HEENT nose Flashcards by Ana Bramute

Rhinitis consist of one or more of the following:

congestion
rhinorrhea
sneezing
pruritus

How well did you know this?

Not at all

Perfectly

rhinitis differential Dx consist of

infectious
vasomotor
obstructive
drug induced
hormonal
allergic

How well did you know this?

Not at all

Perfectly

history for viral URI (common cold)

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

How well did you know this?

Not at all

Perfectly

PE for viral URI (common cold)

nasal mucosal edema, clear rhinorrhea, pharugneal injection/ cobblestoning

How well did you know this?

Not at all

Perfectly

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

Flase

How well did you know this?

Not at all

Perfectly

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

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

wheezing + = beta agonists (albuterol)

How well did you know this?

Not at all

Perfectly

drug induced rhinitis is called …

rhinitis medicamentosa

How well did you know this?

Not at all

Perfectly

what causes rhinitis medicamentosa

intranasal decongestants (afrin: oxymetazoline)/ cocaine

NSAIDS/ Aspirin
ACE1
phosphodiesterase 5 selective inhibitors
alpha receptor antagonists

How well did you know this?

Not at all

Perfectly

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

vasomotor rhinitis

How well did you know this?

Not at all

Perfectly

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

profuse eating - gustatory

drug use- cocaine

smoking

hot/ spicy food

How well did you know this?

Not at all

Perfectly

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

(describe what symptoms show)

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)

How well did you know this?

Not at all

Perfectly

treatment for nasal obstruction

oral/nasal steriods

leukotriene inhibitors

surgery

aspirin desensitization

How well did you know this?

Not at all

Perfectly

rhinitis gravidarum treatment

deliver the baby since it ends 2 weeks post partum

1 and 2nd generation antihistamines

rhinocort B

saline

How well did you know this?

Not at all

Perfectly

patients with CSF rhinorrhea will complain of

headache and sweet taste

How well did you know this?

Not at all

Perfectly

CSF rhinorrhea can result from … and cause…

trauma to head, nasal surgery, spontaneously

headache and meningitis

How well did you know this?

Not at all

Perfectly

how to test for CSF rhinorrhea

place CSF on a filter paper = halo ring will appear

beta-2-transferrin test (hard to collect)

How well did you know this?

Not at all

Perfectly

allergic rhinitis happens when you have _______ predisposition and ____________ reaction

genetic

gell and combs type 1 hypersensitivity reaction

How well did you know this?

Not at all

Perfectly

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

histamine

leukotrienes

kinins

How well did you know this?

Not at all

Perfectly

allergic rhinitis comorbities

asthma

otitis media

sinusitis

atopic dermatitis

allergic conjunctivities

How well did you know this?

Not at all

Perfectly

associated symptoms with allergic rhinitis

sneezing, itchy/watery eyes, congestion, rhinorrhea

How well did you know this?

Not at all

Perfectly

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

temporal and environmental patterns and how the symtoms

How well did you know this?

Not at all

Perfectly

allergic r. has similiar symptoms to ….. rhinitis

viral

How well did you know this?

Not at all

Perfectly

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 ….

allergic rhinitis

How well did you know this?

Not at all

Perfectly

long, silky eyelashes

dennie’s line

inferior turbinate hypertrophy

deviated septum

shiners

pale nasal mucosa and nasal polyp

posterior pharyngeal cobble stoning

is….

allergic rhinitis

How well did you know this?

Not at all

Perfectly

for allergic rhinitis, you will do the following tests

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)

allergy treatment will be ...

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

immunotherapy works by ...

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

allergy immunotherapy has both .... and .... treatments

subcutaneous - well studied, 90% rate for inhalants/ risk anaphylaxis sublingual - not fda approved. - ragweed and grass available: dust mite pending - no risk for shock

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)

posterior

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

for epistaxis, acute management, you should

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

treatment for minor anterior epistaxis is

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

treatment for minor but recurrent anterior epistaxis

anesthetize septal area with 2% lidocaine apply silver nitrate to bleeding vessels do not over apply = septal perforation avoid bilateral septal cautery

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

when bleeding does not stop

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

to prevent sinnuitis and infection

most often cause of posterior epistaxis is

hypertension

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

airway comprise uncontrolled bleeding aspiration

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

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

every 2 hrs when awake before and after bedtime

unilateral obstruction, malodorous, mucopurulent nasal drainage is

FB it is a FB until proven otherwise

explain what sinusitis is and the etiology of it

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)

what bacterial can cause sinusities

strep. pneumonia, H. Influenza, M. catarrhalis atypical - mycoplasma, pseudomonas resistant bacteria

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

aspergillus immunocompromised pts foul smelling, nasal discharge

differential diagnosis for sinusitis

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

sinus neoplasm will show which symptoms

vision changes unilateral nasal obstruction unilateral epistaxis CN deficits

acute siniuites will have

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

chronic sinuities will have

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

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

possible localized tenderness - face normal TM - ears

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

mucosal edema, inferior turbinate hypertropy, mucosale erythema, mucopus - nose clear sounds - lungs

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

+/- cervical adenopathy - neck thick postnasal drip, posterior pharygenal cobblestoning - pharynx

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

4 weeks = acute more than 3 months = chronic

which test is best to see sinus ?

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

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

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

what is the initial antibiotics for ACUTE sinusitis?

augmentin (amoxicillin/ clavulanic acid

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

doxycycline or clindamycin

.... scan sinusities if it is not improving or recurrent

which nasal steroid do you give for pts with sinusities

flonase

which oral steriod do you give for pts with sinusities

prednisone

should you give antihistamine for sinusities

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

orbital cellulitis

HEENT nose Flashcards

(60 cards)