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Nose Flashcards

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1
Q

what is rhinitis?

A

inflammation of the nasal mucosa

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2
Q

etiologies of rhinitis

A

viral infection
allergic
acute bacteria infection
vasomotor

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3
Q

what is allergic rhinitis?

A

hay fever

seasonal allergic rhinitis is MOST common

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4
Q

Pathophysiology of allergic rhinitis

A

activation of humoral and cell mediated immune responses that lead to IgE mediated inflammatory response

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5
Q

allergic rhinitis nasal symptoms

A

rhinorrhea (clear)
sneezing
watery eyes
allergic shiners
Dennie’s lines (lines under eyes)
transverse nasal fold or “allergic salute”
throat discomfort
nasal congestion
hyposmia
malaise

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6
Q

allergic rhinitis eye symptoms

A

eye irritation
pruritus
conjunctival erythema
excessive tearing

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7
Q

what is the triad of allergic rhinitis?

A

nasal congestion, sneezing, clear rhinorrhea

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8
Q

what is associated with allergic rhinitis?

A

strong genetic component
asthma, nasal polyps, nasal speech, history of atopic dermatitis

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9
Q

testing for allergic rhinitis?

A

clinical diagnosis
nasal smear - elevated eosinophils
allergy skin tests or RAST tests often positive for specific allergens

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10
Q

treatment of allergic rhinitis

A

avoid allergens
corticosteroids - intranasal AND/OR oral or IM for severe cases
antihistamines
anticholinergic agents
antileukotrienes
immunotherapy for resistant cases

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11
Q

physical findings of allergic rhinitis

A

pale-bluish, edematous or boggy nasal mucosa
venous engorgement

AND

nasal polyps - yellow boggy masses of mucosa
associated with chronic allergic rhinitis

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12
Q

what are nasal polyps?

A

benign lesions that arise from nasal mucosa caused by chronic inflammation
associated with asthma, CF, aspirin tolerance, allergic rhinitis

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13
Q

what is viral rhinitis?

A

also known as the common cold, coryza

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14
Q

T/F: viral rhinitis most common adult infection

A

FALSE: most common pediatric infection
children < 5 years average 6-12 “colds” per year

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15
Q

testing for viral rhinitis?

A

diagnosis made by history
lab test unnecessary
complications may prolong illness (ear infection, pneumonia, pharyngitis, sinusitis)
*can trigger asthma attacks

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16
Q

viral rhinitis symptoms

A

rhinorrhea (clear to opaque)
nasal congestion, headache
hyposmia
sneezing
malaise
throat discomfort
post nasal drip –> cough

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17
Q

T/F: only 1 virus is responsible for the viral rhinitis

A

FALSE: multiple. rhinovirus (majority), adenovirus, coronavirus, enterovirus, influenza, influenza, parainfluenza, RSV

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18
Q

physical findings of viral rhinitis

A

erythematous, edematous, engorged nasal mucosa
watery discharge - intranasal purulent discharge suggest bacterial cause

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19
Q

viral rhinitis treatment

A

self-limiting - no effective anti-viral therapies
zinc acetate lozenges
nasal irrigation
decongestants

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20
Q

what is vasomotor rhinitis?

A

perennial non-allergic rhinitis associated with hyperactive nasal mucosa

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21
Q

Pathophysiology of vasomotor rhinitis

A

caused by increased sensitivity of the vidian nerve (passes through the pterygoid canal supplying the pterygopalatine ganglion)

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22
Q

T/F: vasomotor rhinitis etiology is unknown

A

TRUE

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23
Q

what is vasomotor rhinitis related to?

A

related to geriatric rhinitis and progressive degeneration of nasal mucosa

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24
Q

when and what is the onset of vasomotor rhinitis?

