otorrino 2do parcial

Question 1

INICIO DE MANAGEMENT OF ADENOTONSILLAR DISEAS

Answer 1

:)

Question 2

Both the tonsils and adenoids are part of the _____ a circular structure of lymphoid tissue located in the nasopharynx and the oropharynx

Answer 2

Waldeyer ring

Question 3

largest component of the Waldeyer ring

Answer 3

palatine tonsils

Question 4

The glossopharyngeal nerve lies deep to the superior pharyngeal constrictor and supplies sensation to the tonsil through the tonsillar branch, true or false

Answer 4

true

Question 5

Acute pharyngotonsillitis may be caused by viral infection (most common) or bacterial infection. It is often difficult to distinguish between the 2 etiologies based on clinical exam. Patients with acute pharyngotonsillitis present with:

Answer 5

fever, malaise, odynophagia, dysphagia, foul breath, and tender lymphadenitis

Question 6

Tonsillar enlargement due to infection may also manifest as airway obstruction with symptoms including

Answer 6

mouth breathing, snoring, or sleep­disordered breathing. On physical exam tonsillar enlargement, erythema, and exudates may be present

Question 7

Approximately 70% to 85% of cases of acute pharyngotonsillitis have a ___ etiology

Answer 7

viral

Question 8

Common viral pathogens include:

Answer 8

adenovirus,
rhinovirus,
coronavirus,
Epstein­Barr virus (EBV), cytomegalovirus (CMV), Coxsackievirus
, herpes simplex virus, human immunodeficiency virus (HIV)
, and influenza virus

Question 9

Associated signs and symptoms may help determine the specific virus responsible, for example:

Answer 9

1. conjunctival involvement is associated with adenovirus
2. he presence of herpangina—or ulcerative vesicles over the tonsils—may be due to Coxsackievirus or herpes virus
3. profuse lymphadenopathy is typically seen with EBV, CMV, or HIV

Question 10

Treatment for most viral infections is generally supportive, including:

Answer 10

hydration, antipyretics, and pain relievers as needed—and management does not require further testing

tx in asymptomatic, px should drink water, antihistamine for posterior mucus discharge,
NSAIDs

antifludes: Amantadina/Clorfenamina/Paracetamol

Question 11

EBV belongs to the herpes family of viruses and causes acute pharyngitis as a part of infectious mononucleosis. EBV is transmitted orally and manifests as:

Answer 11

high fever, generalized malaise, lymphadenopathy, hepatosplenomegaly, and pharyngitis.
The tonsils are often severely enlarged, sometimes to the point of compromising the airway, and are covered with an extensive grayish­white exudate.

Question 12

distinguishing feature of EBV in clinical exam:

Answer 12

lymphoid hypertrophy, especially with involvement of the posterior nodes

Question 13

Influenza presents with

Answer 13

sore throat, fever, and cough, similar to other viral illnesses.

Question 14

most common cause of acute bacterial pharyngotonsillitis in children:

Answer 14

Group A beta­hemolytic streptococcus (GABHS)

Question 15

“Strep throat” is a very common disease among adolescents and children. Symptoms include:

Answer 15

fever, sore throat, cervical lymphadenopathy, dysphagia, and odynophagia

Question 16

Group A beta­hemolytic streptococcus physical examination typically reveals:

Answer 16

tonsillar and pharyngeal erythema with purulent exudate

Question 17

standard method for establishing the diagnosis of group A streptococcus pharyngitis in children

Answer 17

Throat culture with a blood agar plate (BAP)

Question 18

The definitive test for GABHS infection measures:

Answer 18

serum titers of antistreptolysin O (ASO)

Question 19

standard of care to prevent the development of rheumatic fever in patients with GABHS

Answer 19

Early diagnosis and appropriate antimicrobial treatment

Question 20

treatment regimen of choice for GABHS

Answer 20

10­day course of penicillin V.
Amoxicillin is commonly substituted for penicillin

Question 21

Complications of GABHS infection:

NONSUPPURATIVE COMPLICATIONS

Answer 21

Scarlet fever occurs secondary to endotoxin production by bacteria during acute streptococcal pharyngotonsillitis.

Question 22

clinical presentation of Scarlet fever

Answer 22

erythematous rash, fever, lymphadenopathy, dysphagia, and erythematous tonsils and pharynx covered with a yellow membranous film. The tongue may become red with desquamation of the papillae, often described as “strawberry tongue.”

