Nose Flashcards
(96 cards)
1
Q
What are the different types of Rhinorrhea?
A
Allergic rhinitis
non-allergic rhinitis
Vasomotor rhinitis
Acute and chronic rhinosinusitis (sinusitis)
2
Q
What is allergic rhinitis?
A
Clear rhinorrhea, sneezing, tearing eye irritation
Associated symptoms: cough, bronchospasm, eczematous dermatitis
Environmental allergen exposure with the presence of allergen specific IgE
3
Q
How common in allergic rhinitis?
A
14-40% prevalence
4
Q
What are the seasonal allergies for rhinitis?
A
Most common: shrub and tree pollens
Spring: flowering shrub and tree pollens
Summer: flowering plants and grasses
Fall:ragweed and molds
5
Q
Symptoms of allergic rhinitis?
A
History of atopy sneezing watery eyes seasonal predilection prolonged symptoms congestion and pale mucosa with clear discharge (d/c) Afebrile
6
Q
What facial features are associated with allergic rhinitis?
A
Allergic shiners
Allergic salute (crease over nose)
Pale boggy turbinates
7
Q
What tests are used to diagnose allergic rhinitis?
A
CBC Nasal smear for eosinophils ELISA RAST skin prick test (affected by antihistamine or steroid use)
8
Q
What are the components of a differential for allergic rhinitis?
A
Nonallergic rhinitis w/ eosinophilia syndrome (NARES)
Vasomotor rhinitis
Chronic sinusitis
Nasal polyps or tumor
FB
medications-rebound effect from topical nasal decongestants
septal/anatomic obstruction
9
Q
Treatment for allergic rhinitis?
A
Avoidance 1rst line: nasal steriods (nasonex/flonase) 2nd line: antihistamines oral or intranasal decongestants Leukotriene receptor antagonist (singulair) Intranasal antihistamines (omnaris) cromolyn sodium "Allergy shots"
10
Q
what are the side effects of nasal steroids?
A
Epistaxis
perforated septum
taste perversion
oral candidiasis
11
Q
What is Non-Allergic Rhinitis?
A
a common condition characterized by the chronic presence of one or more of the following: nasal congestion, rhinorrhea, postnasal drainage
12
Q
How is NAR distinguished from AR?
A
onset is at a later age
absence of nasal and ocular itching and prominent sneezing
nasal congestion and postnasal drainage are prominent symptoms
symptoms are perennial (year round)
13
Q
what are the typical triggers for NAR?
A
Irritant odors and strong fragrances tobacco smoke diesel and car exhaust cleaning products newsprint changes in temperature alcoholic beverages
14
Q
What is vasomotor rhinitis?
A
intermittent symptoms of congestion and or watery rhinorrhea and exaggerated reaction to nonspecific irritants such as air pollution, temp changes, exposure to cold or dry air
15
Q
What id gustatory rhinitis?
A
Episodic condition with prominent watery rhinorrhea
triggered by hot or spicy foods
cased by the vagal-mediated reflex
16
Q
what is Rhinitis Medicamentosa?
A
occurs when there is use of intranasal decongestants for greater than 5 days
17
Q
How do you treat RM?
A
strop/wean intranasal steroids PO steroids nasal saline antihistamines decongestants
18
Q
causes of vasomotor rhinorrhea?
A
Fumes odors temp atmospheric changes smoke other irritants
19
Q
What are the drugs involved in drug-induced rhinitis?
A
ACE inhibitors reserpine guanethidine phentolamine methyldopa beta-blockers chlorpromazine gabapentin penicillamine ASA NSAIDS cocaine Exogenous estrogens OCP
20
Q
what is mixed rhinitis?
A
a combination of allergic and NAR
most common form of rhinitis, affecting ~ 45%of the population
21
Q
What is occupational rhinitis?
