Nose and Sinus

Question 1

What is the most frequent acute illness in the US?

Answer 1

URI

Question 2

How many URI episodes do preschool children have per. year?

Answer 2

5-7

Question 3

How many URI episodes do adults have per. year?

Answer 3

2-3

Question 4

What virus is the most common cause for the common cold?

Answer 4

Rhinovirus

Question 5

Transmission of the common cold

Answer 5

1. Respiratory droplets

2. Direct contact

Question 6

Incubation period of the common cold

Answer 6

2-3 days

Question 7

Typical duration of the common cold

Answer 7

3-10 days

Question 8

Day 1 sx’s of the common cold

Answer 8

Sore throat

Question 9

Day 2-3 sx’s of the common cold

Answer 9

Nose sx’s, congestion, drainage

Question 10

Day 4-5 sx’s of the common cold

Answer 10

Cough

Question 11

Why should you to discontinue Nasal Decongestant Spray (Afrin) after 3 days?

Answer 11

To avoid rebound congestion

Question 12

Why do you want to use antihistamines (Diphenhydramine) with a decongestant with a common cold?

Answer 12

to avoid drying out

Question 13

What is the most common cause of acute rhinosinusitis?

Answer 13

Viral: Rhinovirus, influenza, parainfluenza

Question 14

What are some ref flags with acute rhinosinusitis?

Answer 14

1. Fever >102 with severe HA
2. Abnormal vision, EOM, proptosis, papilledema
3. AMS
4. CN palsies
5. Meningeal signs

Question 15

When would a CT with contrast be indicated for acute rhinosinusitis?

Answer 15

Suspected complicated acute bacterial rhinosinusitis (ABRS)

Question 16

What imaging study would you order for recurrent or treatment resistant sinusitis?

Answer 16

Noncontrast CT

Question 17

Features of bacterial cause

Answer 17

1. Persistent signs or sx’s lasting 10 or more days
2. Onset with severe sx’s lasting @ least 3 consecutive days @ beginning of illness
3. “Double-worsening”

Question 18

Acute rhinosinusitis treatment days 1-9?

Answer 18

Supportive care

Question 19

Acute rhinosinusitis abx treatment?

Answer 19

Amoxicillin-clavulanate (Augmentin) x5-7 days

Question 20

When would you give a high dose (2 g PO BID) of Amoxicillin-clavulanate for the treatment of Acute rhinosinusitis?

Answer 20

1. > 65 y/o
2. Recent hospitalization
3. Antibiotic tx in past month
4. Immunocompromised
5. S. pneumo penicillin resistance > 10%

Question 21

What abx are NOT recommended in the treatment of Acute rhinosinusitis?

Answer 21

1. Macrolides
2. Trimethoprim-sulfamethoxazole (Bactrim)
3. 2nd or 3rd generation cephalosporins

Question 22

Indications for referral for urgent endoscopy or surgical biopsy in acute rhinosinusitis?

Answer 22

1. Fungal sinusitis or granulomatous disease is suspected
2. Failure to respond to 1st and 2nd line antimicrobial tx
   + other obvious reasons listed

Question 23

Complicated of acute rhinosinusitis?

Answer 23

1. Periorbital or orbital cellulitis
2. Meningitis
3. Osteomyelitis of sinus bone
4. Intracranial abscess

Question 24

What is the number one risk factor for chronic rhinosinusitis?

Answer 24

Allergic rhinitis

Question 25

chronic rhinosinusitis Ddx?

Answer 25

1. Trigeminal neuralgia 2. Migraines, HA's 3. Recurrent, acute rhinosinusitis 4. Allergic rhinitis

Question 26

Chronic rhinosinusitis supportive care treatments

Answer 26

1. Nasal irrigation 2. intranasal glucocorticoids 3. Topical/oral antimicrobials 4. Oral glucocorticoids 5. Antileukotriene agents

Question 27

Surgical Treatment in chronic rhinosinusitis if the patient can't manage the sx's

Answer 27

Endoscopic sinus surgery

Question 28

Risk factors for allergic rhinitis?

Answer 28

1. Early use of abx 2. First born 3. Male sex 4. Birth during pollen season 5. Presence of allergen-specific IgE

Question 29

Intermittent allergic rhinitis classification

Answer 29

< 4 days/week OR < 4 weeks

Question 30

Persistent allergic rhinitis classification

Answer 30

> 4 days/week AND >4 weeks

Question 31

Moderate-severe allergic rhinitis

Answer 31

1. Sleep disturbance 2. Impaired school/work performance 3. Impaired daily activities, leisure, and/or sport activities 4. Troublesome sx's

Question 32

Perennial allergic rhinitis

Answer 32

Year round sx's

Question 33

Allergic Rhinitis physical exam findings

Answer 33

1. "Allergic Shiners" 2. "Allergic salute" 3. "Cobblestoning"- hyperplastic lymphoid tissue in pos. pharynx 4. Pale, bluish nasal mucosa 5. Clear rhinorrhea 6. TM retractions or serous fluid behind TM

Question 34

What is the most common allergy skin test?

Answer 34

Prick skin test | -Given serum with allergen, trigger mast cels if sensitivity there

Question 35

What is the most sensitive skin test?

Answer 35

Intradermal skin test

Question 36

What do you want to remember to do with allergy skin testing?

Answer 36

Discontinue medications as they may interfere with testing/results

Question 37

What is the benefit of a serum IgE for specific allergens?

Answer 37

- DONT have to stop meds | - Geographic panel

Question 38

Allergic Rhinitis medication options

Answer 38

1. Glucocorticoid + antihistamine nasal spray 2. Oral Antihistamines-2nd or 3rd generation (Claritin, Allegra, Zyrtec) 3. Nasal decongestant sprays 4. Mast cell stabilizer

Question 39

Nonallergic/Vasomotor Rhinitis etiology

Answer 39

- Abnormal autonomic regulation of innervation of nose | - Nasal eosinophilia without allergen sensitivity

Question 40

Nonallergic/Vasomotor Rhinitis triggers

Answer 40

1. Temperature changes-Humidity 2. Eating-Hot or spicy 3. Exposure to odors/chemicals 4. Alcohol use

Question 41

What is the first line treatment of nonallergic/vasomotor rhinitis?

Answer 41

Topical intranasal glucocorticoids

Question 42

What is the most common cause of Epistaxis?

Answer 42

Nasal trauma-Nose picking

Question 43

If someone is having a severe bleed, what lab would you order?

Answer 43

Hematocrit: Type and crossmatch

Question 44

Conservative treatment for epistaxis

Answer 44

Occlusion, continuous x 10-15 minutes

Question 45

Samter triad

Answer 45

Nasal Polyps +Asthma= Avoid Aspirin | -Immunologic salicylate sensitivity causes severe episode of bronchospasm

Question 46

Nasal polyps treatment

Answer 46

Topical intranasal corticosteroids

Question 47

Malignant neoplasms

Answer 47

Squamous cell carcinoma | Adenocarcinoma

Question 48

Presentation of malignant neoplasms

Answer 48

Obstruction + Epistaxis