2 parcial Flashcards
Acute Rhinosinusitis treatment
Saline irrigation
Nasal steroids
Antibiotics
Antihistamines (yellow)
NO systemic steroids or decongestants
Chronic Rhinosinusitis treatment
Saline irrigation
Nasal steroids
Antibiotics
Leukotriene antagonists
Antihistamines, monoclonal bodies, oral steroids(yellow)
NO antifungal
BEST: FESS
Antibiotics for rhinosinusitis
1st Amoxi + clavulanate
2 - quinolonas: Levofloxacino o moxifloxacino
x 14-21 días
Samter’s triad
Aspirin resistance, nasal polyps and asthma
What is the kartagener syndrome
Primary mucosa dyskinesia. Immotile cilia lead to chronic crusting from mucus stasis.
Gold standard for allergy testing in allergic rhinitis
SPT (Skin Prick Test)
Two phases of allergic rhinitis
Sensitization (dendritic cells –> T cells –> B cells –> memory)
Clinical disease (B cells -> IgE binds to mast cells –> histamine, humoral reaction 15 min –> quimiotaxis, symptoms, late-phase reaction 4-6 hrs)
Treatment for allergic rhinitis
1st - Antihistamines (diphenhydramine, chlorpheniramine, loratadine..)
Intranasal corticosteroids - most effective medication for overall control of symptoms (budesonide, triamcinolone)
Decongestants - phenylephrine, oxymetazoline
If nothing works: immunotherapy 3-5 years
3 types of viral adenotonsillar disease
Herpangina
Mononucleosis
Herpes
3 Bacterial acute pharyngotonsillitis
Acute streptococcal
STI (syphilis, gonorrhea)
Diphtheria
Centor criteria (5)
Temperature > 38ºC
Absence of cough
Swollen, tender cervical nodes
Tonsillar swelling or exudate
Age (3-14 +, 15-44 0, > 45 -)
CENTOR criteria score
1 - no more testing or atb
2 - 3 culture, atb if positive culture
4 or more - Empirically with atb and/or culture
If we have ulcers in the mouth we suspect a ___ infection
Viral infection
Best treatment for adenotonsillar disease by herpes
Acyclovir + NSAIDs (paracetamol) + steroids
10 yr old patient, with headache, odynophagia, fever, anorexia and ulcers in the palate
Herpangina
Agent responsible for each one
- herpangina ->
- Herpes ->
- Mononucleosis ->
- herpangina -> coxsackie
- Herpes -> herpes simple 1
- Mononucleosis -> epstein-barr
35 year old patient with high fever of 3 days, adenomegaly, hepatosplenomegaly, skin rash, malaise, and sore throat
Mononucleosis
Most common group of strepts that cause pharyngotonsillitis
Group A of Beta hemolytic (pyogenes)
Treatment for ACUTE STREPTOCOCCAL PHARYNGOTONSILLITIS
oral penicillin V: 10 days
Union of nasal bones and cartilage
Keystone area
Criteria for tonsillectomy
Episodes: At least 7 episodes in the previous year, 5 in the previous 2 years or 3 in the previous three years
Clinical: Sore throat + (fever >38.3, exudates, adenopathy >2cm, positive culture)
Treatment: previous antibiotics
Agent responsible for each one
- Streptococcal ->
- Diphtheria ->
- STD ->
- Streptococcal -> pyogenes
- Diphtheria -> corynebacterium diphtheria
- STD -> syphilis, gonorrhea, ulcers
Treatment for diphtheria
Antitoxin + penicillin or erytromycin
Most paranasal neoplasms come from what sinus
Maxillary sinus