Question 23

Acute rheumatic fever is a complication that can develop 1 to 4 weeks after an episode of pharyngotonsillitis caused by GABHS. Rheumatic fever results from cross­reactive antibodies that are produced in reaction to the streptococcal infection that subsequently affect heart muscle, leading to:

Answer 23

endocarditis, myocarditis, or pericarditis. Once heart tissue damage occurs, little can be done to reverse the process.

Question 24

Complications of GABHS infection:

SUPPURATIVE COMPLICATIONS

Answer 24

peritonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, and cervical lymphadenitis or abscess

Question 25

Peritonsillar abscess (orms as a result of the spread of infection from the superior pole of the tonsil into the potential space between the tonsillar capsule and the pharyngeal muscle bed. Common pathogens include aerobes such as GABHS, Staphylococcus aureus, and Haemophilus influenzae, and anaerobes) usually occur unilaterally and patients present with:

Answer 25

severe pain, odynophagia, muffled voice (or “hot potato” voice), and dysphagia

Question 26

Needle aspiration and incision and drainage should be performed to treat the abscess. In patients with recurrent tonsillitis and recurrent peritonsillar abscesses, a _____ is often recommended.

Answer 26

tonsillectomy

Question 27

Infection from the tonsil or from a peritonsillar abscess can spread through the superior constrictor muscle into a potential space between the superior constrictor muscle and the deep cervical fascia, forming a:

Answer 27

parapharyngeal space abscess

Question 28

parapharyngeal space abscess Patients often present with:

Answer 28

trismus and decreased neck range of motion secondary to inflammation of the adjacent pterygoid and paraspinal muscles. If not treated, the abscess can spread down the carotid sheath and into the mediastinum.

Question 29

A retropharyngeal abscess may result from spread of a peritonsillar abscess or from infection of the lymph nodes in the retropharyngeal space. It is more common in children and symptoms usually include:

Answer 29

fever, dysphagia, muffled speech, noisy breathing, neck stiffness, and cervical lymphadenopathy.

Question 30

Pharyngotonsillitis can lead to lymphadenitis, the enlargement and infection of the corresponding draining lymph nodes. Patients present with:

Answer 30

enlarged, warm, erythematous, tender lymph nodes that can progress to suppuration and abscess formation and may require surgical drainage.

Question 31

Non–group A streptococci have never been shown to cause acute rheumatic fever, true or false:

Answer 31

true

Question 32

Pharyngeal diphtheria, which is caused by

Answer 32

Corynebacterium diphtheria, is now extremely rare due to the widespread use of childhood immunization

Question 33

Pharyngeal diphtheria In addition to the usual symptoms of acute pharyngitis, this disease is characterized by the presence of:

Answer 33

a grayish, firmly adherent pseudomembrane that covers the tonsils and may extend to the nares, uvula, soft palate, and pharynx. Removal of the pseudomembrane reveals bleeding of the underlying surface. The disease can spread to the larynx and tracheobronchial tree, potentially compromising the airway.

Question 34

Exotoxins produced by C. diphtheriae may produce cardiac toxicity and neurotoxicity. The diagnosis is confirmed by:

Answer 34

ulturing the pseudomembrane in Loeffler’s or tellurite selective medium.

Question 35

Treatment for infection by C. diphtheriae:

Answer 35

diphtheria antitoxin and penicillin or erythromycin. Treatment should be started immediately, even before confirmation with a culture

Question 36

atients with exposure to sexually transmitted diseases can develop tonsillar infections with:

Answer 36

Neisseria gonorrhoeae or Treponema pallidum

Question 37

Gonococcal infections may present as:

Answer 37

exudative pharyngitis

Question 38

Primary oral syphilis manifests as:

Answer 38

painless chancre on the lips, buccal mucosa, or oropharynx.

Question 39

Patients with secondary syphilis may present with

Answer 39

bilateral tonsillar hypertrophy and painful oropharyngeal and tonsillar ulcers

Question 40

Oropharyngeal candidiasis, or “thrush,” is caused by overgrowth of Candida albicans and often presents in patients with a history of:

Answer 40

mmunosuppression, radiation, or altered microflora following long­term broad­spectrum antibiotic use

Question 41

Oropharyngeal candidiasis Physical examination:

Answer 41

white cottage cheese­like plaques over the pharyngeal mucosa, which bleed if removed with a tongue depressor

Question 42

Oropharyngeal candidiasis Clinical diagnosis may be confirmed with

Answer 42

potassium hydroxide staining revealing fungal hyphae

Question 43

Treatment of oropharyngeal candidiasis:

Answer 43

Initial therapy usually consists of oral hygiene and topical treatment. Some of the available agents include oral nystatin preparations, amphotericin lozenges, and clotrimazole troches.

