
Q

Tx for Acute Sinusitis?

A

NOT recommended (acute is typically viral) unless sx worsen or do not improve after 7 days

amoxicillin -clavulanate (1st line)
Doxycycline if PCN allergy

Treatment adults: BID 5-7days
Treatment in children: 14 days

Pregnant/ PCN allergy: NO doxy, Macrolide

Analgesics and NSAIDs
Nasal saline or decongestants

50
Q

sinus infection more than 12 wks that resist tx or are recurrent (d/t continued inflammation and impaired drainage)

A

Chronic Sinusitis

51
Q

aka idiopathic or nonallergic rhinitis→ falls under NAR

Patho: abnormal balance favoring parasympathetic control leading to vascular engorgement on nasal mucosa
Causes:
Medications (ACE inhibitors, beta blockers)
Increased estrogen (pregnancy)

A

Vasomotor Rhinitis

52
Q

Clinical Manifestations:
Perennial nasal congestion with little discharge
ABSENCE of itching of eyes and nose, sneezing, and tearing

A

Vasomotor Rhinitis

53
Q

How to Tx Rhinosinusitis?

A

ABX if URI sx don’t improve after 10 days- Amoxicillin Q12
<2 yo, recent antimicrobial use, or in daycare: amoxicillin-clavulanate
tylenol/ibuprofen for pain

54
Q

Pale edema (BOGGINESS) of nasal mucous membranes
Redness/”cobblestone” of the conjunctiva, TEARING- REDNESS, injection, Clear TM
No s/s of infection

A

Allergic Rhinitis

55
Q

How to tx episodic allergic rhinitis?

A

H1 antihistamines w/ decongestants: fexofenadine & pseudoephedrine (Allegra-D), or loratadine & pseudoephedrine (Claritin-D)

56
Q

How to tx perinneal/ seasonal allergic rhinitis?

A

inhaled nasal corticosteroids (first line tx), and/or H1 antihistamine (oral, second generation)

57
Q

What to avoid for allergic rhinitis while pregnant (1st trimester) and breastfeeding?

A

avoid oral decongestants

58
Q

tx option for severe allergies to decrease need for epinephrine or daily medication. Desensitization takes months through controlled allergen exposure. Weekly injections

A

Allergy immunotherapy

59
Q

Viral (adenovirus, rhinovirus, RSV, etc) transmitted via contact or airborne droplets

Clinical Manifestations:
Nasal congestion with rhinorrhea
Coughing, sneezing, fever, hoarseness, pharyngitis.

A

Common cold (URI)

60
Q

How to tx common cold?

A

supportive symptomatic tx (fever, saline nose drops) increased fluid intake; honey for cough if over 1yo

No cough meds under 6yo
Comorbid conditions may limit OTC med use (HTN)

61
Q

posterior nose bleed = arterial bleed →

A

IMMEDIATE referral

62
Q

bacterial rhinitis that originates from viral or allergic swelling of nasal mucosa. Swelling affects drainage and traps microorganisms in the sinuses. Strep. pneumoniae , H. influenzae, or Moraxella catarrhalis

A

Infectious Rhinitis

63
Q

mouth breathing ( bruise, encapsulated) MUST document absence of this finding if nasal trauma occurred

A

Septal hematoma

64
Q

Anosmia→ _____
Hyposmia→ ______
Parosmia → ________

A

Anosmia→ loss of smell
Hyposmia→ diminished smell
Parosmia → smell distortion

65
Q

How to assess for smell changes?

A 
Test CNI (close eyes identify coffee, PB, alcohol)
Inspect nasopharynx (polyps? Mucus? Signs of URI?)
Text CN IX(glossopharyngeal) and CN VII (facial) together: sweet, salty, sour, and bitter on each side of the tongue, then posterior portion

Diagnostics
Labs: CBC, BUN, creat, LFT, TSH, ESR, and antinuclear antibodies

66
Q

How to tx Chronic Sinusitis

A 
Nasal steroids for 4-6 weeks
Acute exacerbation- antimicrobials Amoxicillin or doxy (if PCN allergy- careful with sun exposure)
Avoid irritants 
Saline irrigation- high volume 
Refer if sx continue after 2 treatment
67
Q

Epistaxis management

A

No vigorous exercise or ASA-containing products for 10 days
Call if bleeding occurs (esp while packing is in place)
Avoid tobacco and spicy foods → cause vasodilation

68
Q

How to tx pregnancy rhinitis?

A

nasal lavage using distilled water

69
Q

Ageusia

A

absent taste

70
Q

Nasal congestion with RHINNORRHEA

Coughing, sneezing, fever, hoarseness, pharyngitis.

A

Common cold URI

FNP2- test 1 (7 decks)

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