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ENT > Nasal Disorders > Flashcards

Nasal Disorders Flashcards

1
Q

What viruses are the most common viruses associated with the
common cold?

A

Rhinoviruses

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2
Q

The common cold is also called what?

A

Viral Rhinitis

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3
Q

What are some complications of viral rhinitis?

A

Middle ear effusion

Secondary bacterial infection

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4
Q

Associated with prolonged use of nasal decongestant sprays

Can be caused by chronic Afrin use or cocaine abuse

A

Rhinitis Medicamentosa

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5
Q

Consistent use of nasal decongestant spray subsequently leads to
rebound nasal congestion as the medication wears off

This frequently causes the patient to re-administer more of the medicine

A

Rhinitis Medicamentosa

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6
Q

IgE mediated disease that leads to activation and release of inflammatory mediators from mast cells in response to allergen
exposure

Classifications - Seasonal or Perennial

Atopic dermatitis can be associated with this (atopic triad)

A

Allergic Rhinitis

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7
Q

What are the two classifications of allergic rhinitis?

A

Seasonal – IgE-mediated reaction to seasonal aeroallergens (i.e. pollen)

Perennial – IgE-mediated reaction to perennial (year round) – environmental aeroallergens (dust mites, mold spores, animal dander, etc)

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8
Q

Atopic dermatitis can be associated with this

A

Allergic Rhinitis

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9
Q

What is the standard of care for allergic rhinitis?

A

Nasal corticosteroids

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10
Q

Defined as inflammation of the nasal passage and paranasal sinuses
lasting up to 4 weeks

Incidence in adults: 2-3 episodes per year

Secondary bacterial infection of paranasal sinuses following a viral
URI is estimated to occur in 0.5-2% of adult cases

A

Acute Rhinosinusitis

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11
Q

What is the most frequent cause of acute rhinosinusitis?

A

Viral etiology associated with a URI or the common cold

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12
Q

What are the most common pathogens in secondary bacterial rhinosinusitis?

A

Strep pneumonia and H. influenzae

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13
Q

What are some complications of secondary bacterial rhinosinusitis?

A

Chronic sinusitis
Orbital cellulitis and abscess
Osteomyelitis
Meningitis
Intracranial extension (rare)
Cavernous sinus thrombosis

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14
Q

Describe the clinical presentations (any of 3) are recommended for
identifying patients with acute bacterial v. viral rhinosinusitis

A

Onset with persistent symptoms or signs compatible with ARS, lasting for ≥10 days without clinical improvement

Onset with severe symptoms or signs of high fever (≥102 F) and purulent nasal discharge or facial pain lasting for at least 3-4 consecutive days at the beginning of illness

Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral URI that lasted 5-6 days and were initially improving

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15
Q

What is the drug of choice in bacterial rhinosinusitis?

A

Amoxicillin/Augmentin (7-10 day course)

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16
Q

Definition of recurrent acute rhinosinusitis

A

4 or more episodes per year of ABRS without signs or symptoms of
rhinosinusitis between episodes

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17
Q

Definition of chronic rhinosinusitis

A

Twelve weeks of longer of two or more of the following signs and symptoms:

Mucopurulent drainage

Nasal obstruction (congestion)

Facial pain/pressure/fullness

Decreased sense of smell

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18
Q

What are the two most common organisms seen in invasive fungal sinusitis?

A

Rhinocerebral mucoromycosis

Aspergillus

19
Q

What is the classic finding of rhinocerebral mucomycosis?

A

Black eschar on middle turbinate

20
Q

Symptoms are similar to bacterial sinusitis: Facial pain is more severe, insensate turbinate, nasal mucosa with black, necrotic eschar, cranial neuropathies

MEDICAL and SURGICAL EMERGENCY!!

Mortality rate 20% or more

A

Rhinocerebral Mucomycosis

21
Q

What is the treatment for rhinocerebral mucomycosis?

A

Wide debridement and amphotericin B

22
Q

Inflammation/infection of the
nasal vestibule

Commonly from folliculitis

A

Nasal Vestibulitis

23
Q

What is a concern with nasal vestibulitis to be aware of?

A

Retrograde infection through valveless veins via the cavernous sinus into the cranium

24
Q

What is the most common organism responsible for nasal vestibulitis?

A

Staph aureus

25
Q

Unilateral nasal obstruction and rhinorrhea

Most are inorganic and do not cause many symptoms

Occur most commonly in young children (toddlers and preschoolers)

Nasal discharge typically purulent - Foul smelling

A

Nasal Foreign Bodies

26
Q

What is the most common epistaxis?

A

anterior (95%)

27
Q

What are the two classifications of epistaxis?

A

anterior (95%) and posterior

28
Q

hereditary hemorrhage telangiectasia

A

Oster-Weber-Rendu syndrome

29
Q

Where majority of anterior epistaxis occurs (anterior septum) – 90%

A

Anastomose to form Kiesselbach’s plexus

30
Q

What is the most common cause of epistaxis in children?

A

nose picking

31
Q

List some triggering factors for epistaxis

A

Viral URI
Allergic rhinitis
Trauma
Foreign body
Bleeding disorders (<5%)

32
Q

Highly vascular invasive neoplasm

Presents as epistaxis, nasal obstruction

A

Juvenile angiofibromas

33
Q

Which type of epistaxis is described below?

The most common type of epistaxis

Common in kids

Most active hemorrhages can be controlled

Anterior packing (outpatient)

A

Anterior Epistaxis

34
Q

Which type of epistaxis is described below?

Very rare

Elderly most common

Originate most commonly from the posterolateral branches of the sphenopalatine artery

More serious problem - May be life threatening

A

Posterior Epistaxis

35
Q

In epistaxis, any patient given packing of any sort should be placed on what until packing removed?

A

antibiotics

36
Q

What are some complications of anterior epistaxis to be aware of?

A

complications can include sinusitis or more rarely TSS

37
Q

Posterior epistaxis is most commonly associated with what chronic diseases?

A

HTN and atherosclerosis

38
Q

What are some complications of posterior epistaxis to be aware of?

A

Respiratory failure
Cardiac arrhythmias
death

39
Q

Patients with posterior packaging - is it managed in outpatient or inpatient settings?

A

must be hospitalized if posteriorly packed – typically ICU

40
Q

List some clinical features of a nasal fracture?

A

History of trauma
Pain
Epistaxis
Nasal obstruction
Periorbital ecchymosis
edema

41
Q

What is the best way to assess for a nasal fracture?

A

Palpation and Xray

42
Q

Why is it recommended in a suspected nasal fracture to get facial series?

A

to rule out Le Forte fracture

43
Q

What are some complications of a nasal fracture?

A

Septal hematoma

Unmanageable/uncontrollable hemorrhaging

44
Q

Why should you be concerned about a septal hematoma?

A

Don’t miss this!!! Can lead to saddle deformity

ENT (13 decks)

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