Question 44

The most common bacteria isolated in recurrent tonsillitis are

Answer 44

Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae

Question 45

Current recommendations suggest tonsillectomy for patients with

Answer 45

6 to 7 episodes of acute tonsillitis in 1 year, 5 episodes per year for 2 consecutive years, or 3 episodes per year for 3 consecutive years.

Question 46

Tonsilloliths are microbial biofilms that form within tonsillar crypts and are associated with halitosis and chronic cryptic tonsillitis. Patients may present

Answer 46

foreign body sensation in the throat and expressible, hard white masses on their tonsils. Complete or intracapsular tonsillectomy is a treatment option for chronic cryptic tonsillitis in adults.

Question 47

Paradise criteria for tonsillectomy

Answer 47

PREGUNTA DE EXAMEN!!

Question 48

Chronic tonsillitis is diagnosed when a sore throat is present for at least __ months and is associated with:

Answer 48

3 months onsillar inflammation, halitosis, and persistent tender cervical adenopathy

Question 49

A polymicrobial population—including _________—is responsible for most cases of chronic tonsillitis

Answer 49

Staphylococcus aureus, Haemophilus influenza, and Bacteroides species

Question 50

treatment for chronic tonsillitis

Answer 50

Antibiotics effective against anaerobes and beta­lactamase producing organisms, such as clindamycin or amoxicillin clavulanate, can be used for treatment. ***In patients with chronic tonsillitis unresponsive to appropriate antimicrobial therapy, tonsillectomy is indicated.

Question 51

3 big indications for tonsillectomy

Answer 51

● Infections (paradise criteria) ● Obstructive (p ej adenoid hypertrophy) ● Neoplasia Indications for tonsillectomy ○ Never take a biopsy of the tonsils *Centro criteria para saber si es viral o bacteriano

Question 52

Hypertrophy of lymphoid tissue can occur in response to colonization with normal flora, exposure to pathogenic microorganisms, or as a reaction to environmental factors. Adenoid hypertrophy usually presents as:

Answer 52

nasal obstruction, rhinorrhea, and hyponasal speech. Tonsillar enlargement can cause snoring, dysphagia, and either a hypernasal or muffled voice *Lateral neck soft tissue radiography can be helpful in evaluating hypertrophic adenoids.

Question 53

Chronic adenotonsillar hypertrophy is commonly associated with

Answer 53

sleep­disordered breathing in children, with symptoms ranging from upper airway obstruction to obstructive sleep apnea syndrome (OSAS). Upper airway obstruction can manifest as loud snoring, chronic mouth breathing, and secondary enuresis.

Question 54

A history of witnessed apneic episodes, hypersomnolence or hyperactivity, frequent nighttime awakenings, poor school performance, and a general failure to thrive are common manifestations of _____ in children

Answer 54

obstructive sleep apnea syndrome (OSAS)

Question 55

A tonsil grading system is often used to describe tonsillar size

Answer 55

Tonsil grades. ( A ) Grade 0 tonsils. ( B ) Grade I tonsils. ( C ) Grade II tonsils. ( D ) Grade III tonsils. ( E ) Grade IV tonsils. ESTUDIAR FOTO

Question 56

Symptomatic asymmetric tonsillar hypertrophy is a physical finding that should raise concern for possible:

Answer 56

tonsillar neoplasm

Question 57

The likelihood of a malignant process is increased when tonsillar asymmetry is associated with:

Answer 57

rapid enlargement, constitutional symptoms, atypical tonsillar appearance, ipsilateral cervical lymphadenopathy, or a history of previous malignant growths.

Question 58

tonsillar lymphoma should be considered when unilateral tonsillar enlargement is present in an:

Answer 58

immunocompromised child or when acute asymmetric tonsillitis is unresponsive to medical therapy.

Question 59

Management when asymmetry is accompanied by a suspicious clinical course or history:

Answer 59

tonsillectomy should be performed to provide tissue for biopsy

Question 60

most common primary tonsillar neoplasms:

Answer 60

Lymphoma and squamous cell carcinoma (SCC)

Question 61

Benign tumors of the tonsil are rare and include:

Answer 61

lipomas, fibromas, and schwannomas

Question 62

indications for tonsillectomy and adenoidectomy

Answer 62

estudiar del libro

Question 63

one of the important complications of tonsillectomy:

Answer 63

Bleeding There must be a good hemostasis/cauterization

Question 64

Herpangina Coxsackie → (hand, teeth and mouth), frequent in children Characteristics

Answer 64

- Ulcers on the soft palate it's an effect from the fever - 5-7 days - red with circles gray Everytime we have ulcers we have to think in a viral infection (bacterial not usually causes ulcers) Do NOT give aciclovir

Question 65

tx for herpangina

Answer 65

Antivirals may be used ● Amantadina → Avirol ● Chlorpheniramine ● Paracetamol

Question 66

When is acyclovir prescribed?

