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HEENT > Nose and Paranasal Sinuses > Flashcards

Nose and Paranasal Sinuses Flashcards

1
Q

What is the most likely culprit of URI’s?

A

Rhinoviruses

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2
Q

Presentation:
Rhinitis, rhinorrhea, nasal congestion, ST, cough, laryngitis, lymphadenopathy, mild systemic sx, fever uncommon in adults but may be present in children - usually low grade

A

URI

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3
Q

PE findings:
may be normal
common findings: conjunctival injection, nasal mucosal swelling, pharyngeal erythema, exudates and cobblestoning, lungs usually clear

A

URI

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4
Q

treatment URI

A

symptomatic relief OTC medications
analgesics - tylenol, NSAIDS
decongestants - intranasal or oral
Antitussives - dextromethorphan or benzonatate
Cool moist humidifiers, saline nasal sprays

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5
Q

URI prognosis

A

usually lasts about 3-10 days, up to 2 weeks if smoking, other comorbidities

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6
Q

Rhinitis is

A

inflammation of nasal mucosa

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7
Q

Most common forms of rhinitis

A

allergic
vasomotor
rhinitis medicamentosa

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8
Q

Allergic Rhinitis happens when

A

climate changes resulting in increased amounts of pollen and season duration
spring - flowering shrub and tree pollens
summer - flowering plants and grasses
fall - ragweed and molds

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9
Q

Allergic Rhinitis is due to (immune-mediated)

A

Ige response to airborne antigens/ allergens
ie pollen mold dander dust

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10
Q

Symptoms of allergic rhinitis can develop at

A

any age, usually children or young adults

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11
Q

ssx:
nasal itching, watery rhinorrhea, nasal congestion, sneezing
itchy or watery eyes
dry cough
“allergic salute” in kids

A

Allergic Rhinitis

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12
Q

Allergic Rhinitis - treatment

A

antihistamines - immediate but temporary, can be used prn
Corticosteroids - intranasal, shrink nasal polyps and mucosa
Intranasal anticholinergics - ipratropium bromide spray
intranasal saline, neti pot

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13
Q

Vasomotor rhinitis is

A

increased secretion from nasal mucosa precipitated by temp or humidity, odors, light, alcohol or neurovascular imbalance

symptoms clear quickly

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14
Q

Treatment of vasomotor rhinitis

A

avoid irritant

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15
Q

Rhinitis medicamentosa is

A

rebound congestion from overuse of nasal decongestants - discontinue afrin

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16
Q

Acute sinusitis/ rhinosinusitis (ARS) is

A

inflammation in nasal cavity and para-nasal sinuses
most common etiology = viral infection

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17
Q

What makes mucus green?

A

breakdown of WBC
green means infection not either bacterial or viral

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18
Q

nasal/ear/facial pressure
low grade fever
sneezing, rhinitis, cough, ST
rhinorrhea may be discolored
duration 7 to 10 days

A

Viral acute sinusitis

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19
Q

Viral acute sinusitis treatment

A

symptomatic treatment

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20
Q

usually have preceding URI
nasal/ear/facial pressure, may be worse with bending forward, sinus tenderness
purulent discharge, nasal obstruction > 10 days after sx onset
fever fatigue malaise
duration > 10 days and worsening
facial/ eyelid swelling and/or erythema concerning for periorbital/ orbital cellulitis

A

Bacterial acute sinusitis

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21
Q

Acute bacterial sinusitis workup

A

clinical dx - transillumination may be positive but not necessary
imaging usually considered in chronic sinusitis (CT scan)

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22
Q

Acute bacterial sinusitis treatment

A

abx - augmentin (amoxicillin-clavulanate) for 10-14 days
if penicillin allergy - doxycycline or levaquin
include education on nasal hygiene
w/o abx pts will improve within 2 wks

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23
Q

Chronic sinusitis is when

A

a single infection lasts > 12 wks

24
Q

sx of chronic sinusitis

A

persistent rhinorrhea, productive cough, foul breath, low grade fever, malaise, HA, facial or dental pain

25
Q

Complicated acute bacterial sinusitis

A

high persistent fever > 102
periorbital edema, inflammation or erythema
cranial nerve palsies
severe HA, altered mental status or meningeal signs