A
Airborne allergens or irritants in patients workplace
symptoms are more prominent at work and improve on days off
underlying mechanisms may be allergic or irritant
22
Q
what are common examples occupational irritants?
A
proteins from urine or fur of lab animals
food proteins
enzymatic proteins in detergent manufacturers
organic dusts in wood workers
23
Q
what is CSF rhinorrhea?
A
Straw colored leakage of CSF
may cause one or more nasal symptoms
usually results in unilateral or bilateral clear nasal discharge without signs and symptoms of mucosal inflammation
24
Q
what can CSF rhinorrea result from?
A
skull or nasal fractures
intracranial surgery
inferior extension of sella turscia
25
what are the postural reflexes?
increased congestion with supine position and increased congestion in the lower nasal passage when lying on one side
normal nasal cycle in the vertical position produces alternating congestion in the nostrils
26
what is crutch reflex?
increased congestion with pressure in the ipsilateral axilla
27
Hot and cold cutaneous temp reflexes
sneezing upon sudden exposure of the skin to dramatic temp extremes
28
Visible and infrared light reflexes
sneezing upon sudden exposure to bright light
29
Bronchonasal reflex
brochoconstriction in response to nasal stimulation (such as with cold air)
30
Ovulatory rhinitis
increased nasal congestion in the periovulatory period of the menstrual cycle in women
31
What is the definition of acute sinusitis?
symptomatic inflammation of 1 or more paranasal sinuses resulting from impaired drainage and retained secretions
< 4 weeks duration
32
how long subacute sinusitis?
symptomatic for 4-12 weeks
33
How long is chronic sinusitis?
symptomatic for > 12 weeks
34
what is Rhinosinusitis?
the term given to rhinitis and sinusitis because they usually coexist
35
how many annual cases of sinusitis are there each year?
31 million with an annual cost of 5.8 billion
36
what us the 5th leading reason for prescribing antibiotics?
acute bacterial rhinosinusitis
| about 0.2-2% episodes of viral rhinosinusitis have bacterial superinfection
37
When is incidence of sinusitis the highest?
early fall through early spring because it is related to viral URI (adults have 2-3 URIs per year- 90% accompanied by rhinosinusitis)
38
what is pathophysiology of sinusitis?
inflammation and edema of the sinus mucosa
obstruction of the sinus ostia
impaired mucociliary clearance
secretions that are no cleared become hospitable to bacterial growth
inflammatory response damages mucosal surfaces
39
what viruses cause sinusitis?
```
Rhinovirus
Influenza A and B
parainfluenza virus
respiratory syncytail
adeno/corona/enteroviruses
```
40
What cases bacterial sinusitis?
S. pnemoniae
H. Influenzae
M catarrhalis
More likely if symptoms are worse after 5-7 days or > 10 days
complicates 0.2-2% of viral cases
often over diagnosed (leads ton increased antibiotic resistance)
41
when is fungal sinusitis seen?
```
in immunocompromised ( uncontrolled DM, neutropenia, or use of corticosteroids)
As a nosocomial infection
```
42
Symptoms of bacterial sinusitis?
```
worsening symptoms 5-7 days after initial improvement
persistent symptoms more than 10 days
persistent purulent nasal discharge
unilateral upper tooth or facial pain
unilateral maxillary sinus tenderness
fever
```
43
what are the risk factors for sinusitis?
```
viral URI
Allergic rhinitis
Asthma
smoking
dental infections and procedures
tonsillar and adenoid hypertrophy
Turbinate hypertrophy
nasal polyps
deviated septum
cleft palate
HIV
Cystic fibrosis
*no genetic factor
```
44
What are the PE findings for sinusitis?
```
Fever
Edema and erythema of nasal mucosa
Purulent discharge
tenderness to palpation over sinus
Transilllumination of the sinuses (only helpful for unilateral sinusitis)
```
45
What are some pediatric considerations for sinusitis?