Answer 66

● Herpes ● CMV ● Varicella

Question 67

Tx for herpes

Answer 67

Tx is acyclovir is a treatment for herpes caused ulcers → (800 mg every 6 hours for 7-10 days), Pregabalin (Neuropathic pain due to the virus nerve location), Benzamide (Vantal, is a Topical anesthetic, anti inflammatory antiseptico)

Question 68

Infectious mononucleosis

Answer 68

● IgG and IgM antibodies can help determine the presence of the disease ● The kiss disease” → High virulence ● PCR may be performed, antibodies and antigens can also be used to identify the infection. ● Ask for a complete blood count → Look for the elevation of white blood cells, specifically lymphocytes ● Do NOT give antibiotics (like amoxicillin with ac clavulanic), do the differential diagnosis with bacterial tonsillitis ● An antibiotic will cause skin rash and the symptoms will not get better **NO se debe iniciar antibiótico hasta tener mono test o biometría hemática para buscar linfocitosis (común en estos pacientes)

Question 69

Signs and symptoms of mononucleosis

Answer 69

Symptoms ● High fever ● Adenopathies ● Pain Signs ● Enlarged tonsils ● Yellow/gray exudate ● Nodules ● Hepatosplenomegaly → Search with USG

Question 70

Streptococcus

Answer 70

copiar tabla de pdf

Question 71

seguir estudiando este tema en pdf

Question 72

INICIA RHINITIS

Answer 72

:)

Question 73

Rhinitis is defined as an inflammatory condition that affects the nasal mucosa. The symptoms of rhinitis include:

Answer 73

nasal obstruction, hyperirritability, and hypersecretion.

Question 74

Types of rhinitis:

Answer 74

-Allergic: seasonal and perennial -Infectious rhinitis: viral and bacterial -nonallergic, noninfectious:

Question 75

The symptoms of nonallergic rhinitis include:

Answer 75

nasal obstruction, hypersecretion, and irritability, none of which is due to allergy.

Question 76

Nonallergic rhinitis typically presents with:

Answer 76

clear rhinorrhea and nasal obstruction, there is an increasing incidence of nonallergic rhinitis with advancing age.

Question 77

Patients with nonallergic rhinitis should always be questioned about:

Answer 77

the use of over­the­counter nasal sprays, previous trauma, work or chemical exposure, and previous intranasal drug use. Epistaxis, pain, and unilateral symptoms may be harbingers of a neoplasm and should be noted.

Question 78

Viral rhinitis is very common and often associated with other manifestations of viral illness, which can include:

Answer 78

headache, malaise, body aches, and cough. Nasal drainage in viral rhinitis is most often clear or white and can be accompanied by nasal congestion and sneezing.

Question 79

Occupational rhinitis A number of different indoor and outdoor pollutants may affect the nose. These agents include dust, ozone, sulfur dioxide, cigarette smoke, garden sprays, and ammonia. Irritant agents can be found in a variety of work environments. Typically, these agents cause:

Answer 79

nasal dryness, reduced airflow, rhinorrhea, and sneezing.

Question 80

Patients with vasomotor rhinitis present with symptoms of:

Answer 80

nasal obstruction and clear nasal drainage. The symptoms are often associated with changes in temperature, eating, exposure to odors and chemicals, or alcohol use.

Question 81

Nonallergic rhinitis with eosinophilia (NARES) is a recently described syndrome in which patients present with:

Answer 81

nasal obstruction and congestion; these patients frequently experience more severe exacerbations, including the development of sinusitis and polyposis. These patients also display marked eosinophilia on nasal smears (> 25%) but are not allergic to any inhalant allergens by skin testing or in vitro testing.

Question 82

Patients with rhinitis medicamentosa often present with:

Answer 82

nasal obstruction that has worsened over a number of years.

Question 83

Patients with rhinitis medicamentosa typically have been using over­-the-­counter topical_____

Answer 83

vasoconstrictive nasal sprays. Many times these patients need increasing doses of these sprays as tachyphylaxis occurs.

