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FNP 2 > module 3 sinusitis, tumors, and polyps of the nose > Flashcards

module 3 sinusitis, tumors, and polyps of the nose Flashcards

1
Q

rhinosinusitis

A

symptomatic inflammation of the mucosal surface of the paranasal sinuses

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2
Q

subclassifications of rhinosinusitis

A

acute: resolves in less than 4 weeks
subacute: resolves within 4-12 weeks
chronic: continues beyond 12 weeks

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3
Q

Acute rhinosinusitis

A

inflammatory process of the paranasal sinuses caused by:
- viral
- bacterial
- fungal
- allergic
Usually proceeded by an acute viral respiratory infection which extends into the paranasal sinus cavities

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4
Q

Acute Bacterial rhinosinusitis usually caused by

A

streptococcus pneumoniae
HIB
moraxella catrrhalis
S. pneumonia

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5
Q

Acute rhinosinusitis s/s

A

Abrupt onset:
nasal congestion
purulent nasal discharge
dental pain
post-nasal drip
halitosis
ear fullness/otalgia
dec. smell
headache
fever
fatigue

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6
Q

chronic sinusitis

A

prolonged sinus infection that resist tx or recurrent acute infections
- anatomic abnormality
- immunocompromised
- continued irritant/allergen exposure
- incompletely treated bacterial or fungal infection

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7
Q

medical devices that can cause sinusitis

A

NG tube
intubated through nare

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8
Q

largest paranasal sinus

A

maxillary

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9
Q

maxillary anatomy and infections

A

ostium into nose is superiorly placed
- no gravity advantage
- infected secretions are forced into sinus cavity

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10
Q

bacterial sinusitis

A
  • most often a complication of viral rhinosinusitis OR
  • allergies
  • dental infection
  • fluid introduced into sinuses: diving, swimming
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11
Q

sinusitis r/t anatomic abnormalities

A

deviated septum
adenoidal hypertrophy
neoplasms
foreign body
ciliary dysfunction: CF

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12
Q

acute bacterial rhinosinusitis s/s

A

mucopurulent discharge
nasal obstruction
facial pain or pressure
- ARS s/s > 10 days or initial improvement followed by worsening of s/s

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13
Q

Chronic rhinosinusitis s/s

A

purulent nasal drainage
nasal obstruction: bilateral
facial pain or pressure
dec. or loss of smell
- > 12 weeks
frequent throat clearing
cough
INC. in:
- allergy s/s
- asthma
- eczema

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14
Q

rhinosinusitis physical exam

A

General inspection for facial:
- asymmetry
- periorbital edema
- cellulitis
Speech: hyponasal quality
Nasal turbinate:
- edema
- erythema
- discharge
- patency of nares
- septal deviation
- polyps
Transillumination
- inability to transilluminate indicates fluid in sinuses
Palpation and Percussion:
- frontal and maxillary sinuses
Pharynx:
- postnasal drip
- erythema
- lymphoid hypertrophy
Otic exam
- otitis media

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15
Q

Rx management of rhinosinusitis

A

antibiotic tx if s/s > 7 days
NSAIds
nasal saline
oral or topical decongestants
nasal steroids

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16
Q

complications of rhinosinusitis

A

quality of life
osteomyelitis
orbital infection
vision loss: pressure on optic nerve
invasive fungal sinusitis

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17
Q

osteomyelitis of frontal bone

A

fever
pain
edema over bone: Pott’s puffy tumor

18
Q

primary sites for malignant tumors

A

nose
nasopharynx
paranasal sinuses

19
Q

malignant lesions include

A

carcinomas
lymphomas
sarcomas
melanomas
squamous cell carcinoma: most common

20
Q

most common type of benign tumor

A

inverted papilloma
- arises from the common wall between the nose and maxillary sinuses

21
Q

juvenile angiofibroma

A

highly vascular benign tumor
- common in adolescent boys
- bleeds easily
- can cause nasal obstruction

22
Q

nasal polyps

A

inflammatory disorder of the nose and paranasal sinuses
-> chronic nasal obstruction
-> diminished sense of smell

23
Q

nasal polyps on exam

A

pale
edematous
developing: teardrop shape
Mature: resembles a peeled seedless grape

24
Q

nasal polyps assoc. with

A

allergic rhinitis
asthma
acute or chronic infections
cystic fibrosis

25
Q

squamous cell carcinomas arise from

A

keratinocytes of the epithelium
- more common in male
Associated with:
- smoking
- ETOH
- sunlight exposure

26
Q

inverted papillomas develop from

A

squamous cells in which the epithelium is invaginated into the vascular connective tissue

27
Q

complications of inverted papillomas

A

invasion of the orbit or cranial vault

28
Q

nasopharyngeal angiofibromas may be assoc. with

A

familial adenomatous paolyps
- almost exclusively occur in adolescent males who have red hair and fair skin

29
Q

nasal polyps originate

A

from the mucous membrane linings of the maxillary sinuses and prolapse into the nasal cavity

30
Q

4 types of polyps

A

antrochoanal
idiopathic
eosinophilic
polyps with underlying systemic disease

31
Q

antrochoanal polyp

A

non-eosinophilic
unilateral

32
Q

idiopathic polyp

A

unilateral or bilateral
eosinophilic without lower airway involvement

33
Q

eosinophilic polyps

A

assoc. with asthma or aspirin sensitivity

34
Q

polyps with underlying systemic disease

A

CF
Churg-Strauss syndrome
Kartagener syndrome

35
Q

s/s that suggest presence of cancer

A

unilateral nasal obstruction
discharge w/ pain
recurrent hemorrhage
headache
visual or olfactory changes

36
Q

Benign nasal tumors s/s

A

nasal obstruction
discharge
facial swelling
bleed easily: recurrent epistaxis

37
Q

nasal polyps s/s

A

nasal obstruction
hyposmia or anosmia
recurrent sinusitis
headache
post-nasal drip

38
Q

Granulomatosis with polyangiitis (GPA)

A

systemic vasculitis of unknown causes characterized by glomerulonephritis plus granulomas of the nose and lung
- without tx survival rate less than a year

39
Q

GPA s/s

A

nasal congestion
nasal ulcerations
rhinitis
sinusitis
otitis media
otorrhea
hearing loss
gingival hypertrophy
cough
dyspnea
hemoptysis
fever
weakness
malaise
wt loss
conjunctivitis
rash or skin lesions
polyarthralgias

40
Q

GPA physical exam

A

nasal congestion and crusting
rhinorrhea
ulceration of nasal septum
epistaxis
destruction of nasal septum
-> saddle nose deformity
erosion through skin that cover the nose and sinuses
rales
rhonchi
wheezing
unilateral proptosis
red eye
otitis media
symmetric polyarticular arthritis
purpura

FNP 2 (30 decks)

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