nose/throat/sinus Flashcards by Mai Wells

I came in to see my physician assistant because of…

I’ve had a cold for about a week and it is getting worse

Headache

Runny nose

Sinus pain, tooth pain

Fever

General malaise

sinusitis

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Labs, Studies and Physical Exam Findings

Transillumination – putting a light up to the ___

Tender over __

Nasal endoscopy may be helpful with chronic ___ lasting longer than 12 weeks

CT may be helpful with chronic __ lasting longer than 12 weeks

_**what is dx and tx?_

sinusitis and treatment

Nasal irrigation with saline

Steam

Hot packs

Lots of fluids

Humidifier

Acetaminophen or ibuprofen

Decongestant

Antibiotics after 10 days

Amoxicillin

Surgical correction by

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I came in to see my physician assistant because of…

Runny nose – typically clear mucus

Itchy watery eyes – bilateral

Sneezing

what is dx and tx?

allergies, tx:

Prevention! Avoid triggers

Best choice – Intranasal corticosteroids

Require several days of treatment to achieve desired effect

Beclomethasone BID or Flunisolide BID

Antihistamines

Decongestants

Desensitisation

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No true known cause

Increased incidence with allergic rhinitis

Increased incidence with asthma

Nasal polyps

Inflamed sacs of tissue along the nasal mucosa

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bluish discoloration below eyes, bluish/pale/boggy nasal mucosa, horizontal nasal crease, clear and watery discharge

allergic rhinitis

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kiesselbach vs woodruff plexus

anterior is kiesselbach

posterior(woodruff) is an emergency! cause it can bleed into the posterior pharynx

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organisms of sinusitis

usually viral. or same organisms as OM:

Most common pathogens are

Strep pneumoniae

Haemophilus Influenzae

Moraxella catarrhalis(less often)

Staph aureus(less often)

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risk factors for sinusitis

recent URI, chronic rhinitis, smoking, trauma/FB, obstructing draining, infection risk

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osteomyelitis, cavernous sinus thrombosis, orbital cellultis complications of what

sinusitis

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xray tests for sinusitis

CT, water view radigraph, MRI(malignancy)

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Causes and predisposing factors

Typically secondary to an upper respiratory infection

Allergies

Anything which obstructs drainage from the sinuses

Smoking – decreases movement of cilia

Deviated septum

Cystic fibrosis

Large adenoids

sinusitits

get a CT

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I came in to see my physician assistant because of…

I’ve had a cold for about a week and it is getting worse

purulent nasal discharge, Headache, Runny nose, Sinus pain, tooth pain, Fever, General malaise

Labs, Studies and Physical Exam Findings

decreased Transillumination – putting a light up to the ___

Tender over ___

Nasal endoscopy may be helpful with ___ lasting longer than 12 weeks

CT may be helpful with ___ lasting longer than 12 weeks

sinusitis

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sinusitis tx

Treatment

Nasal irrigation with saline

Steam, Hot packs, Lots of fluids, Humidifier

Acetaminophen or ibuprofen

Decongestant

Antibiotics after 10 days (Amoxicillin first line)

PCN allergic: bactrim, FQ, macrolide, doxy

Surgical correction

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CT vs MRI for sinusitis

CT sensitive but lacks specificity

MRI indicated w/ possible malignancy or intracranial spread of infection

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3 types of rhinitis

allergic rhinitis, vasomotor rhinitis, rhinitis medicamentosa

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what causes vasomotor rhinitis

caused by increased secretion of mucus from the nasal mucosa

it may be precipitated by changes in temperature or humidity, odors, alcohol, or result from a neurovascular imbalance

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rhinitis tx

Treatment

Prevention! Avoid triggers

Best choice – Intranasal corticosteroids

Require several days of treatment to achieve desired effect

Beclomethasone BID

Flunisolide BID

Antihistamines, Decongestants, Desensitisation

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Anterior nosebleed vs Posterior nosebleed

Anterior nosebleed is the most common and originates from Kiesselbach’s plexus.

Posterior nosebleed is less common and much more difficult to treat.