Question 84

Treatment of Nonallergic Rhinitis

Answer 84

1. Irritant avoidance 2. Saline irrigation: help avert intranasal stasis and reduce crusting. The use of saline not only increases the efficacy of intranasal topical medications but also improves ciliary function. 3. Topical steroids: reduce eosinophil and neutrophil chemotaxis; they also reduce inflammation Other treatments for nonallergic rhinitis include adrenergic agents. The 2 main families of adrenergic drugs are: (1) phenylamines and (2) imidazolines

Question 85

Surgical Measures in Nonallergic Rhinitis

Answer 85

1) septal procedure: The surgical treatment for nonallergic rhinitis is focused on correcting structural abnormalities that may contribute to patient symptoms 2) used to counteract nonallergic rhinitis

Question 86

ALLERGIC RHINITIS ESSENTIALS OF DIAGNOSIS

Answer 86

- May be seasonal, perennial, or both. - Characterized by sneezing, itching, rhinorrhea, and congestion. - Can be associated with other chronic conditions, including asthma, otitis media with effusion (OME), rhinosinusitis, and nasal polyposis. - Typical symptoms of sneezing, rhinorrhea, and nasal congestion can be associated with viral, bacterial, allergic, and nonallergic etiologies. - Can have multiple triggers, both inhaled and ingested.

Question 87

Allergic rhinitis is an inflammation of the nasal mucous membranes caused by:

Answer 87

an IgE­ mediated reaction to 1 or more allergens

Question 88

The allergic response is mediated primarily by:

Answer 88

Type I hypersensitivity reaction. This response involves the excess production of IgE antibodies and is termed an atopic reaction.

Question 89

the early­phase or humoral reaction and occurs within 10 to 15 minutes of allergen exposure; the release of histamine causes the symptoms of:

Answer 89

sneezing, rhinorrhea, itching, vascular permeability, vasodilatation, and glandular secretion.

Question 90

The development of atopy may be influenced by the following:

Answer 90

(1) genetic susceptibility (ie, family history); (2) environmental factors (eg, dust and mold exposure); (3) exposure to allergens (eg, pollens, animal dander, and foods); (4) passive exposure to tobacco smoke (especially in early childhood); and (5) diesel exhaust particles (in urban areas)—among other factors.

Question 91

Characteristic symptoms of seasonal allergies include:

Answer 91

sneezing; watery rhinorrhea; itching of the nose, eyes, ears, and throat; red and watering eyes; and nasal congestion. Symptoms are usually worse in the morning and are aggravated by dry, windy conditions when higher concentrations of pollen are distributed over a wider area.

Question 92

The symptoms of perennial allergic rhinitis are usually constant, with little seasonal variation, although they may vary in intensity. Characteristic symptoms are:

Answer 92

predominantly nasal congestion and blockage, and postnasal drip.

Question 93

Common allergens that cause perennial allergic rhinitis are:

Answer 93

indoor inhalants, predominantly dust mites, animal dander, mold spores, and cockroaches (in inner cities).

Question 94

In children with allergies, there may be a higher incidence of respiratory tract infections, which in turn tend to aggravate allergic rhinitis and may lead to the development of complications, especially:

Answer 94

rhinosinusitis and otitis media with effusion

Question 95

classifications of allergic rhinitis: Symptoms are classified (1) as being intermittent (< ___ days/week or < ___ weeks’ duration) or persistent (> ___ days/week or > ___ weeks’ duration)

Answer 95

intermittent (< 4 days/week or < 4 weeks’ duration) or persistent (> 4 days/week or > 4 weeks’ duration)

Question 96

Perennial symptoms usually mean an allergy to:

Answer 96

dust mites, mold, or animals.

Question 97

A physical examination should include:

Answer 97

inspection of the ears, throat, and nasal passages (including after decongesting with a topical decongestant).

Question 98

Typical findings in the nose in patients with seasonal allergic rhinitis include:

Answer 98

bluish, pale, boggy turbinates; wet, swollen mucosa; and nasal congestion with nasal obstruction.

Question 99

With perennial allergies, ______ is the predominant sign, but the nasal examination may appear normal.

Answer 99

nasal congestion Anatomic abnormalities, such as a deviated nasal septum, concha bullosa, and nasal polyps, may be present

Question 100

ALLERGIC RHINITIS Special Tests

Answer 100

Allergy testing is performed to establish objective evidence of atopic disease: Two major types of testing are available for identifying and quantifying allergen sensitivity: skin testing and in vitro serum assays.

Question 101

Skin testing

Answer 101

Skin testing can be epicutaneous, intradermal, or a combination of both

Question 102

The ____ is the most common epicutaneous test used. In general, it is a quick, specific, safe, and cost­effective test.

Answer 102

skin­-prick test

Question 103

Using quantitative 1:5 serial dilutions, is the skin testing method used by most otolaryngic allergists but it is time consuming and costly. - Is an excellent quantifier of allergen sensitivity - Is of benefit in the preparation of safe subcutaneous immunotherapy treatment.