Sinus are not fully developed until age 20
maxillary and ethmoid sinuses present at birth
children are at risk for developing sinusitis
diagnosis can be harder because symptoms are more subtle
46
What are symptoms of sinusitis that need urgent attention?
Visual disturbances-Diplopia
Periorbital swelling or erythema
altered mental status
47
Are diagnostic tests used for sinusitis?
NO
| imaging techniques do not distinguish bacterial from viral
48
why would a coronal CT be used?
for recurrent infection or if medical treatment is not working
49
How are most cases of rhinosinusitis resolved?
supportive care by treating the pain and nasal symptoms
| antibiotics are used only when symptoms last more that 10 or get worse in 5-7 days
50
What medications are first line for sinusitis?
Decongestants
Analgesics
Antibiotics
51
What are the first line antibiotics for sinusitis?
Amoxicillin: adults 80-90 mg/kg/d
Trimethoprim-sulfamethoxazole (BACTRIM)
Doxycycline 100 mg (adults only because it yellows children's teeth)
52
What are the general treatments for sinusitis?
```
Hydration
steam inhalation (20-30 min)
Saline irrigation
sleep with head of bed elevated
avoid smoke, fumes, caffeine, alcohol
Analgesics
NSAIDS
```
53
What are follow up recommendations for sinusitis?
return if there is no improvement in 72 hours or symptoms continue for more than 10 with antibiotics
no follow up is symptoms resolve
54
What is the prognosis for sinusitis?
alleviation of symptoms in 72 hours and complete resolution within 10-14 days
55
What is nasal vestibulitis?
inflammation of nasal vestibule which may be from folliculitis of hairs lining the orifice
56
what is the leading nosocomial pathogen in the world?
Staph aureus
| 30% have of individual have no vestibulitis symptoms and are carriers
57
What is the tx for vestibulitis?
Antibiotics that cover S. aureus (dicloxacillin 250 mg PO QID 7-10 D)
Topical mupirocin or bacitracin BID or TID
58
what is invasive fungal sinusitis?
it is similar to acute bacterial rhinosinusit but with more sever facial pain
clear nasal drainage
*black eschar on middle turbinate
59
How is IFS spread?
spreads through the vascular system
very rare
lethal if not detected early
60
What are contributing factors for IFS?
DM
L-T corticosteroid use
end stage renal disease
61
what are the features of epistaxis?
very common
most case are <10 or 45-65
most cases are uncomplicated
62
what is the source of anterior epistaxis?
Kiesselbach's plexus
63
What is the source of posterior epistaxis?
Posterolateral branches of the sphenopalatine artery
may also be from carotid artery
can result in significant hemorrhage
64
Causes of anterior epistaxis?
MC: manual mucus extraction via the digitus secunduc (digital trauma)
low moisture in the air
Mucosal hyperemia (allergic or viral)
FB when there is blood and purulent discharge
chronic excoriation leading to small septal perforation from internasal drug use
facial trauma
65
what are the causes of anterior and posterior epistaxis?
```
Anticoagulated patients ( on coumadin)
familial blood dyscrasias ( VwF disorder)
nasal neoplasm
Alcohol
Long standing HTN
```
66
How should epistaxis be evaluated?
Main focus is airway assessment and cardio stability
predisposing conditions
Timing, frequency, and severity
Presence of chronic medical conditions that could cause more blood loss or that could be related to dyspnea, CP, lightheadedness
67
what is the initial course of treatment for epistaxis?
1. tamponade
2. Pt blows nose to remove clots
3. PA sprays nose with Afrin or cocaine
4. patinet pinches nose againt septum for 5-10 minutes
68
What is the tx for anterior epistaxis?
Cautery:chemical via silver nitrate sticks or electrical
| use topical lidocaine
69
What is the tx for posterior epistaxis?
Nasal packing via nasal tampon made of merocel
Nasal ballon catheter (rapid rhino encased in carboxymethylated cellulose mesh)
Gauze packing via ribbon gauze
70
what is a nasal obstruction?
something causing the sensation of insufficient airflow through the nose
divided into mucosal and structural causes
71
How do you diagnose NO in a PE?
