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Clinical med > HEENT nose > Flashcards

HEENT nose Flashcards

1
Q

Rhinitis consist of one or more of the following:

A

congestion
rhinorrhea
sneezing
pruritus

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2
Q

rhinitis differential Dx consist of

A

infectious
vasomotor
obstructive
drug induced
hormonal
allergic

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3
Q

history for viral URI (common cold)

A

nasal congestion, rhinorrhea, malaise, sore throat, +- fever, 5-7 day

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4
Q

PE for viral URI (common cold)

A

nasal mucosal edema, clear rhinorrhea, pharugneal injection/ cobblestoning

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5
Q

T/F: you give zpaks and antibiotics for viral URI

A

Flase

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6
Q

how do you treat symptoms for common cold (viral URI) if you can not give antibiotics or zpaks?

A

decongestants
nasal saline
antihistamine
tylenol for fever
nonsterodial anti-inflammatory drugs (ibuprofen)
intranasal corticosteriod

wheezing + = beta agonists (albuterol)

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7
Q

drug induced rhinitis is called …

A

rhinitis medicamentosa

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8
Q

what causes rhinitis medicamentosa

A

intranasal decongestants (afrin: oxymetazoline)/ cocaine

NSAIDS/ Aspirin
ACE1
phosphodiesterase 5 selective inhibitors
alpha receptor antagonists

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9
Q

condition where there is abnormal autonomic responsiveness and vascular dilatation of submucosal vessels is called ….

A

vasomotor rhinitis

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10
Q

vasomotor rhinitis, which is more common in elderly people, happens during …

A

profuse eating - gustatory

drug use- cocaine

smoking

hot/ spicy food

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11
Q

nasal obstruction, which can cause rhinitis, can happen due to 5 things

(describe what symptoms show)

A

neoplasm - unilateral bloody discharge. no response to antibiotic

FB - unilateral obstruction, smelly, purulent discharge

deviated septum - snoring, nasal blockage, history of nasal fracture

nasal polyp: pearly, nontender, mobile, gray saclike growth, + inflamed nasal mucosa

samter’s triad: asthma, aspirin intolerance, and nasal polyp (aspirin blocks prostaglandins and leukrotrene production)

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12
Q

treatment for nasal obstruction

A

oral/nasal steriods

leukotriene inhibitors

surgery

aspirin desensitization

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13
Q

rhinitis gravidarum treatment

A

deliver the baby since it ends 2 weeks post partum

1 and 2nd generation antihistamines

rhinocort B

saline

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14
Q

patients with CSF rhinorrhea will complain of

A

headache and sweet taste

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15
Q

CSF rhinorrhea can result from … and cause…

A

trauma to head, nasal surgery, spontaneously

headache and meningitis

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16
Q

how to test for CSF rhinorrhea

A

place CSF on a filter paper = halo ring will appear

beta-2-transferrin test (hard to collect)

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17
Q

allergic rhinitis happens when you have _______ predisposition and ____________ reaction

A

genetic

gell and combs type 1 hypersensitivity reaction

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18
Q

during allergic rhinitis, there is sensitized mast cells that bind to IgE molecules. the mast cell degranulates and releases …… , …….. , ……

A

histamine

leukotrienes

kinins

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19
Q

allergic rhinitis comorbities

A

asthma

otitis media

sinusitis

atopic dermatitis

allergic conjunctivities

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20
Q

associated symptoms with allergic rhinitis

A

sneezing, itchy/watery eyes, congestion, rhinorrhea

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21
Q

for allergic rhinitis, ask pt about their ……/….. patterns

A

temporal and environmental patterns and how the symtoms

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22
Q

allergic r. has similiar symptoms to ….. rhinitis

A

viral

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23
Q

on PE, you noticed the patient is sneezing, nasal congestion, without fever, allergic lashes, and with dennie’s lines (muellers mm spasm), and shiners (venous stasis, and hemosiderin deposits) the pt has ….

A

allergic rhinitis

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24
Q

long, silky eyelashes

dennie’s line

inferior turbinate hypertrophy

deviated septum

shiners

pale nasal mucosa and nasal polyp

posterior pharyngeal cobble stoning

is….

A

allergic rhinitis

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25
Q

for allergic rhinitis, you will do the following tests

A

RAST - measure Ige antibodies and total serum Ige level . low sensitivity, high specificity . serum sample

Skin test (gold standard)
*skin prick,
*patch test
*intradermal
*intradilutional testing (IDT)

26
Q

allergy treatment will be …

A

steroids (oral/nasal) - first line
antihistamine (oral/nasal)
expectorant/decongestants
leukotriene inhibitor (singulair- montelukast)
mast cell stabilizers (cromolyn)
saline
xolair (omalizumab) - allergic asthma/ chronic urticaria