Answer 103

Intradermal testing (ID)

Question 104

test - For kids over 2 years and high history of allergies and it is cheap - Allergen specific serum IgE testing - Clinical evaluation + miniscreen - Nonatopic → No further testing is needed - Atopic → Search for the specific allergen testing - Microarray a. Used to find the molecular component(s) which cause the sensitivity

Answer 104

In vitro testing

Question 105

treatment of allergic rhinitis

Answer 105

Depends on the component causing the allergy There are 3 options: - Avoidance and environmental Controls - Pharmacotherapy - Immunotherapy

Question 106

Avoidance and environmental controls

Answer 106

- reduce household humidity to below 50% - wash bed linens in hot water - remove carpets and pets from the most often used living areas, especially bedrooms - encase pillows, mattresses - box springs in hypoallergenic coverings - in poor and urban settings, eliminate cockroaches - air purifiers can be used

Question 107

Pharmacotherapeutic Measures _____are frequently used as a first­line therapy; most are available without a prescription

Answer 107

Antihistamines They block H1 receptor sites and prevent histamine­induced reactions

Question 108

First­ generation antihistamines :

Answer 108

diphenhydramine (eg, Benadryl), hydroxyzine (eg, Atarax), chlorpheniramine, and brompheniramine. Are effective in early-phase reactions and therefore reduce sneezing, rhinorrhea, and itching.

Question 109

Second Generation antihistamines have a better safety profile - Are used as a first line therapy - they have little affinity for central H1 receptors - rapid onset of action and symptom relief usually within 1 hour Examples:

Answer 109

- Acrivastine - Azelastine - Loratadine - Desloratadine

Question 110

Most effective medications for the overall control of allergic rhinitis symptoms:

Answer 110

Intranasal corticosteroids

Question 111

Intranasal corticosteroids

Answer 111

triamcinolone (eg, Nasacort), budesonide (eg, Rhinocort), fluticasone propionate (eg, Flonase), and mometasone (eg, Nasonex). - They relieve sneezing, itching, rhinorrhea, and also nasal congestion. - Maximal effect may take from 1 to 2 weeks after the onset of their use.

Question 112

Systemic corticosteroids

Answer 112

-Systemic corticosteroids may be necessary for severe, intractable symptoms. - a tapering dose is usually given over 3 to 7 days. -significantly reduce all the symptoms of allergic rhinitis. The repeated use of these agents can cause serious side effects, such as HPA axis suppression, as well as other common side effects of steroid use.

Question 113

Decongestants

Answer 113

-act on α­adrenergic receptors of the nasal mucosa, producing vasoconstriction and thus reducing turbinate congestion. They improve nasal patency but do not relieve rhinorrhea, pruritus, and sneezing. -Intranasal decongestants (eg, oxymetazoline) can cause rebound nasal congestion and cause dependency if used for more than 3 to 4 days, a condition called rhinitis medicamentosa.

Question 114

Intranasal anticholinergics

Answer 114

One of the most commonly used intranasal anticholinergics is ipratropium bromide (eg, Atrovent). intranasal cromolyn (eg, Nasalcrom) must be used before the onset of symptoms to be effective. The recommended dosage is 4 times daily.

Question 115

Leukotriene modifiers

Answer 115

Antagonize the action of leukotriene receptors or inhibit 5 lipoxygenase and the formation of leukotrienes - Example: Montelukast (singulair)

Question 116

Intranasal Cromolyn of sodium

Answer 116

- Must be used before the onset of symptoms to be effective. - must be used throughout the entire exposure - Is be very safe - The recommended dosage is 4 times daily. - Example: Nasalcrom

Question 117

tx for Intermittent Allergic Reaction

Answer 117

Antihistamine and then corticosteroids

Question 118

Tx for persistent allergic rhinitis

Answer 118

corticosteroids and then antihistamine

Question 119

IMMUNOTHERAPY indications

Answer 119

- Long term pharmacotherapy for prolonged periods of time - Inadequacy or intolerability of shrug therapy - Significant allergen sensitivities It takes from 3-5 years

Question 120

- Before beginning immunotherapy, the physician must first confirm the atopic diagnosis by testing ___ specific to the offending allergen

Answer 120

IgE

Question 121

______ is a new, safe, efficacious and more convenient method for delivering immunotherapy.

Answer 121

Sublingual immunotherapy (SLIT)

Question 122

IMMUNOTHERAPY - It blocks the production of IgE in the mast cell → block anaphylaxis cascade - Most use and it is expensive

Answer 122

Omalizumab

Question 123

Estudiar TREATMENT ARIA 2008

Answer 123

.