26
Q

Complicated acute bacterial sinusitis treatment

A

urgent referral to otolaryngologist for evaluation and dx
image of choice - CT scan with contrast

27
Q

Nasal Obstruction - turbinate hypertrophy

A

inflammation of turbinates resulting in increased congestion and drainage
URI, allergic rhinitis, vasomotor rhinitis, drugs

28
Q

Nasal Obstruction - turbinate hypertrophy treatment

A

treat the underlying condition
surgery is last resort - clean out airway

29
Q

Deviated Septum - Etiology

A

Trauma
connective tissue disease
drugs - cocaine
Postsurgical changes

30
Q

Deviated Septum - Treatment

A

nasal endoscopy
surgery
implants

31
Q

Adenoid Hypertrophy is the most common cause of

A

nasal obstruction in a child

32
Q

Adenoid Hypertrophy symptoms

A

mouth breathing, mucopurulent discharge, snoring, sleep apnea

33
Q

Adenoid Hypertrophy - etiology

A

chronic inflammation, allergies, chronic sinus sx

34
Q

Adenoid Hypertrophy - prolonged mouth breathing due to adenoid hypertrophy affects

A

facial and dental growth and development
“adenoid facies” - open mouth, flattening and elongation of midface, retraction of upper lip, narrowing of hard palate resulting in crowing of maxillary teeth

35
Q

Adenoid Hypertrophy dx

A

clinical suspicion, endoscopic visualization

36
Q

Adenoid Hypertrophy treatment

A

adenoidectomy

37
Q

Nasal Polyps is the most common

A

tumor of the nasal cavity

38
Q

Etiology of Nasal Polyps

A

long-standing inflammation, aspirin sensitivity, environmental allergies, Cystic fibrosis

39
Q

Sx of Nasal polyps

A

mouth, breathing, sneezing, rhinorrhea, reduced smell and taste, frequent sinusitis

40
Q

PE findings of nasal polyps

A

nasal obstruction, pale mucosa, fleshy mass with superficial vessels

41
Q

Nasal Polyp treatment

A

steroids (PO, topical, intra-polyp injections), avoid aspirin, surgical excision for larger polyps, test and treat for allergies

42
Q

Foreign body - nasal locations

A

floor of nasal passage just under the inferior turbinate
or
superiorly in nasal cavity in front of the middle turbinate

43
Q

FB ssx

A

nasal discharge
foul odor
epistaxis
nasal obstruction
mouth breathing

44
Q

FB = button batteries warning!

A

may result in septal perforation in ~ 4 hours

45
Q

FB treatment

A

fogarty catheter
Katz extractor
forvents (if you can visualize object)
irrigation

46
Q

Epistaxis is

A

nose bleeds!

47
Q

Epistaxis can be due to

A

trauma vs spontaneous
anterior (kiesselbach plexus) vs posterior
anticoagulation
ETOH

48
Q

90% of bleeds are

A

anterior

49
Q

Posterior is most commonly from

A

posterolateral branches of sphenopalatine artery, can be from the carotid artery

50
Q

1 cause of epistaxis

A

nose picking

51
Q

Other causes of epistaxis

A

dryness
allergic or viral rhinitis
FB
Chronic intranasal drug use
Blunt trauma

52
Q

Epistaxis treatment - anterior bleed

A

clear clots
topical medications (afrin drops, boyette’s solution)
topical tranexamic acid (TXA)
direct pressure for ~ 15 mins on the bulb of the nostrils
identify source of bleed - check back of throat
cauterize - silver nitrate sticks
nasal packing as needed

53
Q

After cautery there should be no

A

blowing of nose, sneezing, coughing, bearing down
sleep in a humidified environment
topical abx ointment

54
Q

Treatment of posterior bleed

A

balloon catheters: tamponade posterior bleeding
arterial ligation
angiographic embolization

55
Q

Trigeminal Neuralgia is a

A

paroxysmal attack of usually intense, sharp, superficial or stabbing pain in distribution of one or more branches of fifth cranial nerve
pain usually lasts from one to several seconds but may occur repetitively

56
Q

Treatment of trigeminal neuralgia

A

Carbamazepine (used for seizures as well)

HEENT (7 decks)

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