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epistaxis tx

anterior: Direct pressure – pinch the bridge of the nose for 15 minutes; placed in sitting position and lean forward slightly to avoid swallowing blood leading to nausea and vomiting

Topical vasoconstrictor ie cocaine or oxymetazoline

If you can visualize the source silver nitrate may be used to cauterize the vessels

Packing for 24 hrs if necessary; Pneumatic tamponade; Surgical correction

Posterior packing is more difficult; need specialist

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epistaxis associated with HTN and atherosclerosis

posterior/woodruff

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samter triad

nasal polyps, asthma, allergic rhinitus

AVOID ASPIRIN due to possibility of severe brochospasm

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nasal polyp tx

Treatment

Topical nasal steroid for 1-3 months(initial course)

Oral steroid may be helpful

Surgical removal

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triad for polyps with allergic rhinitis

asthma, nasal polyps, aspirin sensitvity

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centor criteria [group A b-hemolytic streptococci]

Study These Flashcards

1)100.4 fever greater 2)tender ant cervical adenopathy, 3)lack of cough, 4)exudates

abdomial pain in kids secondary to adenopathy in the abdomen

strep pharyngitis

complications of strep pharyngitis

rheumatic fever, ludwigs angina, tonsillar abscess

onset of strep vs viral pharyngitis

acute for strept and insidious for viral etiology is more commonly viral

hoarseness is the hallmark for what

laryngitis

Acute pharyngitis viral causes

Epstein barr – mononucleosis Adenovirus Cold viruses Herpes

acute pharyngitis bacterial organisms

Strep pneumonia: The most common bacterial cause of acute pharyngitis however this only accounts for between 15 and 30% of sore throats ## Footnote Neisseria gonorrhoeae Mycoplasma Chlamydia

**I came in to see my physician assistant because of…** Sudden onset Fever/chills Difficulty swallowing Tender, swollen throat No cough Typically younger than 15 years old

acute pharyngitis

**Labs, Studies and Physical Exam Findings** ## Footnote Tender anterior cervical adenopathy Purulent exudate in pharynx Shaggy white tonsillar exudate think mono Throat culture – 90-95% sensitive for \_\_\_\_ Rapid antigen test is 90-99% effective for \_\_\_\_

acute pharyngitis \*\*strep

acute pharyngitis tx

Treatment Symptomatic treatment NSAIDS or tylenol Fluids Appropriate antibiotic treatment Strep – Penicillin 500 mg BID or Amoxicillin 500 mg TID PCN allergic: cefuroxime, emycin, macrolide

**I came in to see my physician assistant because of…** Severe, one sided sore throat Odynophagia – difficulty swallowing Fever Tender glands – pain in head and neck Trismus – difficulty opening the mouth **HOT Potato Voice – muffled voice** **_deviation of soft palate/uvula_**

peritonsillar abscess

**Labs, Studies and Physical Exam Findings** Erythematous pharynx Uvula displaced towards unaffected side Ultra sound CT with contrast **\*what is dx and tx?**

peritonsillar abscess and treatment ## Footnote Needle aspiration Incision and drainage Tonsillectomy Antibiotic therapy Amoxicillin – though likely resistant to PCN Clindamycin – probably the better choice here. parenteral antibx for severe cases

what symptoms are not suggestive of strep

coryza, hoarseness, cough

rapid strep test sensitivity

90-99% for GABHS

inadequate tx of strep can lead to what

scarlet fever, glomerulonepritis, abscess formation

inadequate tx of strep can lead to what

**I came in to see my physician assistant because of…** **Hoarseness**, Fever, Swollen glands, Cough, Cold and flu symptoms **Labs, Studies and Physical Exam Findings** Usually clinical diagnosis Laryngoscopy may be helpful in chronic patients

