Nose and Sinus

Question 1

immune mediated response of nasal mucosa to previously sensitized allergen

Answer 1

allergic rhinitis

Question 2

the genetic predisposition to develop allergic diseases

Answer 2

atopy

Question 3

risk factors of allergic rhinitis (6)

Answer 3

1. family hx
2. male
3. birth during pollen season
4. firstborn
5. early ABX use
6. maternal smoking

Question 4

“boggy/ Pale mucosa”

Answer 4

allergic rhinitis

Question 5

high arched palate from mouth breathing; “cobblestoning”

Answer 5

allergic rhinitis

Question 6

allergic rhinits can be dx

Answer 6

clinically–suggestive clinical hx + risk factors

Question 7

gold standard for dx allergies (3)

Answer 7

allergy test:

1. skin prick
2. intradermal
3. skin patch

Question 8

allergic rhinitis tx (5)

*best

Answer 8

1. allergen avoidance
2. intranasal corticosteroids *
3. oral/ intranasal antihistamines *
4. decongestants
5. immunotherapy

Question 9

allergic rhinitis may be

Answer 9

1. intermittent-no troublesome symp

2. persistent- abnormal sleep, work, school–^ symptoms

Question 10

A polyp presents in the nasal cavity w/ a grape-like appearance, having a ‘body’ and a ‘stalk’. The surface is smooth and the color is more YELLOW than the PINK mucous membrane. Is usually SEMITRANSLUCENT

Answer 10

Nasal polyposis

Question 11

• a triad of nasal polyposis, aspirin sensitivity, and asthama

Answer 11

The aspirin (Samter’s) triad

Question 12

mucous gland hyperplasticity w/ eosinophilic accumulation due to inflammatory mediators

Answer 12

Pathophysiology of nasal polyposis

Question 13

> 80 of people w/ _____ _____ ______ have polyps

Answer 13

Allergic fungal rhinosinusitis

Question 14

PE of nasal polyposis

Answer 14

1. congestion
2. polyp
3. rhinorrhea
4. “cobblestoning”

Question 15

dx of nasal polyposis (3)

Answer 15

1. nasal endoscopy

2. CT/MRI

Question 16

Nasal polyposis tx

Answer 16

1. NASAL STEROID (oral/spray)
2. surgery
3. desensitization (for aspirin allergy)

Question 17

inflammation of infection of NASAL MUCOSA and paranasal sinuses lasting <4WKS

Answer 17

Acute Rhinosinusitis (maxillary sinus most common)

Question 18

Most acute rhinosinusitis’ are

Answer 18

viral (rhinovirus, flu, paraflu)

Question 19

acute rhinosinusitis criteria for urgent referral (bacterial) (3)

Answer 19

1. abnormal vision
2. altered mentation
3. periorbital edema

Question 20

acute rhinosinusitis hallmark

Answer 20

“double-worsening”

Question 21

acute viral rhinosinusitis =
acute bacterial rhinosinusitis =
real world

Answer 21

• cold

- sinusitis

Question 22

Dx of acute rhinosinusitis (3)

Answer 22

1. cultures not accurate
2. CT – used to r/o complications
3. MRI – used to r/o complications

Question 23

Acute rhinosinusitis TX

Answer 23

symptomatic OTC – be careful abt overlap

Question 24

An INFLAMMATORY condition involving the nasal mucosa and paranasal sinuses that lasts 12 WEEKS or LONGER

Answer 24

Chronic Rhinosinusitis

Question 25

S&S of chronic rhinosinusitis (4)

Answer 25

1. anterior/posterior nasal mucopurulent drainage 2. congestion/ obstruction 3. Facial pain/pressure 4. anosmia

Question 26

CRS subtypes (3) high to low fq

Answer 26

1. CRS w/out nasal polyposis--allergic rhinitis 2. CRS w/ nasal polyposis-- ass w/ AERD, polyps bilat 3. Allergic fungal rhinosinusitis--allergic mucin

Question 27

AERD

Answer 27

aspirin exasperated respiratory disease

Question 28

thick mucus from light tan to brown to dark green, containing degranulated Eos w/ fungal hyphae

Answer 28

allergic mucin

Question 29

chronic rhinosinusitis dx

Answer 29

1. subjective--2 or mor lasting >12 wks | 2. objective--documentation of inflammation

Question 30

* Chronic Rhinosinusitis Tx

Answer 30

1. Nasal Saline | 2. Intranasal glucocorticoids

Question 31

Anterior ___ Posterior epistaxis

Answer 31

>

Question 32

Anterior epistaxis etiology (4)

Answer 32

1. trauma (nose picking) 2. low moisture 3. hyperemia 4. foreign body

Question 33

Posterior epistaxis etiology (5)

Answer 33

1. anticoagulation 2. HHT 3. bleeding disorder 4. aneurysm 5. neoplasm

Question 34

suspected history w/ epistaxis (3)

Answer 34

1. coagulation disroder or medication 2. recent trauma 3. Fq and severity of bleed

Question 35

anterior plexus highly implicated in epistaxis

Answer 35

Kiesselbach's plexus

Question 36

Tx epistaxis (3) in order

Answer 36

1. pressure 2. cautery 3. nasal packing (tampon, balloon)

Question 37

#1 site for foreign body

Answer 37

right nare

Question 38

foul odorous mucopurulent nasal discharge ^ in

Answer 38

nasal foreign body