nose & paranasal sinuses

Question 1

How long can viral particles remain viable on skin

Answer 1

2 hours

Question 2

What is the most common cause of URIs

Answer 2

Rhinovirus

Question 3

What is another name for influenza

Answer 3

Syncytial virus

Question 4

How many episodes of the common cold will preschool kids have

Answer 4

5-7

2-3 for adults

Question 5

What is the best way to diagnose URI

Answer 5

clinically

Question 6

What are common findings with URI

Answer 6

conjunctival injection
nasal mucosa swelling
pharyngeal erythema
exudates & cobblestoning

Question 7

how long do URI symptoms typically last

Answer 7

5-10 days
*can be up to 14

Question 8

How long are people infectious with URI

Answer 8

as long as symptoms are present

Question 9

What are the most common forms of rhinitis

Answer 9

allergic
vasomotor
rhinos medicamentosa

Question 10

What is generally the cause of allergic rhinitis

Answer 10

Climate changing resulting in an increased amounts of pollen

Question 11

what type of pollen is present in the spring

Answer 11

flowers and trees

Question 12

What type of pollen is present in summer

Answer 12

flowers and grass

Question 13

What type of pollen is present in fall

Answer 13

ragweed and mold

Question 14

What type of immune response is allergic rhinitis

Answer 14

IgE

Question 15

What are signs and symptoms of allergic rhinitis

Answer 15

nasal itching
watery rhinorrhea
sneezing
dry cough
itchy/watery eyes

Question 16

What is seen on physical exam with allergic rhinitis

Answer 16

nasal polyps
allergic salute in kids
pale/boggy/bluish nasal mucosa

Question 17

What is vasomotor rhinitis

Answer 17

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

Question 18

What is senile rhinitis

Answer 18

clear rhinorrhea from increased sensitivity of the vidian nerve

Question 19

What is rhinitis medicamentosa

Answer 19

rebound congestion from overuse of nasal decongestants

Question 20

What is acute sinusitis / rhino sinusitis (ARS)

Answer 20

Inflammation in nasal cavity and para-nasal sinuses

Question 21

What is the most common etiology of ARS

Answer 21

Viral infections

Question 22

what are the risk factors of ARS

Answer 22

Older age
recent URI
chronic rhinitis
cigarette smoking
allergies

Question 23

What is the main difference between viral and bacterial sinusitis

Answer 23

Bacterial will have purulent discharge and duration >10days and worsening

Question 24

How do you treat bacterial sinusitis

Answer 24

amoxicillin- clavulanate (Augmentin) for 10-14 days

*If PCN allergy = doxy or levaquin

Question 25

When do you use abx with bacterial sinusitis

Answer 25

when s/sx have lasted >10days or if symptoms are severe / complicated

Question 26

What duration of time does sinusitis have to last to be considered chronic

Answer 26

>12weeks

Question 27

What are symptoms of chronic sinusitis

Answer 27

persistent rhinorrhea productive cough foul breath facial/dental pain

Question 28

What are s/sx of complications with bacterial sinusitis

Answer 28

indications spread beyond paranasal sinuses to CNS, orbit, or surrounding tissue *urgen referral to otolaryngologist high persistent fever >102 vision changes cranial nerve palsies AMS

Question 29

What is the imaging of choice when there are complications with acute bacterial sinusitis

Answer 29

CT

Question 30

What are common pathogens for chronic sinusitis

Answer 30

s. aureus S. pneumo Anaerobes Fungus *mostly mixed flora

Question 31

What are some nasal mucosal disorders

Answer 31

turbinate hypertrophy rhinosinusitis rhinitis nasal polyposis

Question 32

What are some nasal structural disorders

Answer 32

turbinal hypertrophy septal disorders adenoid hypertrophy foreign body tumors

Question 33

What are some inflammatory nasal mucosal obstructions

Answer 33

rhinosinusitits rhinitis polyps sarcoidosis wegeners

Question 34

What are some infectious nasal mucosal obstructions

Answer 34

HIV Syphilis TB

Question 35

What types of medications can cause mucosal nasal obstruction

Answer 35

thyroid meds BP meds anti-depressants NSAIDs PDE-5 inhibitors benzodiazepines

Question 36

How do you treat a deviated septum

Answer 36

nasal endoscopy surgery implants

Question 37

What is the most common cause of nasal obstruction in children

Answer 37

adenoid hypertrophy

Question 38

What are symptoms of nasal hypertrophy

Answer 38

mouth breathing mucopurulent discharge snoring sleep apnea

Question 39

What can cause adenoid hypertrophy

Answer 39

Chronic inflammation allergies chronic sinus symptoms

Question 40

What is long term damage that can occur with adenoid hypertrophy

Answer 40

adenoid facies *prolonged mouth breathing due to adenoid hypertrophy affects facial and dental growth/development

Question 41

How do you diagnose adenoid hypertrophy

Answer 41

clinical suspicion endoscopic visualization

Question 42

How do you treat adenoid hypertrophy

Answer 42

adenoidectomy

Question 43

What is the most common tumor of the nasal cavity

Answer 43

nasal polyp

Question 44

What will be seen on physical exam with nasal polyps

Answer 44

nasal obstruction pale mucosa fleshy mass with superficial vessels

Question 45

Where are foreign bodies of the nose located

Answer 45

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

Question 46

What is the risk with a button battery being up the nose

Answer 46

septal perforation within 4 hours

Question 47

How can you remove foreign bodies from the nose

Answer 47

Fogarty catheter Katz extractor forceps irrigation

Question 48

what is a Keisselbach plexus

Answer 48

most common location for anterior epistaxis

Question 49

Where do most nose bleeds occur

Answer 49

anterior

Question 50

What is the source of posterior nose bleeds

Answer 50

posterolateral branches of sphenopalantine artery

Question 51

What are the most common causes of nose bleeds

Answer 51

nose picking dryness allergic / viral rhinitis foreign body cocaine blunt trauma

Question 52

How do you treat anterior nose bleeds

Answer 52

clear clots topical meds +/- TXA direct pressure for 15 min cauterize nasal packing

Question 53

After cautery of the nose, what are you not allowed to do

Answer 53

blow nose or sneeze

Question 54

how do you treat a posterior nose bleeds

Answer 54

tamponade the bleed -Foley catheter -Brighton -simpson balloon -arterial ligation -embolization

Question 55

What is the most common cause of facial pain

Answer 55

trigeminal neuralgia

Question 56

What are some causes of facial pain

Answer 56

trigeminal neuralgia trigeminal neuropathy cluster-tic syndrome glossopharyngeal neuralgia

Question 57

What is trigeminal neuralgia

Answer 57

Paroxysmal attack of intense, sharp, superficial, stabbing pain in distribution of one or more branches of trigeminal nerve

Question 58

Where is pain the highest with trigeminal neuralgia

Answer 58

at or near onset and describes as electric, shock-like, or stabbing

Question 59

What is the treatment of choice for trigeminal neuralgia

Answer 59

carbamazepine