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Clinical medicine HEENT > Quiz 2 > Flashcards

Quiz 2 Flashcards

(62 cards)

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1
Q

symptoms and signs of allergic rhinitis?

A

-sneezing, inflammation, rhinorrhea, congestion, hyposmia, ear/eye/nose itch, scratchy throat from post nasal drip, fatigue, mouth breathing, shiners, dens lines, nasal salute, violet mucosa or white mucosa and nasal polyps

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2
Q

what are 2 types of allergic rhinitis?

A

seasonal and pereniel

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3
Q

other names for allergic rhinitis

A

hay fever, ige mediated rhinitis

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4
Q

perennial diagnosis time line?

A

> 2 hours per day for > 9 months

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5
Q

how to confirm allergic rhinitis diagnosis?

A

-skin intradermal test, RAST IgE, sinus CT if truly persistant

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6
Q

Allergic differential diagnosis?

A

URTI, medicalmentosa, sarcodosis, wegeners granulomatosis

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7
Q

sarcoidosis

A

lymph node enlargement

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8
Q

wergners granulomatosis

A

inflammation of the bv, blood stained mucosa, must confirm with a biopsy

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9
Q

allergic rhinitis antihistamine treatment options

A

antihistamins: loratadine and cetirizene

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10
Q

allergic rhinitis adjunct treatments:

A

-monteleukast, cromolyn, ipratropium, immunotherapy

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11
Q

complication of allergic rhinitis?

A

-facial deformaties, serous otitis media, secondary rhinosinusitis, nasal congestion, nasal speech, euschian tube dysfunction, URTI susceptibility, laryngeal edema

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12
Q

common pathogens causing bacterial rhinosinusitis

A

-streptococcus pneumoniae, heamophilus influenza, moraxella, catrrhalis

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13
Q

pathogens causing chronic bacterial rhinosinusitis

A

pseudemonus auregenosa, group A streptococcus, s. aureus, anaerobes
-can happen in hospital from ng tubes, oxygen etc

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14
Q

bacterial rhinosinusitis causing what rhinorrhea?

A

purulent and cloudy

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15
Q

acute bacterial rhinosinusitis symptoms

A

-cough, fever (101), fatigue, hyposmia, anosmia, maxillary dental pain, ear pressure/ fullness, double worsening

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16
Q

acute bacterial rhinosinusitis symptom management?

A

pseudophedrine (sudafed), guafenesin (mussinex/ tussin), oxymetazoline (affrin), fluticasone

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17
Q

acute bacterial rhinosinusitis antibiotic options? first line

A

-first line: augmentin (amoxicillin+clavulanate) 500mg/125mg 5-7 days every 8 hours OR 800/125 every 12 hours
-high risk pt: 2000 mg/125mg 7-10 days

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18
Q

acute bacterial rhinosinusitis antibiotic options? second line

A

-clindamycin, levoflaxin, azithromycin, trimethoprim, dupilumab

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19
Q

acute bacterial rhinosinusitis not improving, what do you do to meds

A

at 5 days change to broad spectrum antibiotic, no response in 3-4 weeks add clindamycin to cover anaerobes
-may also require surgical drainage, antral lavage with cocaine through the meatal window, frontal sinus draining irrigation or ethmoidectomy

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20
Q

acute bacterial rhinosinusitis complication?

A

-orbital cellulitis: warning signs include eyelid edema, redness, ptosis, chemosis and opthamoplegia
-osteomyelitis through the frontal sinus, abscess in that frontal bone, has to be drained and IV antibiotics (pott puffy tumor)

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21
Q

test for hyposmia or aposmia

A

UPSIT scratch and sniff

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22
Q

treatment of epistaxis

A

antibiotics, analgesics, decrease activity

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23
Q

epistaxis complications:

A

septal hematoma perforating the septum, aspiration of blood, nasal deformity from the hematoma collapsing the cartilage, necrosis

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24
Q

nasal poly associated with?