Via an external examination: look at external nasal contour for body or cartilaginous deformities
look for evidence of nasal trauma
cervical lymphadenopathy upon palpation
also do an otoscopic exam
72
what can contribute to nasal obstruction in older patients?
deterioration or hypertrophy of the cartilage in the nasal tip
73
How do you treat a nasal obstruction?
it depends on the cause but usually alligator forceps or nasal sprays
74
What are nasal polyps?
sac-like growth of inflamed tissue lining the nose or sinuses
75
what are the risk factors for nasal polyps?
```
ASA sensitivity
Asthma
chronic sinus infections
cystic fibrosis
Allergic rhinitis
```
76
What are the symptoms of nasal polyps?
Mouth breathing
Nose blockage
decreased sense of smell (hypoosmia)
rhinorrhea
77
How do you diagnose nasal polyps?
they are visible upon exam as well as on CT scans
78
what is the treatment of nasal polyps?
Glucocorticosteriods
1. nasal steroid sprays-fluticisone, budesnide, mometasone
2. oral- only for severe cases
Tx of the underlying allergies
daily lavage with saline
surgery is usually temporary tx because they usually come back because they are allergy driven
79
what are the congenital anomalies of the nose?
Congenital nasal mass
1. epidermal inclusion mass
2. glioma
3. meningocele or meningomyelocele
80
what is the common cause to septal deviation?
Impact trauma
81
what are the symptoms of septal deviation?
```
sinusitis
sleep apnea
sneezing
facial pain
epistaxis
difficulty breathing
hypoosmia
```
82
What is the tx for a deviated septum?
no tx if mild
Antihistamines, nasal steroids, and decongestants help
if severe- septoplasty
83
what are juvenile nasopharyngeal adenomas (JNA)?
benign locally aggressive vascular tumor that grown in the posterior nasal cavity
Tends to bleed
Occurs in the nasopharynx of prepubertal and adolescent male
84
Who does JNA affect?
Males 7-19 years old
| there is a hormonal theory
85
What is JNA also know as?
juvenile nasopharyngeal angiofibrima or nasopharyngeal fibroma
86
How does JNA present?
one sided nasal obstruction with recurrent bleeding
87
symptoms of JNA?
Frequent epistaxis
Nasal obstruction and rhinorrhea
conductive hearing loss from eustation tube disfunction
Diplopia (due to erosion into cranial cavity and pressure on optic chiasma)
Rare: anosmia, recurrent otitis media and eye pain
88
How is JNA diagnosed?
PE- smooth submucosal mass in posterior nasal cavity ( this is very hard to see, PA has to be looking/ have a suspicion of it)
CT scan
89
what is the third most common fracture?
Nasal bone fracture
34%- from fights
28%- from accidents
23% from sports
90
How to diagnose a NBF?
Look for asymmetry upon xray
Nasal patency
Epistaxis
*refer to ENR w/i 3-5 days unless more cute referral is needed
91
TX for nasal bone fracture?
Manual realignment
| septoplasty if there is septal deviation
92
How does malignant nasopharyngeal and paranasal sinus tumors present?
```
Hx of chronic sinus congestion
recurrent nasal obstruction
Nasal discharge
intermittent epistaxis
unilateral symptoms
```
93
what are the symptoms of advanced lesions?
It depends on where the tumor has spread:
1. widening of the bride of the nose
2. Frontal headaches
3. proptosis (eyes pushing out), diplopia or palpable orbital mass
94
what doeswidening of the bride of the nose indicate?
the lesion is invading the olfactory region
95
What do frontal headaches indicate?
extension through the cribriform plate or into the ethmoid sinuses
96
what doproptosis, diplopia or palpable orbital mass indicate?
Invasion of the medial orbit
