HEET QUIZ 3- NOSE

Question 1

what percentage of rhinitis is allergic, non-allergic and combination of both

Answer 1

allergic: 43%
non-allergic: 23%
combined: 34%

Question 2

ddx for rhinorrhea

Answer 2

1. trauma: check for bennedicts ol’n : CNS fluid vs nasal
2. foreign body: odor, unilateral, d/c
3. neoplasm: bloody discharge
4. chonanal atresia: congenital defect in septal development with obstruction of nasopharynx in one or both sides

Question 3

what is the most prevelant chronic illness in <18 y/o

Answer 3

allergic rhinitis

Question 4

risk factors for allergic rhinitis

Answer 4

1. family hx of atopy
2. exposure to tobacco or indoor allergens

Question 5

what should be ruled out in children with nasal polyps

Answer 5

all children with multiple polyps should be evaluated for cystic fibrosis and asthma

Question 5

sx of nasal polyps

Answer 5

-nasal obstruction
-congestion or rhinorrhea
- decreased sense of smell
-dull H/A
-snoring
-epistaxis may be a sign of malignancy

Question 5

correlation between fungal sinusitis and multiple nasal polyps

Answer 5

85% of patients with fungal sinusitis have multiple nasal polyps

Question 5

where do most nasal polyps arise

Answer 5

in the middle meatus

Question 6

correlation between ETOH intolerance and multiple nasal polyps

Answer 6

50% of those with polyps have ETOH intolerence

Question 7

what can cause nasal septum perforation

Answer 7

• chronic infection
  -cocaine snorting
• crusting from atrophic rhinitis

Question 8

incidence of sinusitis

Answer 8

-80% of acute bacterial sinusitis follows URI
-20% associated with allergic rhinitis

Question 9

acute bacterial sinusitis , subacute, recurrent acute bacterial sinusitis , chronic, acute bacterial superimposed on chronic : definitions , time

Answer 9

acute bacterial sinusitis: lasting <30 days with resolution of sx

subacute: between 30-90 days with resolution of sx

recurrent acute: episodes lasting <30 days and separated by 10 days : pt is asx during 10 day period

chronic : lasting more than 90 days.with sx continuing

acute superimposed on chronic: pts with residual sx develop new respiratory sx. these new sx resolve with tx but underlying sx do not.

Question 10

sinutis sx

Answer 10

• fever and purulent discharge following a URI for 3-4 days
  -swollen nasal mucosa
  -pain and tenderness over sinuses or behind orbit
  -periorbital swelling or proptosis - red flag
• cough is present in subacute and chronic sinusitis , may be worse at night

Question 11

diagnosis of sinusitis , children vs adults

Answer 11

children: imaging not recommended , clinical diagnosis correlated with X ray in 80% of cases

Adults: coronal CT should be done if chronic or recurrent episodes

Question 12

possible complications of sinutisis

Answer 12

-oribital or periorbital cellulitis: edema, pain moving the eye, very sick

• cavernous sinus thrombosis: fever, deep eye pain,ocular palsy, edema, death can occur in 2-3 days- mortallity is 50%