A

allergic rhinitis, samter triad, and CF

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25
samter triad
aspirin sensitivity reaction, asthma and nasal polyp -chronic condition
26
nasal polyp treat?
topical corticosteroid and surgery
27
nasal polyp complication?
hyposmia and aposmia and nasal obstruction
28
aural foreign body symptoms:
hearing loss, pain, leeding, or can be asymptomatic
29
nasal foreign body symptoms:
nasal occlusion, fetid purulent mucus, bleeding
30
must check what in FB?
-chest xray to look for obstruction -blood gasses to check respiratory -blood lead levels
31
treatment for FB?
-lidocaine and vasoconstrictors -extract the FB -epi can vasoconstrict BV
32
FB complications
if it was a battery can cause damage, septum perforation, necrosis, migrates to trachea in a failed removal, sinusitis or cellulitis, otitis media, barotrauma, epistaxis
33
look for what in nasal trauma
CSF leak and bruising indicating a skill fracture
34
sinusitis is caused by?
ostea that is superior to the maxillary sinus where the mucus will accumulate, hard to drain
35
potential causes of sinusitis?
-immotile cilliary dysfunction where the cilia can't stop particulates -foreign body -rhinitis -polyps -tumor -anything that blocks the ostea
36
kartageners syndrome
-immotile cilia -can also cause situs incersus where the organs are on the wrong side of the body
37
acute rhinosinusitis
< 4 weeks, purulent nasal discharge, facial pain and pressure, diagnose clinically with history
38
acute rhinosinusitis complications
-bacterial, viral, chronic or subacute, infection can spread to localized tissue *especially when immunocomp
39
uri symptoms
-**clear** nasal rhinorrhea, congestion, *hyposmia*, cough, congestion, erythematous/red and enlarged mucosa
40
uri risk
can turn into viral rhinosinusitis
41
acute viral rhinosinusitis symptoms
-self limited -kids: fatigue, irritable, cough, vomit sometimes from gagging on mucus -normally no fever or nausea -cough, sneeze, facial pressure, tooth ache, post nasal drip, malaise, headache
42
acute viral rhinosinusitis signs
-tenderness over sinuses, increased secretions, purulent secretions, red mucosa, water discharge, dark circles
43
sinusitis differential
URTI, nasal polyp, orbital cellulitis, wergener syndrome, neoplasm, immotile cilia
44
acute viral rhinosinusitis treat
-nsaid, acetamenophen, irrigation, corticosterois/ decongestant, antihistamines, mucolytics to thin mucus and zinc lozenges
45
acute viral rhinosinusitis at risk population
-smockers, pollution, UTRI, allergic rhinitis, polyps
46
acute viral rhinosinusitis complications
-more than 3 days of decongestant: medical mentosa -euschian tube dysfunction -middle ear effusion
47
medical mentosa
red beaffy mucus, enlargement of mucosa, pain from rebound of vasoconstriction
48
medical mentosa treat
topical intranasal corticosterois and oral prednisone
49
chronic sinusitis
-**clear discharge**, facial tenderness, mucosal edema, septal perfomation/ deviation
50
chronic sinusitis investigation
-nasal endoscopy, CT, mri (tumor or fungal), **sweat chloride (CF)**, cilliary function study, plain films
51
preseptal orbital cellulitis
lid edema and redness -NO ptosis, muscle restiction or fever
52
postseptal orbital cellulitis
-emergent, hospitalize, IV antibiotics and surgery -progresses to ptosis, chemosis and opthalmoplegia
53
mucormycoses
-diabetees or immuno comp -90% fatal -invasion of the VASCULAR CHANNEL causing hemorrhagic ischemia and necrosis -turbinate engorgement and ischemia and necrosis of nose
54
mucormycoses treat
****-surgical derbreidment, **amphoterecin B** and immunosupressents
55
why does mucormycoses like diabeetes
acidic environment, diabetic ketoacidosis is perfect
56
mucormycoses risk
vision loss
57
what is the risk of sinusitis spread to cavernous sinus
-cavernous thrombosis *high mortality rate -blood clot and progressive chemosis -fever over 105 -damage brain, eyes and nerves
58
cavernous sinus cause
retrograde transmission through valveless veins
59
cavernous sinus treat
-drain and IV antibiotics -heparin but that is controversial
60
intracranial complications
subdural abscess, meningitis, intracranial abscess -most common type of meningitis in kids
61
intracranial complications first symptom
nuchal rigidity
62
intracranial complications treat
-neurosurgery, surgical drainage

Clinical medicine HEENT (10 decks)

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