Question 124

INICIA ACUTE AND CHRONIC SINUSITIS

Answer 124

:)

Question 125

ESSENTIALS OF DIAGNOSIS

Answer 125

-The vast majority of cases of acute rhinosinusitis are self­limiting viral events. -Chronic rhinosinusitis is an inflammatory disease whose causes are often multifactorial. -In chronic rhinosinusitis, nasal endoscopy and/or computed tomography (CT) scan may be necessary to make the diagnosis if symptoms do not correlate well with findings.

Question 126

Rhinosinusitis is broadly defined as:

Answer 126

symptomatic inflammation of the paranasal sinuses (frontal, maxillary, sphenoidal and ethmoidal) and nasal cavity.

Question 127

Acute rhinosinusitis: Duration ≤ _____ Subacute rhinosinusitis: Duration_____ weeks

Answer 127

- Acute rhinosinusitis: Duration ≤ 4 weeks - Subacute rhinosinusitis: Duration 4 to 12 weeks

Question 128

Chronic rhinosinusitis: Duration ≥ ______

Answer 128

- Chronic rhinosinusitis: Duration ≥ 12 weeks or longer of 2 or more of the following symptoms: - Mucopurulent drainage (anterior, posterior, or both) - Nasal obstruction (congestion) - Facial pain­pressure­fullness - Decreased sense of smell And inflammation as seen by 1 or more of the following: - Purulent mucus or edema in the middle meatus or ethmoid region - Polyps in the nasal cavity or the middle meatus - Radiographic imaging showing inflammation of the paranasal sinuses.

Question 129

Recurrent acute rhinosinusitis: ____ or more episodes of acute rhinosinusitis per year, with each episode lasting ≥ ____ days, with symptom resolution between episodes

Answer 129

Recurrent acute rhinosinusitis: Four or more episodes of acute rhinosinusitis per year, with each episode lasting ≥ 7 to 10 days, with symptom resolution between episodes

Question 130

Acute rhinosinusitis (ARS) is most often caused by an infectious agent. ARS is defined as up to 4 weeks of purulent nasal drainage accompanied by:

Answer 130

nasal obstruction, facial pain, facial pressure, or fullness.

Question 131

The clinician must then distinguish between the more common entity of ____ rhinosinusitis and the less common acute ___ rhinosinusitis

Answer 131

viral and bacterial This distinction is made based on illness pattern and duration.

Question 132

Viral rhinosinusitis

Answer 132

Symptoms of ARS are present less than 10 days. Symptoms are not worsening.

Question 133

Acute bacterial rhinosinusitis

Answer 133

Signs or symptoms of ARS are present 10 days or more beyond the onset of upper respiratory symptoms. Signs or symptoms of ARS worsen within 10 days after an initial improvement (“double­worsening sign”).

Question 134

In most cases, ABRS is preceded by a ___ upper respiratory infection. Other common conditions that can predispose a patient to ARS are:

Answer 134

viral cigarette smoke, anatomical factors such as nasal septum deformities, concha bullosa, and allergie

Question 135

Aspirin exacerbated respiratory disease or triada de samter or Widal Syndrome, in 10% of px with asthma. triada de sastre:

Answer 135

- Nasal polyposis - Asthma - Aspirin intolerance

Question 136

Three cardinal symptoms have been found to have high sensitivity and specificity for ABRS:

Answer 136

purulent rhinorrhea, facial pain/pressure, and nasal obstruction

Question 137

ABRS Secondary symptoms that support the diagnosis include:

Answer 137

hyposmia, maxillary dental pain, fever, aural fullness, and cough.

Question 138

The most common organisms responsible for ABRS include:

Answer 138

Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis

Question 139

The most common organisms responsible for Chronic bacterial rhinosinusitis

Answer 139

- P. aeruginosa - S. aureus - H. influenzae

Question 140

Chronic rhinosinusitis CRS is defined as:

Answer 140

inflammatory condition of the nasal cavity and paranasal sinuses lasting for longer than 12 weeks

Question 141

signs and symptoms of CRS:

Answer 141

Nasal obstruction (81%–95%) is the most common symptom, followed by facial congestion­pressure­fullness (70%–85%), discolored nasal discharge (51%–83%), and hyposmia (61%–69%).

Question 142

The pathophysiology of CRS remains incompletely understood, but it is believed to be multifactorial. Numerous factors have been proposed as contributing to the etiology of CRS, including:

Answer 142

Biofilms Osteitis Perturbation of the sinonasal microbiome Allergy Bacterial superantigens Fungi General host factors

Question 143

Biofilms

Answer 143

- 3-dimensional aggregates of bacteria encased in a protective extracellular matrix -Are 1000 time more resistant to antibiotic treatment

Question 144

Most Common biofilm formers in CRS

Answer 144

- Pseudomonas aeruginosa - S. aureus - Haemophilus influenzae.