27
Q

immunotherapy works by …

A

increasing Ig4 so it can block antigen from binding to IgE molecule

decreases antigen specific Ige

28
Q

allergy immunotherapy has both …. and …. treatments

A

subcutaneous - well studied, 90% rate for inhalants/ risk anaphylaxis

sublingual - not fda approved. - ragweed and grass available: dust mite pending - no risk for shock

29
Q

type of nose bleed that comes from arterial, and is more profuse and harder to control, can comprise airway, seen in the back of throat, and comes from the internal maxillary artery (IMA)

A

posterior

30
Q

type of epistaxis that 90 % comes from kiesselbach plexus, little ones area, inferior turbinate

A

anterior

31
Q

for epistaxis, acute management, you should

A

control hypertension
see medication history
amount of blood, how long to control
check back of throat
labs: cbc, prothrombin/partial thrombolastin time, platelets
ENT follow up

32
Q

treatment for minor anterior epistaxis is

A

spray otc afrin into side of blood

soak cotton in afrin and put into anterior cavity

apply pressure by pressing the cartilage

respray every 5 mins until done

33
Q

treatment for minor but recurrent anterior epistaxis

A

anesthetize septal area with 2% lidocaine

apply silver nitrate to bleeding vessels

do not over apply = septal perforation

avoid bilateral septal cautery

34
Q

when do you put nasal pack in the anterior cavity for epistaxis?

A

when bleeding does not stop

35
Q

why would you give a pt who has a nasal pack due to nose bleed antibiotic ?

A

to prevent sinnuitis and infection

36
Q

most often cause of posterior epistaxis is

A

hypertension

37
Q

pts with posterior epistaxis can die from this because it does 3 harmful things and they are

A

airway comprise
uncontrolled bleeding
aspiration

38
Q

this type of nosebleed may require IMA embolization, arterial ligation (sphenopalatine, ethmoid)

A
39
Q

how many times should people with nose bleeds use nasal saline spray

A

every 2 hrs when awake

before and after bedtime

40
Q

unilateral obstruction, malodorous, mucopurulent nasal drainage is

A

FB

it is a FB until proven otherwise

41
Q

explain what sinusitis is and the etiology of it

A

inflammation of the sinuses (air filled cavity in skull) – > blockage of sinus ostia (drainage) –> mucus retention, hypoxia, decreased mucociliary clearance, and bacterial growth

can be caused by viral, bacterial, fungal, noninfectious (allergies)

42
Q

what bacterial can cause sinusities

A

strep. pneumonia, H. Influenza, M. catarrhalis

atypical - mycoplasma, pseudomonas

resistant bacteria

43
Q

which fungal causes sinusitis, on which pt, and which symptoms

A

aspergillus

immunocompromised pts

foul smelling, nasal discharge

44
Q

differential diagnosis for sinusitis

A

TMJ pain
dental infection
viral rhinitis - common cold
allergic rhinitis
trigeminal neuralgia
sinus neoplasm
headache syndrome
migraine
sinus migraines

45
Q

sinus neoplasm will show which symptoms

A

vision changes

unilateral nasal obstruction

unilateral epistaxis

CN deficits

46
Q

acute siniuites will have

A

persistent symptoms for more than 7-10
nasal congestion
post nasal drip
sinus pressure
purulent nasal discharge - thick green/ yellow mucus

47
Q

chronic sinuities will have

A

acute symptoms

chronic headache, cough, halitosis, decrease smell, ear pressure

48
Q

for sinuities, the face will have and the ears will have

A

possible localized tenderness - face

normal TM - ears

49
Q

for sinuities, the nose will have and the lungs will have

A

mucosal edema, inferior turbinate hypertropy, mucosale erythema, mucopus - nose

clear sounds - lungs

50
Q

for sinuities, the neck will have and the pharynx will show

A

+/- cervical adenopathy - neck

thick postnasal drip, posterior pharygenal cobblestoning - pharynx

51
Q

acute sinusities symptoms is less than … and chronic is more than

A

4 weeks = acute

more than 3 months = chronic

52
Q

which test is best to see sinus ?

A

CT scan = can see sinuses, nasal cavity, air, fluid level, ostia

53
Q

which types of pts with sinusitis do you give antibiotics to?

A

Sx not improving after 7 days/ getting worse
fever > 101
immunocompromised
comorbidities, age, health =factor

54
Q

what is the initial antibiotics for ACUTE sinusitis?

A

augmentin (amoxicillin/ clavulanic acid

55
Q

if the pt is allergic to PCN and you can not give augmentin to treat their ACUTE sinusitis, what do you give instead

A

doxycycline or clindamycin

56
Q

…. scan sinusities if it is not improving or recurrent

A

CT

57
Q

which nasal steroid do you give for pts with sinusities

A

flonase

58
Q

which oral steriod do you give for pts with sinusities

A

prednisone

59
Q

should you give antihistamine for sinusities

A

no

60
Q

if sinusities is not fixed, the pt can end up having this eye problem

A

orbital cellulitis

Clinical med (6 decks)

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