Treatment of laryngitis Resting the voice Humidifying the air Fluids Treat for GERD if appropriate Antibiotics if appropriate corticosteroids for performers

laryngitis organisms

usually viral: rhinovirus, adenovirus bacterial: m cat, h flu, group A strep

epiglottis organisms

h flu, staph, group A strep, pneumococci

who is at highest risk for epiglottitis

dm used to be in kids but has lessened due to the H flu vaccine

I came in to see my physician assistant because of… High fever quickly developing sore throat/pain Difficulty moving air Difficulty swallowing Drooling possible tripod position describe dx and PE

epiglottitis ## Footnote Stridor Cyanosis Laryngoscopy in OR as it may cause spasms Throat culture X-ray – Thumbprint sign on c spine film CT

epiglottitis tx

Be prepared for intubation (\<10%) Keep patient calm and breathing easily IV Antibiotics may be necessary or corticosteroids then po

50% of humans have ___ in the oral cavity **Causes** Newborns, Uncontrolled Diabetes HIV/AIDS, Chemotherpy Side effect of inhaled steroids Side effect of antibiotics Dentures or poor hygiene

thrush ## Footnote Lesions can be scraped off and may bleed Culture of scarpings Microscopic examination of scrapings

thrush tx

Treatment Address underlying cause Fluconazole 100mg x 7 days for non-immunocompromised patients ½ hydrogen peroxide mouth rinse

Herpetic Whitlow Herpes keratitis Herpes encephalitis Neonatal infection

Herpetic Whitlow – infection of the fingers Herpes keratitis – eye infection Herpes encephalitis – CNS infection Neonatal infection – Active herpes infection in the mother is an indication for a c-section [FATAL]

aphthous ulcer virus

human herpes virus 6

single or multiple painful, round ulcers with yellow gray centers and red halos occur where

aphthous ulcers occur on non keratinized mucosa and usually recurrent

aphthous ulcer tx

No true cure Typically self limiting Topical antiviral 5% acyclovir Oral antiviral, acyclovir, valacyclovir 1 wk prednisone, Tylenol and ibuprofen cimetidine used as maintenance therapy in recurrent cases

leukoplakia

painless white area on tongue, inside cheek, lower lip, or on the floor of the mouth. **cannot be scraped off**. 5% malignant

**Causes** Often associated with tobacco use Alcohol and smoking HPV **I came in to see my physician assistant because of…** painless white plaque on the oral mucosa/ does not scrape off Often found on routine exam

Treatment for leukoplakia Remove offending agents Monitor closely as this is a premalignant condition if associated with erythematous appearance- risk of dysplasia is 90%

what is parotitis? from what? 2 most common organisms

Parotitis An inflammation of one or both salivary glands Viral infection Historically the number one cause was the mumps Para influenza and Epstein barr are the most common HIV Bacterial infection: Staph Aureus is the most common bacteria

Autoimmune disease, sjogrens, Blockage, stone, Mucus plug **I came in to see my physician assistant because of…** Facial swelling, Facial pain, Difficulty swallowing **Labs, Studies and Physical Exam Findings** Clinical diagnosis

Treatment of parotitis Supportive care Appropriate antibiotics

\_\_\_ usually occurs after hyposecretion or duct obstruction but may develop without an obvious cause. \_\_\_ typically occurs in Patients in their 50s and 60s, xerostomia, Sjögren syndrome Adolescents and young adults with anorexia radiation therapy to the oral cavity or radioactive iodine therapy for thyroid cancer.

Sialadenitis is most common in the parotid gland The most common causative organism is Staphylococcus aureus Although sometimes described as sialoadenitis, this inflammation is rarely a bacterial infection, particularly in the absence of fever.

The major salivary glands are the \_\_\_

parotid, submandibular, and sublingual glands.

Symptoms and Signs of sialadenititis Diagnosis

Fever, chills, and unilateral pain and swelling develop. The gland is firm and diffusely tender, with erythema and edema of the overlying skin. Pus can often be expressed from the duct by compressing the affected gland and should be cultured. Focal enlargement may indicate an abscess. CT, ultrasonography, and MRI can confirm sialadenitis or abscess that is not obvious clinically, although MRI may miss an obstructing stone. If pus can be expressed from the duct of the affected gland, it is sent for Gram stain and culture.

nose/throat/sinus Flashcards

(58 cards)