Question 145

DIAGNOSIS MAJOR AND MINOR CRITERIA ★2 or more major factors or 1 major + 2 minor MAJOR:

Answer 145

- Facial pain or pressure - Facial congestion or fullness - Nasal obstruction - Purulent discharge - Hyposmia or anosmia - Purulence on examination - Fever (acute only)

Question 146

DIAGNOSIS MAJOR AND MINOR CRITERIA ★2 or more major factors or 1 major + 2 minor MINOR

Answer 146

- Headache - Fever - Halitosis - Fatigue - Dental pain - Cough - Otalgia or aural fullness

Question 147

DIFFERENTIAL DIAGNOSIS - Viral rhinosinusitis

Answer 147

(it is the most common, 90% present it) - The viral infection should improve in NO MORE than 10 days, if it passes more than 10 days you suspect that it is a bacterial infection - Temporomandibular joint pain - Headache - Trigeminal pain

Question 148

Allergic and odontogenic causes

Answer 148

- Facial pressure and pain - Purulent nasal discharge - Nasal congestion - Hyposmia - Tooth pain - Poor response to nasal decongestants

Question 149

Sinus neoplasms

Answer 149

- Uncommon - Critical to exclude - Unilateral nasal obstruction - Epistaxis - CT scans and nasal endoscopy - Changes in vision - Cranial nerve deficits - Palatal numbness or dry eyes - Lesions in the pterygopalatine fossa

Question 150

Acute invasive fungal rhinosinusitis

Answer 150

(black fungal → mucormycosis), in px with covid they die from immunosuppression - Rapidly progressive - Extension of the infection - Immunosuppressed patients or poorly controlled diabetes

Question 151

Noninfectious rhinitis

Answer 151

Allergic rhinitis and nonallergic vasomotor rhinitis - sneezing , rhinorrhea, nasal congestion, nsal itching

Question 152

Projections of CT Scan

Answer 152

● Caldwell (to visualize the frontal and ethmoid sinuses) ● Waters (for the maxillary sinuses) ● Lateral (for the anterior and superior walls of the frontal, maxillary, and sphenoid sinuses), and submental vertex views (for the ethmoid and sphenoid sinuses).

Question 153

LUND MACKAY STAGING SYSTEM OF CRS

Answer 153

(score for CT SCAN to calculate the stage of the disease) →parasinusitis = score of 24 in Lund Mackay ESTUDIAR

Question 154

Treatment ARS

Answer 154

-Saline irrigations (do not give) -Nasal steroids for inflammation → Mometasone or Fluticasone - Antibiotics - Antihistamines - Systemic steroids (do not give) - Decongestants (do not give) ● 1 line therapy = amoxicillin with clavulanate

Question 155

Treatment CRS (chronic rhinosinusitis with polyps or without polypes)

Answer 155

- Antibiotics (levofloxacin y moxifloxacin → quinolones, azithromycin and doxycycline →are macrólidos, etc, a moxicillin (macrólido) with clavulanic , gram positive, gram negative... - Nasal steroids - Saline irrigations - Leukotriene antagonist - Oral steroids - Antihistamines - Monoclonal antibodies → Omalizumab, Mepolizumab, Reslizumab, Dupilumab - Antifungic (do not give) - FESS (functional endoscopic sinus surgery) - Take out bone structures to make a pathway

Question 156

EMPIEZA EPISTAXIS

Answer 156

The most common otolaryngologic emergency and affects up to 60%

Question 157

6% require medical attention, when:

Answer 157

caused by another patology (tumor, cuagulopatía, etc)

Question 158

Causes of epistaxis

Answer 158

- Idiopathic (most common) - Traumatic - Iatrogenic - Primary neoplasms (SQUAMOUS CELL CARCINOMAis the most frequent) also angiofibroma

Question 159

ESTUDIAR EPISTAXIS DE PDF

Answer 159

.

Question 160

EMPIEZA NASAL TRAUMA

Answer 160

ESSENTIALS OF DIAGNOSIS History of recent trauma to midface; should assess mechanism of injury, presence of epistaxis or rhinorrhea, history of previous injury, and new onset of nasal airway obstruction or deformity. On examination, note any mucosal laceration, septal disruption, or septal hematoma. Depending on severity of insult, must rule out concurrent injury to eyes, lacrimal system, paranasal sinuses, teeth, and oral cavity