A

adults

presents with rapid onset of nasal congestion and postnasal drip

*No family history of allergies

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25
physical exam of vasomotor rhinitis
clear rhinorrhea
26
triggers for vasomotor rhinitis
* cold temperature, * inhaled irritants, * strong odors, * spicy foods, * other nonallergenic environmental stimuli
27
what is rhinitis medicamentosa
* overuse of Decongestant nasal spray (limit use to \<5 days) * Swollen, red mucous membranes
28
what do the lab tests look like for vasomotor rhinitis
negative lab tests
29
treatment for vasomotor rhinitis
Inhaled decongestants or corticosteroids Topical Ipratropium bromide (atrovent) - dries up drainage Avoidance of triggers
30
how to differentiated between allergic, viral and vasomotor
* **_Allergic Rhinitis_** – precipitated by allergen, nasal congestion, sneezing, clear rhinorrhea, * PE: Watery Rhinorrhea, Pale, boggy nasal mucosa * **_Viral Rhinitis_** – precipitated by virus, inflammation of nasal mucosa, \<10 days * PE: erythematous mucosa, clear/yellow rhinorrhea * **_Vasomotor Rhinitis_** – precipitated by a trigger, hyperactive nasal mucosa, adults, no hx of allergies * PE: clear, constant rhinorrhea
31
function of nose
* 80% Flavor of Food * Recognize thousands of smells * Smell affects our emotions * Helps block bacteria from entering
32
function of sinuses
* Humidifying and warming inspired air * Regulation of intranasal pressure * Lightening the skull * Resonance * Absorbing shock
33
when is the frontal sinus present?
at significant size at 3-4 yrs. old, sphenoid at 8yrs
34
T/F: 3-4 liters of mucus produced per day
FALSE - One - Two Liters of mucus produced per day
35
common etiology of acute rhinosinusitis
VIRUS
36
how to manage acute rhinosinusitis
* Symptomatic management for comfort * Does NOT decrease duration * Helps with symptoms * Self – limiting * Usually lasts 7 – 10 days
37
viral rhinosinusitis
Inflammation and swelling of the mucous membranes of the nose
38
how long does viral rhinosinusitis lasts
\<10 days, self-limited
39
symptoms of viral rhinosinusitis
* Clear/yellow rhinorrhea More mucoid in appearance after day 2 * Erythematous Mucosa * Congestion * post-nasal drip * Cough * Low-grade fever
40
treatment acute viral rhinosinusitis
* Purpose: Relieve Nasal Obstruction and Rhinorrhea * Antiviral drugs not effective / Abx. not effective * Analgesic – Tylenol / Motrin * Hypertonic saline nasal rinses * Intranasal Glucocorticoids * Nasal Decongestant Spray (use \< 5 days) * Antihistamines * Drying affect – could lead to further * Mucolytics (Guaifenesin)
41
bacterial rhinosinusitis
Precipitated by viral rhinosinusitis
42
how do you diagnose bacterial rhinosinusitis
Viral symptoms for \> 10-14 days Worsening of symptoms after 5-7 days
43
what is sinuses involved with bacterial rhinosinusitis
Maxillary and ethmoid sinuses
44
what are the cardinal signs of bacterial rhinosinusitis
Purlent Nasal discharge, nasal obstruction, facial pain
45
pathogens involved with acute sinusitis
0-1 months Strep pneumococcus H. influenza Moraxella catarrhalis
46
pathogens involved with chronic sinusitis
\> 3 months Gram neg Staphylococcus Staph aureus, including MRSA Anaerobes
47
sinusitis symptoms
Facial pain/pressure Facial congestion Nasal obstruction Purulent PND Inability to smell Fever, malaise Headache
48
urgent sinusitis symptoms
Persistent Fevers \> 102 F Periorbital Edema / Erythema Cranial Nerve Palsies Proptosis Visual Changes Severe HA / AMS Meningeal Signs
49
sinusitis exam
Edema Hyperemia Purulence Polyps Pain to palpation over sinus Inability to transilluminate +/- swelling or erythema over a sinus +/- fever in severe cases
50
T/F: Plain radiography generally diagnostic
FALSE - NOT, Requires non-contrast CT Max/Face – use if complicating factors o/w not necessary
51
treatment of sinusitis
* Symptomatic treatment * 80% of patients will improve within 10 -14 days * Will Improve WITHOUT antibiotics * This tx plan must include appropriate follow-up * Antibiotics after trial with symptomatic tx. x 7 days with no improvement or presents with urgent symptoms.
52
when to treat sinusitis
Lack of adequate follow-up Worsening Symptoms during symptomatic tx No improvement after 7 days
53
Risk factors for a poor outcome sinusitis
Extremes of Age Recent Hospitalization Recent Abx use Immunocompromised Multiple Comorbidities Severe Infection (Urgent Symptoms)
54
sinusitis complications
* Orbital cellulitis * Osteitis of frontal bone * Cheek cellulitis * Brain abscess * Osteomyelitis * Meningitis
55
treatment of complications
surgical debridement and 4-6 weeks of ABO
56
signs and symptoms of foreign body
* Hx of FB insertion * Mucopurulent Nasal Discharge * Foul Odor * Epistaxis * Nasal Obstruction * Mouth Breathing
57
