NoseThroat-Table 1

Question 1

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

Answer 1

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

Question 2

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

Answer 2

4

Question 3

What is the osteomeatal complex?

Answer 3

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

Question 4

Rhinosinusitis affects which sinuses for adults?

Answer 4

Maxillary or Frontal Sinuses

Question 5

Rhinosinusitis affects which sinuses for children?

Answer 5

Ethmoid sinuses

Question 6

Most common antecedent event of rhinosinusitis

Answer 6

Allergic rhinitis

Question 7

Most common pathogens for rhinosinusitis

Answer 7

S. pneumo, H. influenza, Moraxella catarrhalis

Question 8

Complications of rhinosinusitis

Answer 8

Osteomyelitis, orbital cellulitis, cavernous sinus thrombophlebitis, intracranial suppuration

Question 9

When should you consider bacterial sinusitis?

Answer 9

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

Question 10

Treatment of rhinosinusitis

Answer 10

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

Question 11

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

Answer 11

TRUE

Question 12

When would you Rx antibiotics for acute rhinosinusitis

Answer 12

Moderate-severe symptoms

Question 13

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

Answer 13

S. penumo or H. influenza

Question 14

What would you Rx for ARS and for how long?

Answer 14

Amoxicillin 500 mg TID x 10-14 days

Question 15

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

Answer 15

TMP/SMZ

Question 16

How would you treat MRSA associated ARS?

Answer 16

TMP/SMZ

Question 17

What would you Rx for pseudomonas associated ARS

Answer 17

Ciprofloxacin

Question 18

What is the primary therapy for bacterial sinusitis?

Answer 18

Antibiotics

Question 19

Recurrent acute rhinosinusitis is defined as _________

Answer 19

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

Question 20

What should signify an emergency admit

Answer 20

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

Question 21

What do you need to differentiate in a nose bleed

Answer 21

Anterior vs posterior nose bleed

Question 22

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

Answer 22

Anterior nose bleed, associated with Kiesselbach’s plexus

Question 23

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

Answer 23

Posterior bleed

Question 24

Treatment of anterior nose bleed

Answer 24

1:1000 epi, phenylephrine or oxymetazoline on cotton ball

Question 25

Most common cause of chronic or recurrent nasal congestion

Answer 25

Allergic rhinitis

Question 26

What drugs can cause drug induced rhinitis

Answer 26

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

Question 27

First line treatment to reduce itching, sneezing or rhinorrhea

Answer 27

Antihistamines (second generation should be considered before first generation)

Question 28

What should you caution with decongestants?

Answer 28

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

Question 29

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

Answer 29

Nasal corticosteroids

Question 30

Intranasal cromolyn is most effective with _____ or ______

Answer 30

Exercise or gustatory related rhinitis.

Question 31

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

Answer 31

Intranasal anticholinergic, rhinitis

Question 32

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

Answer 32

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

Question 33

What test would you run for Epstein-Barr?

Answer 33

Monospot for IgM or IgG to E-B virus

Question 34

HSV infectious pharyngitis presents with what?

Answer 34

Shallow ulcers on palate

Question 35

How does Coxsackie virus present?

Answer 35

Tonsillar pillar/soft palate vesicles/ulcers

Question 36

Pathogens associated with bacterial pharyngitis

Answer 36

GABHS, Spirochetes, Yersinia, Gonorrhea, corynebacterium exudate

Question 37

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

Answer 37

Primary, Secondary syphilis

Question 38

What disease is associated with adherent whitish blue pharyngeal exudate

Answer 38

Corynebacterium diptheriae

Question 39

Why do we treat GABHS pharyngitis?

Answer 39

Prevention of acute rheumatic fever, peritonsillar/retropharyngeal abscess

Question 40

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

Answer 40

``` 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 ```

Question 41

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

Answer 41

Maxillary sinus

Question 42

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

Answer 42

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

Question 43

What are the life threatening complications of sinusitis?

Answer 43

Meningitis, epidural abscess and cerebral abscess

Question 44

Biggest distinguishing factor for determining viral vs bacterial sinusitis

Answer 44

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

Question 45

True or false- CT is recommended for acute sinusitis

Answer 45

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

Question 46

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

Answer 46

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

Question 47

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

Answer 47

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

Question 48

What predisposes people to malignant otitis externa

Answer 48

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.