4.Rhinosinusitis- Epistaxis -Deep venous thrombosis - Pulmonary emboli

Question 1

A patient is diagnosed with rhinosinusitis. Where does this most typically affect adults?

Answer 1

This is obstruction of sinus drainage into the nasal cavity causing inflammation and pain, typically involving the maxillary sinuses

Question 2

A 53-y/o man has pain in his maxillary sinuses from obstruction of sinus drainage. What is the most common acute cause of this condition?

Answer 2

Viral URIs are the most common cause

Question 3

A patient has epistaxis. What is the most common location of the bleeding?

Answer 3

The anterior segment of the nostril also known as the Kiesselbach plexus

Question 4

A patient presents with extensive bleeding from the nose. It is not an anterior bleed. Could this bleeding be life-threatening?

Answer 4

Yes, as the bleeding may be from the posterior section of the nostril, where the sphenopalatine artery (branch of the maxillary artery) lies

Question 5

Which three factors that promote blood coagulation are known as the Virchow triad?

Answer 5

Stasis, Hypercoagulability, and Endothelial damage (SHE)

Question 6

A patient diagnosed with factor V Leiden is at risk of developing deep venous thrombosis. Which element of the Virchow triad is affected?

Answer 6

Hypercoagulability

Question 7

How does endothelial damage lead to the formation of a clot?

Answer 7

Exposed collagen triggers the clotting cascade

Question 8

A patient presents with dyspnea and tachycardia. Chest CT shows a pulmonary embolus. From where did the embolus most likely originate?

Answer 8

The deep veins of the leg

Question 9

Describe the Homan sign.

Answer 9

In the Homan sign, dorsiflexion of the foot results in a tender calf muscle because of the presence of a deep venous thrombosis

Question 10

A patient presents with a red, swollen leg. Venous Doppler confirms a deep venous thrombosis. Acutely, what is your treatment of choice?

Answer 10

Unfractionated heparin or heparins of low molecular weight

Question 11

A patient with recurrent deep venous thromboses requires long-term anticoagulation. Which medications may be prescribed?

Answer 11

Oral anticoagulants (e.g., warfarin, rivaroxaban)

Question 12

A patient has sudden chest pain and difficulty breathing. If he is diagnosed with a pulmonary embolus, what signs will you discover?

Answer 12

Sudden-onset dyspnea, chest pain, tachypnea, tachycardia

Question 13

• Name the types of emboli to the lungs.

Answer 13

An embolus moves like a FAT BAT (Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor)

Question 14

A patient presents with sudden-onset dyspnea 1 hour after a femur fracture. He is found to have a V/Q mismatch. What is your diagnosis?

Answer 14

Fat embolus

Question 15

A patient presents with sudden-onset dyspnea, altered mental status, and a petechial rash after liposuction. What is the likely cause?

Answer 15

Fat emboli (the classic presenting triad is hypoxemia, neurologic abnormalities, and petechial rash)

Question 16

A postpartum woman suddenly throws an amniotic fluid embolus. This will likely lead to what dangerous hematologic condition?

Answer 16

Disseminated intravascular coagulation

Question 17

A diver who ascended too quickly complains of joint pain and shortness of breath. How would you treat this patient?

Answer 17

Treat with hyperbaric O2 (the patient has an air embolus, as nitrogen bubbles can precipitate in divers who ascend too quickly)

Question 18

A patient presents with sudden chest pain, tachypnea, and dyspnea. What is the imaging test of choice? What is being looked for?

Answer 18

Computed tomography pulmonary angiography; look for filling defects

Question 19

You are informed that your bed-bound patient on cardiac monitoring suddenly developed sinus tachycardia. Do you consider a chest CT scan?

Answer 19

Yes, as this may be a sign that the patient just threw a pulmonary embolus (being bed bound, which promotes stasis, makes this more likely)