are x-rays helpful for foreign bodies
NO, most FB are radiolucent
58
complications of FB
* Risk of Toxic Shock Syndrome * Pressure risk - tissue necrosis * Epistaxis * Obstruction can lead to acute sinusitis * Button Battery * Paired Disc Magnets
59
when to refer FB
Posterior FB Unable to Visualize Impacted FB Complications Initial 1-2 attempts failed
60
techniques of FB
Positive Pressure (soft or smooth FB that occlude the ant. nasal cavity) Instrumentation (non-occlusive FB)
61
what is epistaxis
Nose is a vascular organ with incredible heating/humidification requirements Vasculature runs just under mucosa
62
anterior bleeding
Occurs in younger patients Usually septal or anterior ethmoid Usually not severe
63
posterior bleeding
Occurs in older patients Usually from posterior ethmoid Often severe
64
epistaxis etiology
* \*\*Self-Induced * HTN * Coagulopathy * Dessication (Dryness) * Drug Use (Cocaine) * Trauma – Facial Fractures * Vascular malformations * Infection/Inflammation * Iatrogenic * Neoplasm * Foreign Bodies * Post- op
65
coagulopathy causes
* Thrombocytopenia (Leukemia, TTP, HELLP) * Platelet dysfunction (Systemic disease – Uremia and Drug-induced – Coumadin, Heparin, ASA) * Clotting Factor Deficiencies (Hemophilia, VonWillebrand’s disease, Hepatic failure)
66
trauma causes
Nose picking Nose blowing/sneezing Nasal fracture Nasal intubation Trauma to sinuses, nose, orbits, middle ear, base of skull
67
neoplasm causes
Benign nasopharyngeal tumors Squamous cell carcinoma Adenocarcinoma Melanoma Lymphoma
68
desiccation (extreme dryness) causes
Temperature, Humidity Nasal oxygen Atrophic rhinitis Septal perforation (Nasal sprays, cocaine)
69
epistaxis management
* Medical history/Medications * Vital signs
70
non-surgical treatments of epistaxis
* If direct pressure ineffective, suction to remove clots * Apply topical vasoconstrictors / anesthetic * Cautery with AgNO3 (Silver Nitrate) or Bovie NEVER both sides of septum Less than 10 seconds * Gelfoam * Surgicel * Topical Thrombin * Control hypertension * Correct coagulopathies if indicated
71
anterior bleed treatment
Afrin+pressure Cauterization Gelfoam Surgicel Topical thrombin
72
posterior bleed treatment
call ENT coagulopathy
73
surgery for epistaxis?
* Continued bleeding despite nasal packing * Nasal anomaly precluding packing * Patient refusal/intolerance of packing * Failed medical mgmt after \>72hrs * Many times can’t tell anterior or posterior until pack and bleeding persists = POSTERIOR
74
septal perforation etiologies
* Overuse of nasal steroid * Latrogenic * Nasal cautery * Post-operative complication * Cocaine/Ketamine
75
nasal polyps
benign lesions that arise from nasal mucosa
76
what are nasal polyps caused by
chronic inflammation
77
nasal polyps are associated with
asthma, CF, aspirin intolerance, allergic rhinitis
78
samter's triad
nasal polyps asthma hypersensitivity to aspirin nasal polyps + asthma = no ASA
79
what is AERD
Aspirin Exacerbated Respiratory Disease
80
how to treat nasal polyps
nasal or oral steroids
81
how to diagnose nasal polyps
Diagnosed with nasal endoscopy CT/MRI
82
can you give aspirin to someone with nasal polyps
NOOOO
83
inverted papilloma
caused by HPV treated with surgical resection
84
most common broken bone in the body
nose high incidence of LeFort fractures
85
is imaging needed for nasal fractures?
* no unless…. * Septal hematoma * Orbital or facial nerve involvement * Tenderness is not limited to bridge of nose * Patient cannot breathe through both nares * Severe asymmetry suspecting comminuted fracture
86
nasal fracture
* Prior Injury? * Edematous, Painful, Epistax. * Eval for Hematoma * +/- imaging * Delayed repair
87
septal hematoma
* Septal cartilage lacks its own blood supply * Untreated hematoma can lead to destruction of septum * Must I&D (saddle or perf)
88
what is charge syndome?
* Coloboma – hole in one of the eye structures * Heart disease * Atresia of choanae - Posterior naris * Retarded growth * Genital hypoplasia * Ear anomalies
89
choanal atersia
Congenital blockage of one or both nasal passages, usually by abnormal bony or soft tissue growth during fetal development life threatening emergency
90
signs and symptoms of choanal atersia
cyanosis during feeding continuous nasal drainage
91
how to diagnose choanal atresia
Inability to pass 6F catheter CT sinus
92
treatment of choanal atresia
Surgical drilling and stent placement Often need multiple surgeries through adolescent years and adulthood
93
lefort I
horizontal edema, mobility of hard palate / teeth
94
lefort II
pyramidal edema, subconj hemorrhage, mobility at nasofrontal suture, epistax., CSF rhinorrhea
95
lefort III
separation of all facial bones from cranium massive edema, movement of all facial bones, epistaxis, CSF rhinorrhea

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