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Flashcards in NoseThroat-Table 1 Deck (48):
1

How do you define acute, subacute, and chronic rhinosinusitits?

Shorter than 4 weeks (acute)
4-12 weeks (subacute)
Longer than 12 weeks (chronic)

2

Recurrent sinusitis is when you have ____ or more recurrent episodes annually

4

3

What is the osteomeatal complex?

Functional unit and is the most common site of origin of sinus inflammation

4

Rhinosinusitis affects which sinuses for adults?

Maxillary or Frontal Sinuses

5

Rhinosinusitis affects which sinuses for children?

Ethmoid sinuses

6

Most common antecedent event of rhinosinusitis

Allergic rhinitis

7

Most common pathogens for rhinosinusitis

S. pneumo, H. influenza, Moraxella catarrhalis

8

Complications of rhinosinusitis

Osteomyelitis, orbital cellulitis, cavernous sinus thrombophlebitis, intracranial suppuration

9

When should you consider bacterial sinusitis?

Consider if >7days of maxillary pain or tenderness in maxillary area/teeth- especially unilateral, purulent nasal secretion… or worsening of s/s after initial improvement

10

Treatment of rhinosinusitis

Saline nasal spray, sinus irrigation, decongestants (limited duration if delivered nasally- rebound congestion if prolonged), nasal steroids, prednisone taper, antihistamines if allergic or surgical intervention

11

True or false: most cases of acute rhinosinusitis resolve without an RX

TRUE

12

When would you Rx antibiotics for acute rhinosinusitis

Moderate-severe symptoms

13

What organisms would you want to cover for Rx of acute rhinosinusistis

S. penumo or H. influenza

14

What would you Rx for ARS and for how long?

Amoxicillin 500 mg TID x 10-14 days

15

What would you Rx for someone with PCN allergy for ARS?

TMP/SMZ

16

How would you treat MRSA associated ARS?

TMP/SMZ

17

What would you Rx for pseudomonas associated ARS

Ciprofloxacin

18

What is the primary therapy for bacterial sinusitis?

Antibiotics

19

Recurrent acute rhinosinusitis is defined as _________

Failed Rx with 2 courses of antibiotics, history of more than 4 per year

20

What should signify an emergency admit

High fever, rigors, lid edema, diplopia, pupillary abnormality, ptosis, EOM palsies

21

What do you need to differentiate in a nose bleed

Anterior vs posterior nose bleed

22

Unilateral, continuous, “moderate”, lasting minutes to ½ hour. Generally venous, but can be arterial. Associated with what?

Anterior nose bleed, associated with Kiesselbach’s plexus

23

Often bilateral, down into oropharynx. Brisk arterial bleed, spontaneous more common in older; after facial trauma

Posterior bleed

24

Treatment of anterior nose bleed

1:1000 epi, phenylephrine or oxymetazoline on cotton ball

25

Most common cause of chronic or recurrent nasal congestion

Allergic rhinitis

26

What drugs can cause drug induced rhinitis

ACE inhibitors, reserpine, phentolamine, methyldopa, prazosin, besta blockers, chlorpramazine

27

First line treatment to reduce itching, sneezing or rhinorrhea

Antihistamines (second generation should be considered before first generation)

28

What should you caution with decongestants?

Caution with arrhythmias, angina pectoris, some with HTN and hyperthyroidism; topical for short term

29

What is the most effective class of medication in controlling symptoms of allergic rhinitis

Nasal corticosteroids

30

Intranasal cromolyn is most effective with _____ or ______

Exercise or gustatory related rhinitis.

31

Ipatropium bromide is a ____________, and is used with the treatment of _________

Intranasal anticholinergic, rhinitis

32

Prodrome is associated with what form of infectious pharyngitits? What other symptoms will you see with this?

Epstein-Barr. Exudate, palatal petechiae, splenomegaly, tender hepatomegaly

33

What test would you run for Epstein-Barr?

Monospot for IgM or IgG to E-B virus

34

HSV infectious pharyngitis presents with what?

Shallow ulcers on palate

35

How does Coxsackie virus present?

Tonsillar pillar/soft palate vesicles/ulcers

36

Pathogens associated with bacterial pharyngitis

GABHS, Spirochetes, Yersinia, Gonorrhea, corynebacterium exudate

37

Vincent’s Angina and necrotic tonsillar ulcers are associated with what?

Primary, Secondary syphilis

38

What disease is associated with adherent whitish blue pharyngeal exudate

Corynebacterium diptheriae

39

Why do we treat GABHS pharyngitis?

Prevention of acute rheumatic fever, peritonsillar/retropharyngeal abscess

40

What are the centor criteria? What is it used to determine? How many are needed?

Tonsillar exudate
Tender anterior cervical LAD
History of fever
Absence of cough
Used to decrease unneeded abx use. If 3 of 4 are present, ~75% sensitivity and specificity compared to throat culture

41

Someone with in infection in the ____________ might present with tooth pain

Maxillary sinus

42

Presenting signs of acute sinusitis (harrison’s info starts here)

Sinus pain or pressure localizing to involved sinus. Can be worse when patient bends over or is supine

43

What are the life threatening complications of sinusitis?

Meningitis, epidural abscess and cerebral abscess

44

Biggest distinguishing factor for determining viral vs bacterial sinusitis

Viral= 10 days- persistent symptoms accompanied by 3 cardinal signs (purulent nasal discharge, nasal obstruction, and facial pain)

45

True or false- CT is recommended for acute sinusitis

False- CT is not recommended on acute, recommended for persistent, recurrent or chronic sinusitis (of which CT is the radiographic study of choice)

46

What is the preferred initial treatment in patients with mild-moderate symptoms of short duration?

Aimed at symptom relief • Decongestants
• Nasal saline lavage
• Nasal glococorticoids (in patients with Hx of chronic sinusitis or allergies)

47

When should you Rx abx for acute rhinosinusitis? And what should you initial Rx be?

In patients with moderate symptoms (nasal congestion/cough) for >10d or for severe Sx (unilateral/focal facial swelling or tooth pain) for any duration • Amoxicillin 500 mg PO tid or
• Amox/clavulaunate 500/125 mg PO tid or
• Amox/clavulaunate 875/125 mg PO bid

48

What predisposes people to malignant otitis externa

DM. Usually secondary to P aeurginosa infection in the soft tissue surrounding the external auditory canal. Usually begins with pain and discharge, and may rapidly progress to osteomyelitis and meningitis.