The Nose and Sinus Flashcards
(22 cards)
What are common symptoms of Sinusitis?
Facial pain
discolored nasal discharge
bad tase in mouth
Fever
What is the most accurate diagnostic test for Sinusitis?
Sinus biopsy or aspirate
What is the next best step if a question described typical Sinusitis symptoms: facial pain, discolored nasal discharge, and fever?
Start antibiotics and a decongestant
What Antibiotic is commonly used for Sinusitis?
Amoxicillin
What is the first diagnostic test for Sinusitis?
CT of the sinuses
What is the indication to perform a biopsy in Sinusitis?
Frequent recurrence of infection or no response to different empiric therapies
What is usually the first line drug for Sinusitis?
Augmentin: Amoxicillin/Clavulanic acid
What is the cavernous Sinus?
venous drainage system that receives venous drainage from the face, nose, orbits and tonsils
How does a Cavernous Sinus Thrombosus present?
Fever, headache, ptosis and proptosis
-damage of CN III, IV and VI as they travel through the cavernous sinus
What is the key to Cavernous sinus thrombosus as the most likely diagnosis?
History of Sinusitis and diplopia with the inability to move eyes normally on exam
What is the best initial test for Cavernous Sinus Thrombosus?
CT or MRI with contrast showing the thrombosis
What are the most common pathogens associated with Cavernous Sinus Thrombosus?
Staphylococcus
Streptococcus
Anaerobes
How do you treat cavernous sinus thrombosus?
Vancomycin, Ceftraixone
Ampicillin/Sulbactam + Vancomycin: good choice
Steroids: decrease inflamamtion
Anticoagulation is essential
What is Tolosa-Hunt Syndrome?
Granulomatous inflammation of the cavernous sinus with Ophthalmoplegia
How does Tolosa-Hunt Syndrome Present?
eye pain and paralysis of CN: III, IV and VI
How do you diagnose Tolosa-Hunt Syndrome?
MRI
How do you treat Tolosa-Hunt Syndrome?
Steroids
Are anterior or posterior Epistaxis more common?
Anterior
What are anterior Epistaxis most commonly caused by?
Venous bleeds of Kiesselbach venous plexus
How to manage Anterior Epistaxis?
Have patient blow nose and hold closed for 5 minutes
Vasoconstrictor drops
silver nitrate
sealants
glue
nasal packing
Phenylephrine or oxymetazoline
What are Posterior Epistaxis from?
Arterial bleeds
How do you treat Posterior Epistaxis?
Packing or ballooning
Cephalexin to prevent Growth of Staphylococcus and toxic shock
Check platelet count
